HEREDITARY GINGIVAL FIBROMATOSIS WITH ASSOCIATED SEVERE PERIODONTITIS IN A PATIENT WITH CHRONIC ALCOHOL ABUSE

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

J Gen Intern Med

Abstract

CASE: A 40-year-old female patient with a longstanding history of alcohol abuse presented with altered mental status and facial swelling. Due to incomprehensible speech, there was concern for alcohol intoxication versus withdrawal. Oral cavity examination revealed significant diffuse gingival hyperplasia with a ridge of gum tissue overlying the hard palate, as well as periodontitis. She was hemodynamically stable on arrival with negative serum and urine alcohol levels; laboratory studies were otherwise unremarkable. Computed tomography scanning of the oral cavity was negative for abscess but revealed severe periosteal mandibular molar disease. During her hospitalization, she was managed conservatively with fluids. After close observation, it was noted that her incomprehensible speech was due to gingival hyperplasia rather than acute intoxication/withdrawal. Upon further questioning, she revealed a family history of similar gingival disease in her mother and brother. Her condition had worsened since childhood and contributed to social isolation and depression, leading her to consume alcohol. Given extensive negative work-up for secondary causes along with a convincing family history, she was diagnosed clinically with Hereditary Gingival Fibromatosis (HGF) and provided social services, alcohol cessation resources, and behavioral therapy referral. IMPACT/DISCUSSION: HGF is a rare disorder characterized by slowly progressive enlargement of the maxillary and mandibular gingiva. Autosomal dominant inheritance is more common and typically non-syndromic, as in this case [2]. The marginal gingiva, attached gingiva, and interdental papilla are involved, whereas drug-induced hyperplasia spares edentulous areas [3]. Our patient had an extreme case with gingival covering of exposed tooth surfaces, separation of teeth, and distortion of the jaw. While scurvy causes tender, bleeding gingiva [3], the tissue in HGF is pink, non- hemorrhagic, and firm. Gingivectomy is the recommended intervention, however recurrence rate is high [3], reflected by our patient who underwent multiple procedures in childhood. While our patient suffered from this condition for many years and was admitted frequently for alcohol intoxication and withdrawal, her heavy alcohol use left her incomprehensible during admissions, likely contributing to suboptimal medical care. This patient's associated severe periodontitis likely stemmed from a lack of access to consistent primary medical and dental care. Two prior case reports describe hereditary [1] and idiopathic [2] gingival fibromatosis with associated aggressive periodontitis, which is also known to be genetically inherited and influenced by environmental factors including smoking [2]. CONCLUSION: This case of hereditary gingival fibromatosis highlights the distinguishing characteristics of this rare and potentially debilitating condition, its association with severe periodontitis, and the impact of social determinants of health on disease progression and complications.

Volume

37

First Page

S459

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