What Is Reactive Gingival Hyperplasia or Gingival Enlargement?
Gingival enlargement or reactive gingival hyperplasia is the most common feature of the gingival disease. Reactions to drugs, or improper oral hygiene are the risk factors causing acute to chronic lesions of the gums. Gingival enlargement is a common clinical manifestation in people with immunocompromised or systemic diseases. Gingival hyperplasia includes reactive hyperplasias comprising connective tissue lesions occurring in the oral mucous membranes due to injury, chronic irritation, or trauma. In these cases of chronic trauma, the inflammatory process induced in the oral cavity is responsible for the production of granulation tissue comprising endothelial cells, chronic inflammatory cells, and fibroblasts which proliferate and manifest outwardly as an overgrowth seen visibly on the gingiva.
Upon the histopathologic examination of reactive hyperplasia lesions of the gingiva, the lesions are composed of a mass of hyperplastic connective tissues along with dilated blood vessels and inflammatory residue. The inflammatory cells observed in these lesions are mainly lymphocytes and plasma cells. The epithelial features may either be ulcerative, acantholytic, keratotic, or even a combination of these features when observed microscopically.
What Does Reactive Gingival Hyperplasia Look Like?
The reactive lesions of gingiva clinically appear as tumor-like lesions but are not neoplastic or malignant. They indicate a chronic inflammatory process in the gums that occurs more often due to an exaggerated repair or response of the oral defense to irritation and trauma in the form of granulation tissue and then accompanied by the formation of scar. Granulation tissue and scar formation are the most important stages of repair. People with reactive hyperplasia of the gingiva may complain of swelling, pain, oral discomfort, esthetic discomfort in the anterior regions, and often ulceration upon the surface if any. People can often present to the dentist with the chief complaint of bleeding gums from painless ulcerative lesions that may be observed over some time or acutely. These lesions may be nodular and involve the marginal or interdental gingival more often than the attached gingiva. The adjacent tooth may have moderate to severe plaque deposits or calculus also.
What Causes Reactive Hyperplasias?
Local and systemic factors can also influence gingival healing in the affected patients. The risk factors for reactive hyperplasias are numerous and varied, resulting in a spectrum of diseases classified under these causes :
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Developmental lesions.
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Reactive lesions.
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Inflammatory to neoplastic lesions.
Reactive hyperplastic lesions hence represent not only the most commonly encountered mucosal lesions of the oral cavity but also the natural immune response to these causes :
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Any irritation in the oral mucous membrane.
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Low-grade injuries during chewing or swallowing or sucking.
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Trapped food particles.
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Calculus deposits of teeth.
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Fractured teeth.
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Iatrogenic factors because dental materials may induce allergies in some people.
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Overextended denture flanges.
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Improperly placed dental restorations or overhanging dental restorations.
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Broken fillings or sharp restorations.
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Sharp tooth edges can cause soft tissue trauma.
Why Is a Regular Dental Visit Essential for People With Reactive Gingival Hyperplasia?
The pathogenesis of inflammatory or reactive hyperplasias involves complex processes where there are significant fibrosis that can undergo shrinkage post dental treatment. This is also because, in hyperplasia or enlarged gingiva, the cause may be mainly the accumulation or retention of dental plaque. Regular dental follow-ups or checkups are always advisable for affected people. Poor oral hygiene, lack of dental visits, or evading dental prophylaxis and restorative health may be a setback in most individuals who tend to ignore the dentist or regular oral hygiene measures. For people undergoing orthodontic treatment, physical irritation of the gingiva can be due to improper restoration or excess forces due to orthodontic appliances.
How Are Reactive Gingival Hyperplasia Diagnosed?
These gingival hyperplasias, irrespective of origin (developmental or reactive or inflammatory or neoplastic), tend to be fibrous, clinically presenting as well-demarcated exophytic masses upon the gingiva. These exophytic masses can either be soft or firm when palpated. These soft tissue growths can range from normal to white or reddish lesions that depend more upon the affected surface. The dentist preliminary observes whether the surface is ulcerated, keratotic, or in some cases. The dentist differentiates the condition from drug-induced gingival lesions by eliciting the person's drug history.
How Are Reactive Gingival Hyperplasia Treated?
Surgical excision is the treatment of choice. The surgeon also removes any local irritants in the oral cavity to prevent further recurrence of exophytic lesions. Oral hygiene instructions and awareness, including mechanical and chemical plaque control measures, should be given to the people, and regular dental follow-ups should be done. Post the surgical excision of the reactive lesions, any residual calculus deposits should be removed and root planing performed by the periodontist. The excised lesions, usually on suspicion, can also be sent for cross-verification for histopathological examination to determine the exact nature of the lesion. For hyperplastic lesions, conservative approaches are recommended with the removal of local irritants.
Conclusion
Reactive gingival hyperplasia is the most common feature of gingival disease. These lesions need prompt management by the dentist to remove the local irritation or the cause of reactive gingival hyperplasia. The importance of oral hygiene and dental treatment awareness should be a key highlight to the patients impacted by Reactive Gingival hyperplasia for long-term healing and prognosis.
