Table 1 Differential diagnoses of generalized gingival overgrowth in children

Gingivitis

The inflammatory response to a local irritant can lead to chronic hyperplastic gingivitis. Gingival enlargement is usually limited to areas affected by the irritant

Drug-induced gingival overgrowth [21]

Intake of anticonvulsants, immunosuppressants, calcium channel blockers, or other drugs implicated in the occurrence of gingival overgrowth

Gingival overgrowth associated with systemic diseases

Leukemia [22]

Anemia, neutropenia, thrombocytopenia, easy fatigability, fever, bone pain, spontaneous gingival bleeding, gingival enlargement, petechial hemorrhages, mucosal pallor, herpetic infections, candidiasis, and oral ulceration

Vitamin C deficiency [23]

Vitamin C deficiency is defined as a serum ascorbic acid level < 2 μg/mL. Clinical manifestations of scurvy include anemia, myalgia, bone pain, swelling, gingival enlargement, poor wound healing, and spontaneous bleeding

Crohn’s disease [24]

Crohn’s disease is a chronic gastrointestinal inflammatory disease. Clinical manifestations include abdominal pain, diarrhea, nausea, vomiting, and weight loss. Oral manifestations include mucosal tags; swelling of the lips, cheeks, and gingiva; and cobblestone appearance of the mucosa

Genetic diseases and syndromes

Neurofibromatosis, type I (MIM 162200) [25]

Café-au-lait macules, axillary and inguinal freckling, neurofibromas, plexiform neurofibroma, optic pathway gliomas, sphenoid wing dysplasia or long-bone dysplasia, and Lisch nodules

Autosomal dominant

17q11.2

Hereditary gingival fibromatosis (MIM 135300, 605544, 609955 et al.) [26,27,28]

Benign, slow-growing, non-hemorrhagic, fibrous hyperplasia of the maxillary and mandibular gingiva

Autosomal dominant

2p22.1, 5q13-q22, 2p23.3-p22.3 et al

Congenital generalized hypertrichosis with or without gingival hyperplasia (MIM 135400) [29, 30]

Hypertrichosis, gingival hyperplasia, dysmorphic and coarse facies

Autosomal dominant, autosomal recessive

17q24.2-q24.3

Mucolipidosis (MIM 252500, 252600) [31]

Short stature, skeletal abnormalities, cardiomegaly, developmental delay, and gingival hyperplasia

Autosomal recessive

12q23.2

Winchester syndrome (MIM 277950) [32]

Generalized osteoporosis, multicentric osteolysis, and progressive joint destruction

Autosomal recessive

14q11.2

Zimmermann-Laband syndrome (MIM 135500, 616455, 618658) [33,34,35]

Gingival fibromatosis, hypo/aplastic nails and distal phalanges, hepatosplenomegaly, hypertrichosis, joint hypermobility, and abnormalities of the cartilage of the nose and/or ears

Autosomal dominant

1q32.2, 8p21.3, 1q21.3

Frank-ter Haar syndrome (MIM 249420) [36]

Thick skin, osteolysis, gingival hypertrophy, craniofacial anomalies, skeletal dysplasia, and cardiac defects

Autosomal recessive

5q35.1

Amelogenesis imperfecta, type IG (MIM 204690) [37]

Generalized thin hypoplastic or absent enamel in the primary and permanent teeth, pulp stones, delayed tooth eruption, root dilacerations of impacted teeth, gingival hyperplasia, and nephrocalcinosis

Autosomal recessive

17q24.2

Raine syndrome (MIM 259775) [38]

Generalized osteosclerosis, craniofacial dysplasia, thoracic hypoplasia, and gingival hyperplasia

Autosomal recessive

7p22.3

Gingival fibromatosis with progressive deafness (MIM 135550) [39]

Gingival fibromatosis associated with progressive neural hearing loss

Autosomal dominant

/

Gingival fibromatosis with distinctive facies (MIM 228560) [40]

Gingival fibromatosis, macrocephaly, bushy eyebrows, synophrys, hypertelorism, downslanting palpebral fissures, flattened nasal bridge, hypoplastic nares, cupid-bow mouth, and highly arched palate

Autosomal recessive

/

Ramon syndrome (MIM 266270) [41, 42]

Gingival fibromatosis, cherubism, short stature, mental deficiency, hypertrichosis, juvenile rheumatoid arthritis, and epilepsy

Autosomal recessive

/

Rutherfurd syndrome (MIM 180900) [43, 44]

Failure of eruption of teeth, gingival hyperplasia, dense corneal opacities

Autosomal dominant

/