INTRODUCTION
A common feature of gingival disease is its enlargement or growth. The many types of gingival enlargement can be classified according to etiological factors and resultant pathological changes. The term gingival hypertrophy was used in the past. Hypertrophy is in fact increase in size of tissue or organ because of increase in size of individual cells, as need based response of the body. In case of gingival disease the enlargement is not primarily the result of increase in size of
components cells and also does not generally occur in response to an increased functional requirement. Gingival enlargement or growth can be classified as under:-
1. Inflammatory:-
• Acute
• Chronic
2. Drug induced enlargement
• Dilantic Sodium used as anti convulsant in epilepsy
• Calcium channel blockers in hypertension
3. Idiopathic gingival enlargement
4. Associated with systemic diseases
5. Neoplastic enlargements.
6. Harmonal enlargements i.e.,
• Puberty
• Pregnancy
• Menu pause
7. Hereditary enlargement
All these types of gingival enlargement affect either the total gingival tissue or along set of teeth or a single tooth in response to presence of dental plague, or some local mechanical irritant in relation to a single tooth, or altered body response in presence of local etiological factors. In my 30 years of experience as a periodontist, I could come across this particular type of case
only once and was not able to logically categorize this type of enlargement in the pattern of classification. Therefore, the wiser comment and critical response of the readers, particularly research oriented will be healthy and positive for my personal knowledge and others, if at all with my confusion regarding the growth category.
 

CASE REPORT
A seventeen years girl belonging to a village near Jammu attended the clinic along with her parents, with the complaint that she cannot chew her food and the face is deformed on right side and also there is difficulty in clear speech. In fact parents wanted the girl to get married but were worried about her swollen right cheek and visible bulging gingival while talking. The patient was
matric passed, intelligent and gave a clear history about the disease as under. Right from the age of 11-12 years she started
noticing gingival inflammation and bleeding on right side. She was using (Datoon) wood stick for teeth cleansing, a common feature in the villages around Jammu and even in Jammu city it self. The commonly used tree is called ‘Flaa’. She was regular user of Datoon and as per her version, she would clean all teeth. After about 2 years time the enlargement was quite significant and she sought local treatment, which included Alum + Salt in water for gorgling. A dentist cleaned her teeth also but could not
properly do it on the right side. With in 4-5 years, the enlargement was so enormous that the teeth got covered with it
completely and were not even visible, bothmandibular as well as maxillary. Lot of traditional local treatment were used. The girl felt tense and depressed.
 

ON INTRA ORAL EXAMINATION:-
There was a bulky enlargement of gingival on right side both in maxilla and mandible, teeth were invisible. Maxillary 1st and 2nd premolars on right side were tilted distally, First molar was absent. Fig 1, Fig2.

Surprisingly the periodontal health in relation to left side both in maxilla and mandible was significantly normal. Teeth were white and clean (Fig 3).

Enlarged tissue on right side was fibrous, did not bleed or pained on palpation, patient could not approximate her left teeth because premature meeting of bulky gingiva on right side. She did not give history of any other physical ailment. She had normal healthy built, excepting that she looked depressed because of her facial appearance, tense facial expression was very much evident Fig 4.

She was not taking any medicine particularly dilantin Sodium. The enlargement could not be designated as Juvenile, because left side was almost healthy, no involvement of first molars maxillary and mandibular. Puberty (Hormonal) enlargement also recedes with growing age and does not occur unilaterally to this much extent. As I was undecided about categorization regarding classification of growth therefore, I started with investigation.
1. Intra oral radiographs were taken for maxillary premolars and molars, mandibular premolars and molars on right side and
maxillary premolars and molars and mandibolars premolar and molars on left side.
2. Blood tests for TLC, DLC, HB, Serum Phosphatase were done. Radiographs revealed enormous bone loss in molar and premolar regions both in mandible and maxilla on right side. It looked horizontal pattern, ultimately affecting total interdental bone. On examining the radiographs u