This is caused by tissue edema and infective cellular infiltration caused by prolonged exposure to bacterial plaque, and is treated with conventional periodontal treatment, such as scaling and root planing.Gingivitis and gingival enlargement are often seen in mouth breathers, as a result of irritation brought on by surface dehydration, but the manner in which it is caused has not been demonstrated.The accumulation and retention of plaque is the chief cause of inflammatory gingival enlargement. Risk factors include poor oral hygiene, as well as physical irritation of the gingiva by improper restorative and orthodontic appliances. Drug-induced enlargement
This type of gingival enlargement is sometimes termed "drug induced gingival enlargement" or "drug influenced gingival overgrowth", abbreviated to "DIGO". Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response: Gingival overgrowth is a common side effect of phenytoin, termed "Phenytoin-induced gingival overgrowth" (PIGO). anticonvulsants (such as phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate and primidone NOT common for valproate)
calcium channel blockers (antihypertensives such as nifedipine, amlodipine, and verapamil). The dihydropyridine derivative isradipidine can replace nifedipine and does not induce gingival overgrowth. cyclosporine, an immunosuppressant.Of all cases of DIGO, about 50% are attributed to phenytoin, 30% to cyclosporins and the remaining 10-20% to calcium channel blockers. Drug-induced enlargement has been associated with a patients genetic predisposition, and its association with inflammation is debated.
Additional findings
Additional findings that may be present in HFGS according to the latest research are:
Limited metacarpophalangeal flexion of the thumb or limited ability to oppose the thumb and fifth finger
Hypoplastic thenar eminences
Medial deviation of the great toe (hallux varus), a useful diagnostic sign when present
Small great toenail
Fifth-finger clinodactyly, secondary to a shortened middle phalanx
Short feet
Altered dermatoglyphics of the hands; when present, primarily involving distal placement of the axial triradius, lack of thenar or hypothenar patterning, low arches on the thumbs, thin ulnar loops (deficiency of radial loops and whorls), and a greatly reduced ridge count on the fingersRadiographic findings 

Hypoplasia of the distal phalanx and first metacarpal of the thumbs and great toes
Pointed distal phalanges of the thumb
Lack of normal tufting of the distal phalanges of the great toes
Fusions of the cuneiform bones to other tarsal bones or trapezium-scaphoid fusion of the carpals
Short calcaneus
Occasional bony fusions of the middle and distal phalanges of the second, third, fourth, or fifth toes
Delayed carpal or tarsal maturation
Metacarpophalangeal profile reflecting shortening of the first metacarpal, the first and second phalanges, and the second phalanx of the second and fifth digitsUrogenital Defects
Females may have the following:

Vesicoureteral reflux secondary to ureteric incompetence
Ectopic ureteral orifices
Trigonal hypoplasia
Hypospadiac urethra
Subsymphyseal epispadias
Patulous urethra
Urinary incontinence (related to structural anomalies and weakness of the bladder sphincter muscle)
Small hymenal opening
Various degrees of incomplete Müllerian fusion with or without two cervices or a longitudinal vaginal septumMales may have the following:

Retrograde ejaculation (related to structural anomalies and weakness of the bladder sphincter muscle)

Treatment
References


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