Gingival enlargements: Differential diagnosis and review of literature

Table 1 Different drugs known to predispose to gingival enlargements

Anticonvulsants[15,16]		Immunosuppressants[17]	Calcium channel blockers[15]
Phenytoin	Vigabatrin	Cyclosporine	Nifidipine
Ethotoin	Ethosuximide	Tacrolimus	Diltiazem
Mephenytoin	Topiramate	Sirolimus	Felodipine
Phenobarbital	Pyrimidinone		Nitrendipine
Lamotrigine			Verapamil
			Amlodipine

Table 2 Gingival enlargement associated with syndromes in different types of genetic disorders

Syndromes associated with heriditary gingival fibromatosis
Zimmerman-Laband syndrome[18]	Abnormal fingers, nails, nose and ears, splenomegaly, hepatomegaly, hyperextensible metacarpophalangeal joints
Ramon syndrome[19]	Cherubism, seizures, mental deficiency, hypertrichosis, stunted growth, juvenile rheumatoid arthritis
Systemic Hyalinosis[20]	Painful joint contractures, diffuse thickening of the skin with pearly papules and fleshy nodules and failure to thrive
Jones syndrome[21]	Progressive sensorineural deafness
Rutherford syndrome[22]	Corneal opacity, mental retardation and aggressive behavior, failure of tooth eruption
Cross syndrome[23]	Hypopigmentation, mental retardation and writhing movement of hand and legs
Schinzel-Giedion syndrome[24]	Severe mid face retraction, severe mental retardation and congenital heart defect, patient usually die under 10 yr of age
Costello syndrome[25]	Macrostomia, redundant skin of neck, hands and feet, nasal and perioral papillomas, enlargement within first years of life
Syndromes associated with lysosomal storage diseases
Hurler syndrome[26]	Dwarfism, flexion contractures, hernias, corneal clouding, macroglossia, short mandibular rami, peg-shaped teeth
Maroteaux-Lamy syndrome[27]	Enlargement of skull, corneal opacities, short peg-shaped poorly formed teeth, hypertrophy of alveolar ridges, anterior open bite
Neimann-Pick disease[28]	Thick lips, macroglossia and widely spaced teeth
Anderson-Fabry disease[29,30]	Painful crises on extremities and abdomen, angiokeratomas of skin, labial mucosa and buccal mucosa
Cowden syndrome[31]	Cobblestone papules of gingiva and buccal mucosa, macrocephaly, multiple hamartomas, learning disabilities, autism
Gingival enlargement associated with vascular disorders
Sturge-Weber syndrome[32]	Unilateral cutaneous nevi, unilateral vascular hyperplasia, neurological manifestations and ocular complications
Klippel-Trenaunay syndrome[33]	Capillary hemangiomas, increased size of lips, tongue, teeth malformations, delayed exfoliation of teeth, calcified roots
Gingival enlargement associated with characteristic dental abnormalities
Wilson syndrome[34]	Enamel hypoplasia, multiple small red papules of lips, early onset periodontitis and repeated oral candidiasis, signs of cirrhosis
GoltzGorlin syndrome[35]	Partial anodontia, hypoplastic teeth, atrophy and linear pigmentation of skin, herniation of fat, multiple papillomas, digital anomalies