# Non-Plaque Induced Diffuse Gingival Overgrowth: An Overview
## 5 Genetically Determined Gingival Enlargement
\begin{table}
\begin{tabular}{c c l} \hline \hline
**Syndrome** & \multicolumn{2}{c}{**Clinical Manifestation of the Gingival Enlargement**} \\ \hline \multirow{6}{*}{Costello Syndrome} & - & Patients frequently present thickening of the posterior maxillary alveolar ridge, and cases involving the anterior mandibular alveolar ridge are also documented [54; 55]. \\  & - & 64\% of these patients have gingival hyperplasia [47]. \\  & - & Gums have a pink color and a hard texture [48]. \\  & - & Possible partial or total coverage of the dental elements (especially posterior) by the gingiva [47; 48]. \\ \hline \multirow{6}{*}{Mucolipidosis II (I-cell disease)} & - & Marked enlargement of the gums and alveolar processes, making the lower part of the face profile appear in the shape of a “fish” [56; 57]. \\  & - & Gingival overgrowth is progressive starting from 4 months of age [49; 50]. \\  & - & Open bite caused, when the patient tries to close the mouth and contact occurs only in the back of it [49; 50]. \\  & - & X-ray examination of the jaws shows that the dental elements are completely buried inside the gums and commonly do not erupt [49; 50]. \\  & - & Gingival tissues are soft and slightly elastic with a vertical growth direction [49; 50]. \\ \hline \multirow{6}{*}{Aspartylglucosamineaminuria} & - & Less extensive than other gingival enlargements [58; 59]. \\  & - & High incidence of gingival overgrowth, although not a direct cause of lysosomal accumulation due to aspartylglucosamineaminuria, could be due to an important inflammatory response triggered by abnormal tissue metabolism. For this reason, the gingival tissues of these patients are clinically compatible with gingivitis [51; 52]. \\ \hline \multirow{6}{*}{Alpha-mannosidosis} & - & Few documented cases in literature [53]. \\  & - & Nodular hyperplastic lesions of hard consistency, slightly erythematous of different sizes, caused by the infiltration of histiocytes into the gingival level are described [60]. \\ \hline \multirow{6}{*}{Menkes Kinky Desease} & - & Upper and lower bilateral gingival overgrowth with delay in the eruption of dental elements related to important gingival development [45; 46]. \\  & - & Marked inflammatory component is not described [45; 46]. \\  & - & Gingival color and consistency appear to be normal [61; 62]. \\ \hline \multirow{6}{*}{Ligneous periodontitis} & - & Gum lesions of this pathology are a direct consequence of the plasminogen deficiency which reduces the natural fibrinolysis causing fibrin deposits. These alterations lead to the formation of mucous pseudo membranes which alter the gingival tissue, and which tend not to heal becoming subject to bacterial superinfections [63; 64]. \\  & - & Gums have a nodular appearance with numerous ulcers and periodontal lesions that over time lead to mobility and subsequent loss of dental elements [56; 57]. \\ \hline \multirow{6}{*}{Cowden Syndrome} & - & Oral lesions are present in 80\% of patients and are considered as a major diagnostic criterion, especially for early identification of the disease [32]. \\  & - & Gum lesions consist of small and multiple pink or whitiish papules or nodules of approximately 1 to 3 mm [32]. \\  & - & Lesions can be isolated or merged, giving a characteristic cobbled appearance [32]. \\ \hline \multirow{6}{*}{Zimmermann-Laband Syndrome} & - & Gingival hypertrophy is the most explicit clinical aspect of this syndrome, leading to chewing, aesthetic, and functional difficulties [58]. \\  & - & Usually occurs at birth or after a few months [58]. \\ \cline{1-1}  & - & Slow and progressive development of the maxillary and mandibular gingiva [65]. \\ \hline \hline \end{tabular}
\end{table} 
Table 2: _Cont._  
\begin{table}
\begin{tabular}{c c c} \hline \hline
**Syndrome** & \multicolumn{2}{c}{**Clinical Manifestation of the Gingival Enlargement**} \\ \hline  & - & Gingival tissues can completely cover the deciduous teeth [66; 67]. \\  & - & Gums have a soft and inflamed texture [59; 60].