Gingival enlargement is a common periodontal pathology seen in medically compromised patients. Although it is not the disease itself, certain medications used to treat these chronic diseases are known to precipitate the gingival enlargement. Periodontitis (PD) and gingival enlargement have been reported increasingly in patients with chronic renal failure. Severe enlargement is detrimental to esthetics and function while having a negative impact on the overall oral health-related quality of life. Treatment of such cases requires comprehensive periodontal management by a specialist, keeping in mind the medically compromised state of the patient. This report presents a case of severe PD with generalized gingival enlargement in a 45-year-old male who was a known case of Stage 4 chronic kidney disease, obstructive uropathy, and hypertension. Gingival enlargement was managed by gingivectomy and gingivoplasty. Six months' follow-up showed no sign of recurrence.

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Peripheral ossifying fibroma is a reactive lesion of the gingiva presenting as a firm and nodular mass more commonly in the anterior maxilla in adolescent females. It originates from the connective tissue of gingiva or periodontal ligament and presents as a benign, slow growing, painless mass that is relatively less common, contributing to 8% of the gingival enlargements. Diagnosis is confirmed by histopathology and treatment includes surgical excision. Recurrence rate has been reported to be 8%-20% and may be due to the remnants of pathologic tissue after excision. This case report presents a classical case of peripheral cement-ossifying fibroma in a 17yr old female in maxillary incisor-cuspid region which was treated by local excision and debridement.