Department of Pediatrics, GATA Medical Faculty, Istanbul, Turkey

Corresponding Author: Ferhat Cekmez, GATA Medical Faculty, Department of Pediatric Endocrinology, 34090 Istanbul, Turkey. Tel: 00.90.216.542 20 20; Fax: 00.90.216.542 36 11; E-mail: ferhat_cocuk@hotmail.com.

Running title: gingival hyperplasia

	ABSTRACT
	INTRODUCTION
	CASE REPORT
	DISCUSSION
	REFERENCES

	ABSTRACT

Gingival hyperplasia is a rare condition but it is important for cosmetic and mechanic reasons and because of its potential as an indicator of systemic disease. Gingival fibromatosis may exist as an isolated abnormality or as part of a syndrome. In this article a case that was diagnosed clinically and histologically as idiopathic gingival fibromatosis is presented. Patient with gingival hyperplasia should be examined to exclude other reasons to determine the idiopathic gingival fibromatosis or not. Treatment is not required in all cases of idiopathic gingival hyperplasia. Surgical excision is indicated if mechanical problems exist. Recurrence has not been reported.

	INTRODUCTION

   Gingival hyperplasia is a rare condition but it is important for cosmetic and mechanic reasons or possibility of a part of a systemic disease.  In some pathological conditions, gingivitis caused by plaque accumulation can be severe. In puberty and pregnancy, hyperplasia of the gingival tissues may be due to poor oral hygiene, inadequate nutrition, or systemic hormonal stimulation (1, 2). Gingival enlargements are also seen in several blood dyscrasias e.g. leukaemia, thrombocytopenia, or thrombocytopathy (3). Other etyologic factors are listed in table 1. A progressive fibrous enlargement of the gingiva is a feature of idiopathic fibrous hyperplasia of the gingiva. Characteristically, this massive enlargement appears to cover the tooth surfaces. While the cause of the disease is unknown, there appears to be a genetic predisposition (4, 5). Gingival fibromatosis may exist as an isolated abnormality or as part of a syndrome (6, 7). Table 2 gives an overview of syndrome related gingival overgrowth. In this article, a 12 year girl who applied to pediatric service with the gingival hyperplasia is presented.

	CASE REPORT

   Patient has had gingival problems for 5 years. There were no any systemic diseases and drug using reported. In intraoral examination, the hyperplastic gingiva covered the teeth. Especially at the palatinal region this hyperplasia covered the palatinal dome and the tongue movements were restricted and speech trouble was seen. The gingival hyperplasia presented with colour. Complete blood cell count and chemistry tests, urinary and blood aminoacids, mucopolysccarides and hormonal profiles were normal. With the clinical and the histopathological examinations, the case was diagnoised as idiopatic gingival fibromatosis which was characteristed by fibrous gingival hyperplasia (Figure 1).

View larger version : [in a new window] Figure 1

	DISCUSSION

   Gingival fibromatosis may exist as an isolated abnormality or as part of a syndrome (6, 7). As an isolated finding, it is mostly sporadic, but an autosomal dominant inheritance pattern is also possible. Rarely, autosomal recessive inheritance is found.

   Patients with gingival hyperplasia should be examined carefully and blood samples sould be taken to exclude blood dyscrasias (3). While the gingiva may be the only tissue involved, some cases display gingival fibromatosis in association with hypertrichosis, and/or mental retardation, and/or epilepsy. The association of gingival fibromatosis and corneal dystrophy is recognized as an autosomal dominant trait known as the Rutherfurd syndrome (6). Cross syndrome is, almost certainly, an autosomal recessive disorder characterized by gingival fibromatosis, microphthalmia, mental retardation, and pigmentary defects (7).  Ramon syndrome is another, probably autosomal recessive, condition involving gingival fibromatosis, as well as hypertrichosis, mental retardation, delayed development, epilepsy and cherubism (8). Laband syndrome features gingival fibromatosis, syndactily, nose and ear abnormalities, and hypoplasia of the nails and terminal phalanges.

   After excluding other reasons of gingival hyperplasia it is named as idiopathic gingival hyperplasia. Treatment is not required in all cases of idiopathic gingival hyperplasia. Surgical excision is indicated if mechanical problems exist (9). Recurrence has not been reported.

	REFERENCES

1. Katsikeris N, Angelopoulos E, Angelopoulos AP. Peripheral giant cell granuloma: clinicopathological study of 224 new cases and review of 95 reported cases. Int J Oral and Maxillofac Surg. 1988; 17(2): 94-99
2. Wood NK, Goaz PW. Differential Diagnosis of Oral Lesions, 4th edn. St Louis: CV Mosby. 1991; 166.
3. Blackwell CC, Weir DM, James VS, Cartwright KAV, et al. The Stonehouse study: secretor status and carriage of Neisseria species. Epidemiol Infect. 1989; 120: 1-10.
4. Salinas CF. Orodental findings and genetic disorders, Birth Defects. 1982; 18:79-120.
5. Shapiro SD, Jorgenson RJ. Heterogeneity in genetic disorders that affect the orifices. Birth Defects. 1983; 19(1):155-166.
6. Aldred MJ, Bartold PM. Genetic disorders of the gingivae and periodontium. Periodontol 2000; 18: 7-20.
7. Gorlin RJ, Cohen MM, Levin LS. Syndromes of the Head and Neck. Oxford: Oxford University Press. 1990: 94-99.
8. ina-Neto J-M, Moreno A-F, Silva L-R, Velludo M-A, Petean E-B, Ribeiro M-V, et al. Cherubism, gingival fibromatosis, epilepsy, and mental deficiency (Ramon syndrome) with juvenile rheumatoid arthritis. Am J Med Gen 1986; 25: 433-441.
9. Roshkind DM The practical use of lasers in general practice. Alpha Omegan. 2008 Sep; 101(3):152-61.

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