Gingival Fibromatosis

Gingival fibromatosis is a rare condition in which accumulation of extracellular matrix components causes slowly progressive enlargement of the gingiva. It may be either hereditary or idiopathic, with hereditary examples occurring as an isolated finding or as part of a syndrome (e.g., multiple hamartoma syndrome, Cross syndrome, Murray-Puretic-Drescher syndrome, Rutherfurd syndrome, Zimmermann-Laband syndrome). Extraoral features that can be noted in association with hereditary gingival fibromatosis include hypertrichosis, epilepsy, intellectual disability, and sensorineural hearing loss. Clinically, gingival fibromatosis may be generalized or localized to one or more quadrants; localized examples often involve the maxillary tuberosities or the facial gingivae in the mandibular molar regions. The onset of enlargement usually coincides with eruption of the deciduous or permanent dentition. With progression, the gingival tissue may cover all or part of the tooth crowns and displace teeth. Sequelae may include diastema formation, cross bite, open bite, open-lip posture, over-retained deciduous teeth, and delayed eruption of permanent teeth. The patient may develop problems with mastication, speech, or aesthetics. The gingiva typically is firm, normal in color, nonhemorrhagic, and smooth or finely stippled. However, it may appear erythematous if there is superimposed inflammation due to plaque accumulation. Usually, there is involvement of the free and attached gingivae without extension beyond the mucogingival junction.
Clinical management includes professional prophylaxis and oral hygiene reinforcement in order to minimize exacerbation by plaque-related gingival inflammation. For severe cases, surgical removal of excess gingival tissue may be performed; in addition, because there is a high risk for recurrence in toothbearing areas, gingivectomy may be combined with selective tooth extraction. Some clinicians prefer to delay surgery until after the permanent teeth have erupted in order to reduce the risk of recurrence. In addition, orthodontic and prosthodontic treatment may be needed, and genetic counseling is indicated for hereditary cases.

Marked enlargement of the maxillary gingiva. (from Color Atlas of Oral and Maxillofacial Diseases)

(A) Diffuse enlargement of the maxillary and mandibular gingivae, with partial coverage of the tooth crowns. (B) Same patient in image A after professional plaque/calculus removal and gingivectomy. (from Color Atlas of Oral and Maxillofacial Diseases)

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