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CASE REPORT


GINGIVAL POLYP



Dr. HSJ INSTITUTE OF DENTAL SCIENCES AND HOSPITAL,
CHANDIGARH

Submitted to: Submitted by:
Department Of Oral Pathology Kanish Aggarwal
BDS 3
rd
year

CONTENTS
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S.No. Title Page No.

1 Introduction 3
2 Gingival enlargement 3
3 Inflammatory enlargement 4
4 Gingival polyp : case report 6
5 Case summary 17
6 Bibliography 18








GINGIVAL POLYP

1. INTRODUCTION
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Gingival polyp represents a form of chronic hyperplastic gingivitis. In chronic
hyperplastic gingivitis, chronic inflammation causes significant enlargement of the
gingival tissue because of edema and fibrosis along with infiltration by the chronic
inflammatory cells. This chronic inflammatory process results from the chronic
irritation of the gingival tissue which may occur due to large numbers of etiological
factors. This hyperplastic change of the gingiva leads to formation of gingival polyp
which begins a slow growing mass and may enlarge if the irritant factor is nor
removed.
2. GINGIVAL ENLARGEMENT
Gingival enlargement or gingival overgrowth is a common feature of the gingival
disease. Gingival enlargement is increase in the size of the gingiva which may be
caused because of large number of factors which are classifies as:
I. Inflammatory enlargement
A. Chronic
B. Acute
II. Drug induced enlargement
III. Enlargement associated with systemic diseases/conditions
A. Conditioned enlargement

1. Pregnancy.
2. Puberty.
3. Vitamin C deficiency.
4. Plasma cell gingivitis
5. Non specific conditioned enlargement (pyogenic granuloma)
B. Systemic disease causing gingival enlargement
1. Leukemia
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2. Granulamatous diseases (Eg: Wegeners granulamatosis, sarcoidosis,)
IV. Neoplastic enlargement (gingival tumor):
A. Benign tumors
B. Malignant tumors.
V. False enlargement.


Gingival hyperplasia

3. INFLAMMATORY ENLARGEMENT
Gingival enlargement may result from chronic and acute inflammatory changes. Out
of these those due to chronic inflammation are commoner as compared to those due to
acute inflammation.
3.1 Chronic inflammatory enlargement
3.1.1 Etiology
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Chronic inflammatory enlargement of the gingiva mainly occurs when there is
presence of certain irritant factors which lead to chronic irritation to the gingiva, to
which gingiva responds by hyperplastic changes. These factors are:
Prolonged local irritation, poor oral hygiene
Factors that favor plaque accumulation and retention
Abnormal relationship between teeth, over hanging margins of restorations
Food impaction, irritation from clasps, orthodontic therapy
Habits, eg: mouth breathing, pressing the tongue against the gingiva.

3.1.2 Clinical features
Chronic inflammatory gingival enlargement originates as slight ballooning of the
interdental papilla and marginal gingiva. In early stages it produces a life preserver
shaped bulge around the involved teeth. This bulge can increase in size until it covers
the part of the crown. This progresses a slow growing painless mass. Acute infection
or trauma may though lead to symptoms of pain and swelling.
Occasionally, chronic inflammatory gingival enlargement occurs as a discrete sessile
or pendunculated mass resembling a tumor. It may be interproximal or on the
marginal or attached gingiva. The lesions are slow growing masses and usually
painless. They may undergo spontaneous reduction in size, followed by exacerbation
and continued enlargement.

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Chronic inflammatory hyperplasia of gingiva

4. GINGIVAL POLYP: CASE REPORT
Gingival polyp as stated earlier is a hyperplastic change in the gingiva in response to a
chronically irritating stimuli. Caries is also one of the chronic irritation factor because
of the bacterial load and infectious nature. A grossly carious tooth may lead to chronic
irritation of the gingiva associated with the tooth, which may lead to hyperplastic
changes in gingiva. It grows as a small enlargement which is usually asymptomatic. If
the source of irritation is removed at this point the lesion does not progress, but if the
irritant continues to present then the lesion grows in size to fill the entire cavity. This
lesion is asymptomatic till secondary infection occurs or trauma is inflicted. In our
OPD we examined a case of gingival polyp which was inflicted because of presence
of grossly carious tooth. The case report is as follows:


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CASE REPORT

DR. H.S.J.INSTITUTE OF DENTAL SCIENCES
PANJAB UNIVERSITY, CHANDIGARH


In our dental O.P.D.; we examined a case of

C.R. No.: X097692 NAME : Meenu
MAILING ADDRESS : AGE: 25 years SEX: Female
House Number 2770
Sector 25, Chandigarh DATE OFBIRTH: 28 March 1985
OCCUPATION : Cook MARTIAL STATUS : Married
HOME PHONE: 9835682491 WORK PHONE:
IN CASE OF EMERGENCY NOTIFY:
NAME: Mr. Sher Singh
PHONE:- 9835682491 RELATIONSHIP: Husband



CHIEF COMPLAINT: Localized severe pain in both right and left lower back
region past 15 days.


HISTORY OF PRESENT ILLNESS & OTHER RELEVANT INFORMATION:

Onset: Gradual Duration: 15 days
Intensity: Severe Progression: Increasing


FAMILY HISTORY: No family history suggestive of diabetes, hypertension,
tuberculosis, asthma etc


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MEDICAL HISTORY:

Current illness(es): Hypertension
Past illness(es): Diabetes (under control by medications)
Drug/Food allergies: No allergies
Current medication(s): Patient is taking regular medications for
hypertension, which is under control

WOMEN ONLY:

Are you pregnant? : No Weeks? Not sure if pregnant?
Using birth control pills? Menopausal/postmenopausal?

DENTAL HISTORY:

Past Dental Treatment: None

Eventful or not?
Regular/Irregular attendance?

SOCIAL HISTORY:

Smoker : No Pipe/Cigarette/Bidi Quantity /Day:
Alcohol consumption : No Amount/week:
Smokeless tobacco : Chewed/sucked/inhaled : Quantity/day :
Site of application :

ORAL HYGIENE ACTIVITY:

Tooth brushing: Frequency/day or week : 2/day method of use : horizontal
Frequency of replacement of tooth brush : 4 months
Interproximal Frequency/day or week : method of use :
cleaning:
Other adjuncts Frequency/day or week : method of use :
cleaning aids
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GENERAL PHYSICAL EXAMINATION:

Pulse: 83 bpm in right radial artery
Good volume, regular rhythm

Color of sclera and conjunctiva : Normal
B.P.: 130/80 mm Hg in right arm


EXTRAORAL EXAMINATION:

Swelling/Lump: Not present Ulcers: Not present
Draining Sinuses/Pus: Not present Rashes: None
White/Red Lesions: none Discoloration of soft tissues: Not present
Lymph Node Examination: Right Submandibular lymph nodes palpable.
Lymph nodes are firm and tender.


INTRAORAL EXAMINATION:
Oral soft tissues

Lips: Competent Gingiva: Soft and edematous, stippling
absent.
Buccal Mucosa: Normal Alveolar Mucosa: No abnormality detected
Tongue: Normal

Salivary gland and orifice : No abnormality
detected
Floor of the Mouth: Normal Salivary Flow: Normal
Hard Palate: Normal Tonsils: Normal
Soft palate :Normal Pharynx: Normal


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CALCULUS AND STAINS: Stains and calculus are present

Distribution:- Generalized/Localized: Generalized
Interproximal/Marginal: Marginal

OCCLUSION:

Type: Class I
Overjet: 3 mm Overbite: 2mm
Diastema:---- Open Bite Anterior: -----
Posterior: -----
Anterior Cross bite:---- Posterior Cross bite: -----
Others :

DENTAL EXAMINATION

Missing (M)
Decayed (D) D D D D D D
Restored (R)
Sensitive (S)
Wasting
diseases
Attrition/
Abrasion/Er
osion/
Ablation/Abf
raction)

Mobility
(Mb)

Tenderness
on
Vertical

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Percussion
(TOP-V)
Tenderness
on
Horizontal
Percussion(T
OP-H)

Fractured
(=)

Furcation
Involvement
(Fr)

Pocket (Pk)
Plaque (Pl) P P P P P P P P P P P P P P P P
Gingival
Bleeding (G)

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Missing (M)
Decayed (D) D D D D D
Restored (R)
Sensitive (S) S S S S
Wasting
diseases-
W(Attrition
Abrasion/Er
osion/
Ablation/Abf
raction)

Mobility
(Mb)

Tenderness
on
Vertical
Percussion(T
OP-V)
T-
V
T-
V

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Tenderness
on
Horizontal
Percussion
(TOP-H)
T-
H
T-
H

Fractured
(#)

Furcation
involvement
(Fr)

Pocket (Pk)
Plaque (P) P P P P P P P P P P P P P P P P
Gingival
Bleeding (G)


OTHER FINDINGS: ----

PROVISIONAL DIAGNOSIS:

Generalized chronic marginal gingivitis
Grossly Decayed : 47,46,36,37
Occlusal caries : 17, 16, 25,26,27,35
Gingival polyp w.r.t 47


INVESTIGATION AND RESULTS:

Biopsy: Histopathological study of the biopsy revealed presence of heavy chronic
inflammatory infiltrate supporting the diagnosis of chronic hyperplastic gingivitis in
form of gingival polyp.
Radiograph: Radiographic examination w.r.t 47 shows presence of a well defined
radiolucency.




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FINAL DIAGNOSIS:

Generalized chronic marginal gingivitis
Grossly Decayed : 47,46,36,37
Occlusal caries : 17, 16, 25,26,27,35
Gingival polyp w.r.t 47


TREATMENT PLAN:
Oral prophylaxis
Restoration and endodontic therapy w.r.t 17,16,25,26,27,35,36,37,46
Excision of gingival polyp
Extraction of 47

REFER TO THE DEPARTMENT OF:

Department of Periodontics
Department of Conservatives
Department of Oral Surgery



Signature of the dentist
Name: Kanish
Designation: BDS-IIIrd year

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Clinical picture of the patient with gingival polyp


Radiograph of gingival polyp

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4.2 Differential Diagnosis
Gingival polyp closely resembles pulp polyp clinically, thus it is very important to
distinguish between the two lesions
Pulp polyp or chronic hyperplastic pulpitis is a unique form of pulpal inflammation.
It occurs when large exposures of pulp occur in which the entire dentinal roof is
messing. Mechanical irritation and bacterial invasion results in a level of chronic
inflammation that produces hyperplastic granulation tissue that extrudes from the
chamber and often fills the associated dentinal defect. This lesion is generally
asymptomatic except for a possible feeling of pressure when it is placed into
masticatory function.
Gingival polyp can be distinguished from pulp polyp by checking the base of the
polyp. In gingival polyp the overgrown mass has attachment with the associated
gingiva i.e. it is attached to the gingiva surrounding the tooth while pulp polyp has no
such attachment.

Pulp polyp resembles gingival polyp clinically

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4.3 Treatment and Prognosis
The treatment of gingival polyp when associated with a carious tooth is mainly
surgical excision of the polyp with endodontic or conservative treatment or extraction
of the effected tooth. If the source of irritation is not removed there are high chances
of reoccurrence of the polyp. When surgically excised it should be sent for
Histopathological examination to rule out any kind of malignant transformation.


Treatment of gingival polyp

Treatment of gingival polyp

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5. CASE SUMMARY
We examined a case of gingival polyp associated with a grossly carious tooth. The
patient was a female of 25 years of age. Patient had diabetes and hypertension and was
taking medication regularly for them. Patient had a grossly carious tooth which leads
to development of gingival polyp due to chronic irritation. Patient had pain in the
tooth from last 15 days. The polyp was tender to touch because of secondary changes.
Polyp arised from the mesial aspect of the tooth and was filling the cavity formed due
to carious lesion. Submandibular lymph nodes were palpable showing infection
associated. The polyp was excised and the tooth was extracted.

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6. BIBLIOGRAPHY
Oral and maxillofacial pathology Neville
Carranzas clinical periodontology
www. dragrawalgumcare.com
www.wikipedia.org