May 2003

By Youn Park, MD, and Pamela Rucki, MD

		CASE: A 19-year-old man with a history of seizure disorder and current symptoms of upper respiratory infection is found to have swelling of the gum tissue. The patient says this change has been noted for many years and has not been associated with any bleeding or pain. WHAT IS YOUR DIAGNOSIS?
		Gingival fibrous hyperplasia may develop after prolonged use of phenytoin, which this patient had been taking to control his seizure disorder. Other drugs have been known to have a similar effect, including cyclosporin and nifedipine. The condition presents grossly as a diffuse enlargement of the gingivae that becomes swollen, rounded, and, later, lobulated. The gums become thicker and harder. Microscopic examination shows sparsely vascular fibrous connective tissue with thick, dense, interlacing bundles of collagen fibers. Generalized fibrous hyperplasia may also occur as a result of an exaggerated reaction to chronic irritation from plaque and bacteria, or as a manifestation of hereditary gingival fibromatosis or Zimmermann-Laband syndrome.

Dr. Park is a clinical professor of otolaryngology at Northeastern Ohio Universities College of Medicine and section head of otolaryngology at Barberton Citizens Hospital in Barberton, Ohio. Dr. Rucki is an attending physician in the department of family practice at Barberton Citizens Hospital.