architecture that allows adequate access for cleaning.
A follow-up programme is essential to ensure a high standard of plaque control and to
detect any recurrence of the enlargement. As the causative drugs need to be taken on a
long-term basis, recurrence is common. When a phenytoin-induced enlargement is
refractory to long-term treatment, the patient's physician may be requested to modify
or change the anticonvulsant therapy to drugs such as sodium valproate or
carbamazepine, which do not cause gingival problems. There is no alternative
medication to cyclosporin, however, and the patients inevitably require indefinite oral
care.
11.6 TRAUMATIC GINGIVITIS (GINGIVITIS ARTEFACTA/FACTITIOUS
GINGIVITIS)
Gingivitis artefacta has minor and major variants. The minor form results from
rubbing or picking the gingiva using the fingernail, or perhaps from abrasive foods
such as crisps, and the habit is usually provoked by a locus of irritation such as an
area of persistent food packing or an already inflamed papilla (617HFig. 11.6). The lesions
resolve when the habit is corrected and the source of irritation is removed.
The injuries in gingivitis artefacta major are more severe and widespread and can
involve the deeper periodontal tissues (618HFig. 11.7 (a)). Other areas of the mouth such as
the lips and tongue may be involved and extraoral injuries may be found on the scalp,
limbs, or face (factitious dermatitis) (619HFig. 11.7 (b)). The lesions are usually viewed
with complete indifference by the patient who is unable to forward details of their
time of onset or possible cause.
The treatment of these patients, other than the dressing and protection of oral wounds,
does not lie with the dentist. Psychological reasons for inflicting the lesions may be
complex and obscure. A psychological or psychiatric consultation, rarely welcomed
either by older children or their parents, is necessary if the patient is to be prevented
from ultimately inflicting serious damage upon themselves.
Key Points
Gingivitis artefacta:
- minor/major;
- self-inflicted;
- habitual;
- psychological.