39: Gingival bleeding and enlargement

39 Gingival bleeding and enlargement

Summary

Kayleigh is 15 years old. She is concerned that her upper gums look abnormal and they bleed whenever she brushes them (Fig. 39.1).

image

Fig. 39.1 Chronic gingivitis.

History

Kayleigh has noticed bleeding when she has been brushing for the last year. She is frightened of brushing because of the bleeding and feels that the bleeding is getting worse. She is also very socially conscious of her gums because they look very red and are ‘bigger’ than normal.

Medical history

Kayleigh has insulin-dependent diabetes. She takes her insulin by subcutaneous injection at 07.30 and 17.30 hours. She has a regulated gram intake of carbohydrate at 07.30, 11.00, 13.00, 15.00, 17.30 and 21.00 hours. Apart from this she is an active girl who plays basketball and hockey at school and has learnt to increase her carbohydrate intake appropriately to cover her sporting activities. Her mum reports that Kayleigh has had the occasional ‘rebellion’ against her condition and at these times diabetic control has been poor, but generally her control is now good with a stable regimen. She is seen every 2 months by her doctor, and she monitors her blood glucose and urinary glucose at home herself.

Dental history

Kayleigh and her family are regular dental attenders and have just moved to the area with her father’s job. This is the first time you have seen her.

Examination

Extraoral examination is normal with no signs of infection. Intraorally there is widespread marginal gingivitis, which is particularly bad in the upper right quadrant anteriorly (Fig. 39.1). Clinical and radiographic examination of the teeth reveal a low caries rate with only the need to replace a cracked and deficient restoration in a lower first permanent molar that has recurrent caries.

image What factors are contributing to the chronic marginal gingivitis?

Poor oral hygiene.
Hormonal changes of puberty.
Poorly controlled diabetes mellitus.

Key point

Gingival bleeding can be as a result of:

• Local causes.
• Systemic causes.

The commonest local and systemic causes of gingival bleeding in childhood/adolescence are shown in Box 39.1.

Box 39.1 Commonest causes of gingival bleeding in childhood and adolescence

Local causes

• Eruption gingivitis.
• Acute/chronic gingivitis.
• Chronic periodontitis.
• Foreign body entrapment.
• Acute necrotizing ulcerative gingivitis.
• Haemangioma.
• Reactive hyperplasias such as pyogenic granuloma.
• Factitial injury.

Systemic causes

• Hormonal changes such as pregnancy or puberty.
• Diabetes mellitus – poor control.
• Anaemia.
• Leukaemia.
• Any platelet disorder.
• Clotting defects.
• Drugs (e.g. anticoagulants).
• Scurvy.
• HIV-associated periodontal disease.

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 39: Gingival bleeding and enlargement

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