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Gingival Swellings Differential diagnosis
Amer Ali College of dentistry, university of Kufa
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Infections
• Gingival abscess• Periodontal abscess• Pericoronal abscess• Acute osteomyelitis• Acute herpetic gingivostomatitis
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Infection Acute herpetic gingivostomatitis
Painful, enlarged, and erythematous palatal gingiva
Painful, enlarged, and erythematous facial gingiva.
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Cystic lesions• Gingival cyst of the adult• Eruption cyst• Peripheral calcifying odontogenic cyst• Glandular odontogenic cyst
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Cystic lesionsGlandular odontogenic cystPeripheral calcifying odontogenic cyst
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Tumor like lesions• Parulis (gum boil)• Gingival epulis• Pyogenic granuloma• Peripheral ossifying fibroma• Peripheral giant cell granuloma• Wegener’s granulomatosis• Focal mucinosis• Mandibula tori• Exostosis
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Tumor like lesions
Peripheral ossifying fibroma Peripheral giant cell granuloma
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Tumor like lesionsWegener’s granulomatosis. Hemorrhagic and friable gingiva (strawberry gingivitis).
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Tumor like lesionsOral focal mucinosis. Nodular mass arising from the gingiva between the mandibular first and second molars.
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Tumor like lesionsTorus mandibularis. Bilateral lobulated bony protuberances of the mandibular lingual alveolar ridge.
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Developmental or congenital
• Intramucosal melanocytic nevus• Congenital epulis• Retrocuspid papilla
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Developmental or congenital
Congenital epulis
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Developmental or congenital Intramucosal melanocytic nevus
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Developmental or congenital Retrocuspid papilla
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Neoplastic - benign
• Papilloma• Hemangioma• Lymphangioma• Peripheral ameloblstoma• Peripheral odontogenic fibroma• Granular cell myoblastoma• Central Giant Cell Tumor
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Neoplastic - benignPeripheral ameloblastoma. Sessile gingival mass
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Neoplastic - benignPeripheral odontogenic fibroma. This sessile gingival mass cannot be clinically distinguished from the common peripheral ossifying fibroma.
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Neoplastic - benignBluish color of central giant cell tumor shows its vascular nature
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Neoplastic - Malignant• Squamous cell carcinoma• Fibrosarcoma• Reticular cell sarcoma• Melanoma• Malignant lymphoma• HIV associated kaposi’s sarcoma• Malignant hemangioendothelioma• Metastatic tumors like metastatic melanoma
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Neoplastic - MalignantSquamous cell carcinoma
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Neoplastic - MalignantMetastatic melanoma. Pigmented nodule of the mandibular gingiva
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Neoplastic - MalignantHIV-associated Kaposi’s sarcoma (KS). Raised, dark-red enlargement of the mandibular anterior facial gingiva on the left side.
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Others, leukemia
Leukemia, diffuse gingival enlargement
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Others, leukemiaLeukemia. Extensive hemorrhagic enlargement of the maxillary and mandibular gingivae.
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Others, vitamin C deficiencyScurvy. Hemorrhagic gingival enlargement (scorbutic gingivitis) because of capillary fragility
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Others, drug related Cyclosporine-related gingival hyperplasia. Diffuse, erythematous, and fibrotic gingival hyperplasia.
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Others, drug related Nifedipine-related gingival hyperplasia. Diffuse, fibrotic gingival hyperplasia
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Others, drug relatedMild phenytoin-related gingival hyperplasia. Gingival enlargement present predominantly in the interdental papillae.
Phenytoin-related gingival hyperplasia.Significant erythematous gingival hyperplasia is covering portions of the crowns of numerous teeth.
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Gingival fibromatosisGingival fibromatosis. Significant fibrotic gingival hyperplasia with resultant delayed eruption of numerous teeth.
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References
• Textbook of Oral medicine 2nd ed Anil Govindrao Ghom
• Oral and Maxillofacial Pathology 3rd edition• Contemporary Oral and Maxillofacial
Surgery, Sixth Edition- Hupp, James R