Download Case Study - LCCCOralPathII

Gingival Fibromatosis & Myltiple
Hyaline Fibromas
Sheena Stegmann
11/08/2010
Name of Syndrome:
Patient:
Calvin Smith
Age:
9
Gender:
Male
Height:
4’ 6”
Weight:
70 lbs.
Vital Signs:
Pulse: 80 BPM
Respiratory rate: 25 RPM
Blood Pressure: 100/60 mmHG
Temperature: 97.9 degrees
Chief
complaint
Medical
Alert
Dense gingival tissue that was
preventing tooth eruption
Teeth were totally entrapped in a
gingival mass of tissue, thus, impairing
their eruption.
Gingival Fibromatosis &
Myltiple Hyaline Fibromas
Cause of Syndrome - Medical History (if
applicable)
Gingival fibromatosis can be caused by
number of factors, including:
• Herdity/Genetics
•Inflammation
•Leukemic infiltration and
•Use of medications such as phenytoin,
cyclosporine or nifedipine and vigabatrin.
Age/race/sex predilections and Systemic
Clinical Features:
•Occurs in children
•Race and age are no concerning factor
•Genetics is the leading cause
•The clinical presentation is generalized
firm nodular enlargements
with pink to red and inflamed, smooth to
stippled surfaces, with little tendency to
bleed.
•In some cases the gingivae can
become so firm and dense as to feel like
bone on palpation.
•The enlargement is painless and may
extend up to the mucogingival junction
but does not affect the alveolar mucosa.
Orofacial Clinical Features
•The histological appearance shows hyperplasia
of fibrous tissue of the corneum.
•The tissues are composed mainly of
dense connective tissue, which is rich in collagen
fibrils.
•The overlying epithelium is normal, but is
slightly hyperplastic in some areas.
•Gingival enlargement may occur during the
eruption of primary teeth and affect both
dentitions, but does not occur once the patient
grows into adulthood.
Radiographic Features of this Syndrome
The radiographic findings indicated a gross
delay in tooth eruption. The permanent
maxillary central incisors and first
permanent molars were still
unerupted.
Special considerations in Treatment of this patient? How is it Diagnosed?
How common is it? Is it a horse or zebra?
•Under general anesthesia, using CO2 laser, surgical removal of dense fibrous tissue
was performed exposing the teeth crowns.
•Conservative restorative treatment was performed as well.
•The patient tolerated the procedure well with no postoperative complications.
•After recovery, oral hygiene instructions were reinforced and complete tissue
recovery was evident after 3 weeks.
•Partial recurrence of the gingival overgrowth was noted after 3 months. At this stage,
professional prophylaxis was performed by a dental hygienist.
•At the six months evaluation, further eruption of all first permanent molars to the
level of the second primary molars was noted.
•Needs a second surgery
•Definitely a ZEBRA case
Intraoral pictures
Upper anterior region—severe
inflammation around the entrapped
Teeth.
Lower anterior region—teeth are
embedded in coarse gingival tissue.
Radiographs
Before any treatment
After 6 months
List Sources and References
•http://www.dent.ucla.edu/pic/members/gingTumors/part1/pyogenic.html
•http://www.aapd.org/upload/articles/Katz3-02.pdf
•www.fccjdentalhygiene.netfirms.com/pathologyquizch6key.htm
•Oral Pathology Textbook p.210-211