Early Onset of Hereditary Gingival Fibromatosis in a 28-month-old

Resident’s Name: Jessica Wilson

Article title: Early Onset of Hereditary Gingival Fibromatosis in a 28-month-old

Author(s): Breen et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2009. 31:4. 286-288.

Major topic: Hereditary Gingival Fibromatosis

Overview of method of research: Case Report

Background:
Hereditary Gingival Fibromatosis (HGF) is also known as idiopathic gingival hyperplasia. This condition can present as part of a syndrome or as an isolated disorder. It is usually an autosomal dominant condition, but has also been shown to be autosomal recessive at times. HGF presents as benign, asymptomatic gingival enlargement. There is little to no bleeding of the dense gingiva which is normal pink in color. HGF can be isolated to one quadrant or generalized throughout the entire mouth. While the underlying bone is not affected, the firm nodular gingiva resembles bone when palpated.
HGF usually manifests along with the eruption of the permanent dentition, but less commonly with the eruption of the primary dentition. In rare cases it can be present at birth. Severe forms can displace teeth and delay eruption. Some syndromes including Zimmerman-Laband, Jones, Ramon, Murray-Puretic Drescher, Cowden, Cross, Rutherford, and prune belly exhibit HGF. The most common characteristics associated with HGF when reviewing these syndromes are mental retardation, epilepsy and hypertichosis.

Case Report:
A 28-month-old Caucasian male presented with a non-contributory medical history, 4 partially erupted mandibular teeth and no visible maxillary teeth. There was significant gingival overgrowth throughout the maxillary arch with the outline of the absent dentition visible and palpable. The mandibular arch was similar and there were no other abnormal intraoral findings. The patient had an older brother diagnosed with HGF who had undergone several gingival reduction surgeries. To confirm his suspected diagnosis of HGF, he was evaluated at a Craniofacial Anomalies Clinic. They also suspected a diagnosis of nonsyndromic HGF.
The patient was referred to an oral surgeon for electrocautery surgical gingival excision under general anesthesia. The buccal and lingual/palatal gingiva was removed from 1st primary molar to 1st primary molar in both arches to the level of the CEJ as well as part of the tissue covering the posterior tuberosities so the patient could occlude. The tissue was biopsied and came back with normal HGF findings. The patient tolerated the procedure well and returned for follow –up appointments with normal healing.

Key points/Summary:
HGF is incurable, but can be treated with professional prophylaxis, scaling and good oral hygiene for mild presentations or surgical intervention for more severe cases.

Assessment of Article:
Short and sweet review of an interesting disorder. Me likey. Have a great holiday everyone!!!!!