This lecture highlights the specific conditions that induced gingival enlargement in children.

1. Conditioned Gingival
Enlargement in Children
yBy
Dr. Ahmed Adel Salama
Senior Lecturer of Pediatric Dentistry department
Cairo University

2. Features Children Adult
Gingival color More Reddish Coral Pink
Contour Free gingival margin: rounded Gingival margin: knife edge
Consistency Flabby due to lack of CT density & lack
of organized collagen fiber bundles
Firm & resilient
Surface texture Stippling absent in infancy mostly seen
by age of 6 yrs
Stippling present

3. Classification of gingival condition in children:
1. Acute non-specific gingivitis
2. Acute specific gingivitis
3. Chronic non specific gingivitis
5. Periodontitis
4. Conditioned gingivitis

4. A- Puberty Gingival
Enlargement
C- Dilantin Gingival
Hyperplasia
B- Gingival fibromatosis
D- Scorbutic Gingivitis
4. Conditioned gingival
enlargement

5. A- Puberty Gingival Enlargement
Age: In children during the prepubertal & pubertal periods
Etiology:
➢ Hormonal changes occurring during prepubertal & pubertal periods
➢ Subclinical nutritional deficiencies (faulty dietary habits; quick meals)
Clinical characteristics:
✓ Gingival enlargement confined to anterior segments
✓ Interdental papillae are bulbous & prominent
✓ Gingival margin: red; bleeds on slightest touch/tooth brushing

6. Treatment:
❑ Improve oral hygiene (remove irritating factors e.g. plaque)
❑ Diet recommendation.
❑ Usually regress after puberty (above 18 years).
❑ In severe persistent cases; gingiva-plasty.

7. B- Gingival fibromatosis (Idiopathic or Familial gingival
enlargement)
Etiology:
Rare type of gingival enlargement referred to as elephantiasis gingiva;
1)Idiopathic (unknown cause) 2)May follow a familial pattern
Clinical characteristics:
➢Location: at free & attached gingiva
➢Characteristics: firm ;painless ;dense(feels like bone)
➢Color: slightly pallor than normal with coarse stippling
➢Time: at time of eruption of primary teeth continue till cover clinical crowns of teeth
➢Complication: delay tooth eruption; tooth displacement; trauma during mastication lead
to 2ry inflammation

8. Treatment:
❑ Gingivectomy in several stages ; although recurrence may occurs
❑ No recurrence in case of removal of teeth & construction of denture

9. C- Dilantin Gingival Hyperplasia
First recognized in 1939 by Glickman et al., reported incidence varying from 3% to 84.5%
Etiology:
Dilantin is a widely used anti-convulsant drug in treatment of epilepsy.
May cause gingival enlargement in 50% of cases (few weeks after initiation of treatment )

10. Clinical characteristics:
✓ Location: Generalized (appear 1st in the interdental papillae)
✓ Characteristic: Lobulated; granular & stippled
✓ Complication: Delay tooth eruption, trauma during mastication
lead to 2ry inflammation

11. Treatment:
❑ Improve oral hygiene measures.
❑ Gingivectomy in most of cases.
❑ Cooperation with physician to change drug (most important strategy).
❑ Antihistaminic, corticosteroids & ascorbic acid may be used (with limited success).

12. D- Scorbutic Gingivitis
Etiology:
✓ Due to vitamin C deficiency
✓ Main function of vitamin C is formation of cementing substance of capillary epithelium
✓ So defects of vitamin C loss of integrity of capillary walls increase fragility & bleeding
Clinical characteristics:
❑ Mild cases are more common than severe cases
❑ Location: interdental papillae; marginal gingiva
❑ Characteristics: Swollen gingiva, bleed easily on slightest touch, impaired wound healing

13. Treatment:
✓ Give vitamin C (after lab. Investigations); dose:100-300 mg/daily
✓ Improve oral hygiene measures; diet correction.

14. 5. Periodontitis

15. ➢Is a disease of the periodontium characterized by rapid destruction of alveolar bone
lead to bone loss
➢In children it is called “Papillon LeFevre syndrome”
❖First described by 2 French physicians Papillon & Lefevre in 1924
❖Prevalence: 1-4 / million of person
❖Male = female & no racial predominance
✓ Clinical picture:
General manifestation:
Hyperkeratosis of palms of hand & sole of feet

16. Oral manifestation :
o Severe gingival inflammation with alveolar bone loss (starts from age of 2 – 3 years)
o Exfoliation of both primary & permanent teeth
o By age 4-5 years all primary teeth are lost lead to subside inflammation
o The same cycle accompanies permanent teeth

17. Radiographic examination:
Severe horizontal bone resorption
Treatment:
➢ Very poor prognosis,
➢ Extraction of teeth
➢ Construct a denture at early age