**4.1 Benign tumors of the gingiva**

Epulis: it is a generic term used clinically to designate all discrete tumors and tumor-like masses of the gingiva [2]. The term is used to explain the location of the tumor mass not to portray it. Most lesions referred to as "epulis" are inflammatory rather than neoplastic (**Figure 9**).

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**Figure 10.** *Fibroma.*

*Treatment of Gingival Enlargement*

*DOI: http://dx.doi.org/10.5772/intechopen.82664*

elevations with minutely irregular surfaces.

vary in size, and may cover several teeth.

**4.2 Malignant tumors of the gingiva**

have been described in the literature [6].

tissue or presence of normal underlying dental tissue [2].

gingiva appear enlarged.

**4.3 False enlargement**

**4.4 Treatment**

as "fibromas" are inflammatory enlargements (**Figure 10**).

Fibroma: fibromas of gingiva arise either from connective tissue of gingiva or from periodontal ligament. Fibromas are slow-growing, spherical tumors that tend to be firm and nodular but may be soft and vascular. Fibromas are usually pedunculated. Hard fibromas of the gingiva are rare; most of the lesions diagnosed clinically

Papilloma: they are benign proliferations of surface epithelium associated with the human papillomavirus (HPV). Gingival papillomas appear as solitary, wart-like or cauliflower-like protuberances. They may be small and discrete or broad, hard

Peripheral giant cell granuloma: giant cell lesions of the gingiva arise interdentally or from the gingival margin, occur most frequently on the labial surface, and may be sessile or pedunculated. They vary in appearance from smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations. Ulceration of the margin is occasionally seen. The lesions are painless,

Central giant cell granuloma: these lesions arise within the jaws and produce central cavitation. They occasionally create a deformity of the jaw that makes the

Squamous cell carcinoma is the most common malignant tumor of the gingiva. It may be exophytic, presenting as an irregular outgrowth, or ulcerative, appearing as flat, erosive lesions. Malignant melanoma is a rare oral tumor that tends to occur in the hard palate and maxillary gingiva of older persons. It is usually darkly pigmented and is often preceded by localized pigmentation. Fibrosarcoma, lymphosarcoma, and reticulum cell sarcoma of the gingiva are rare; only isolated cases

False enlargements are not true enlargements of the gingival tissues but may appear as such as a result of increases in size of the underlying osseous or dental tissues. The gingiva usually presents with no abnormal clinical features except the massive increase in size of the area. It may be caused by increased underlying bone

The treatment of gingival enlargement is based on the understanding of the cause and underlying pathology. The treatment differs for each type of enlargement

**Figure 9.** *Epulis.*

### *Treatment of Gingival Enlargement DOI: http://dx.doi.org/10.5772/intechopen.82664*

*Gingival Disease - A Professional Approach for Treatment and Prevention*

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,

Epulis: it is a generic term used clinically to designate all discrete tumors and tumor-like masses of the gingiva [2]. The term is used to explain the location of the tumor mass not to portray it. Most lesions referred to as "epulis" are inflammatory

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**Figure 9.** *Epulis.*

**Figure 8.**

*Pyogenic granuloma.*

and delayed healing response [25].

**4.1 Benign tumors of the gingiva**

rather than neoplastic (**Figure 9**).

**4. Neoplastic enlargement (gingival tumors)**

Fibroma: fibromas of gingiva arise either from connective tissue of gingiva or from periodontal ligament. Fibromas are slow-growing, spherical tumors that tend to be firm and nodular but may be soft and vascular. Fibromas are usually pedunculated. Hard fibromas of the gingiva are rare; most of the lesions diagnosed clinically as "fibromas" are inflammatory enlargements (**Figure 10**).

Papilloma: they are benign proliferations of surface epithelium associated with the human papillomavirus (HPV). Gingival papillomas appear as solitary, wart-like or cauliflower-like protuberances. They may be small and discrete or broad, hard elevations with minutely irregular surfaces.

Peripheral giant cell granuloma: giant cell lesions of the gingiva arise interdentally or from the gingival margin, occur most frequently on the labial surface, and may be sessile or pedunculated. They vary in appearance from smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations. Ulceration of the margin is occasionally seen. The lesions are painless, vary in size, and may cover several teeth.

Central giant cell granuloma: these lesions arise within the jaws and produce central cavitation. They occasionally create a deformity of the jaw that makes the gingiva appear enlarged.
