A rare case of unusual gingival enlargement post radiotherapy

Abstract

Oral changes following radiotherapy are not uncommon. Oral mucositis, alteration in salivary gland function, radiation caries, and gingival changes have all been reported following radiotherapy and chemotherapy. The gingival changes seen after radiotherapy may be unusual and often cause diagnostic dilemma. Metastasis to the gingiva has also to be ruled out in these cases. A 30-year-old female patient presented with enlargement of the gingiva of 6 months’ duration and lower lip swelling of 7 months’ duration. She was a known case of carcinoma of nasopharynx and had received radiotherapy and chemotherapy. Based on the history, the clinical appearance of the gingiva, and the other oral changes we considered both post-radiotherapy gingival enlargement and secondary metastasis to gingiva as possibilities. An incisional biopsy was performed (internal bevel gingivectomy). The histopathological report did not reveal any metastatic changes. Thus, we diagnosed post-radiotherapy gingival enlargement. For the multiple carious teeth, extraction and root canal treatment was carried out as necessary. The patient was referred to the department of Oral and Maxillofacial Surgery for management of swelling of the lips, which was diagnosed as lymphedema of the lip. Gingival enlargement is rare post radiotherapy. Such nonplaque-associated gingival enlargement in a patient who has undergone radiotherapy should be subjected to biopsy and histopathological examination to distinguish between secondary metastasis and post-radiation changes.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study

“…In addition, an unusual enlargement of the gingiva several months after the end of RT was mentioned in the literature, whereas the multiplication of gramnegative bacilli is cited as a possible mechanism for its occurrence. 5 A change in the oral microflora and an increase in the level of endotoxin released by gram-negative bacilli could play an important role in the development of inflammatory changes in the gingiva and lead to an altered tissue response and consequent gingival enlargement. Poor oral hygiene undoubtedly supports and accelerates the process of periodontium alteration; therefore, dentists must educate their patients undergoing RT.…”

“…RT also causes inflammatory changes in the oral mucosa and gingiva, which can result in necrosis, atrophy, or unusual gingival enlargement. 5 Atrophy of the gingiva leads to recession and painful sensitivity in the exposed tooth root, whereas gingival enlargement causes food impaction and periodontitis. Based on the fact that ionizing radiation causes physical and chemical tissue damages, some authors suggested that applied RT causes dose-dependent alterations of the vascular flow in dental pulps, with possible but not necessarily permanent consequences: fibrosis and atrophy.…”