**3.7 Systemic diseases that cause gingival enlargement**

Leukemia: leukemic enlargement is prominently because of accumulation of leukemic cells in the gingival. It manifests as diffuse or solitary and localized or

**Figure 7.** *Enlargement in pregnancy.*

**Figure 8.** *Pyogenic granuloma.*

generalized. It may appear as either a diffuse enlargement of the gingival mucosa, an oversized extension of the marginal gingival or a discrete tumor-like inter-proximal mass. In leukemic enlargement the gingiva is usually bluish red with a shiny surface. The consistency is moderately firm, but presents with a tendency towards friability and hemorrhage, occurring either spontaneously or on slight irritation [2]. Dreizen et al. found that cases with acute monocytic leukemia had the highest incidence of gingival infiltrates (M5) (66.7%) followed by acute myelomonocytic leukemia (M4) (18.5%) and acute myeloblastic leukemia (M1, M2) (3.7%) [24].

Wegener's granulomatosis: it is a rare disease characterized by acute granulomatous necrotizing lesions of the respiratory tract, including nasal and oral defects. It includes oral mucosal ulceration, gingival enlargement, abnormal tooth mobility, exfoliation of teeth, and delayed healing response [6]. The initial manifestations of Wegener's granulomatosis may involve the orofacial region and include oral mucosal ulceration, gingival enlargement, abnormal tooth mobility, exfoliation of teeth, and delayed healing response [25].
