HORMONALLY INDUCED GINGIVAL ENLARGEMENT: FOCUS ON EPULIS - A NARRATIVE REVIEW

Authors

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6189

Keywords:

Gingival Enlargement, Epulis, Pregnancy Tumour, Oestrogen, Progesterone, Periodontium

Abstract

Gingival enlargement and epulis are common reactive lesions of the oral cavity with a multifactorial aetiology. While dental plaque is considered the primary initiating factor, systemic hormonal influences play a significant modulatory role in their development and clinical expression. This narrative review aims to summarise current evidence regarding the effects of sex steroid hormones on gingival enlargement and epulis, with particular emphasis on pregnancy-associated lesions and hormonal fluctuations throughout life.

A literature search was conducted using PubMed and Google Scholar, focusing on studies investigating the effects of oestrogen and progesterone on periodontal tissues. The available evidence indicates that sex hormones influence inflammatory responses, vascular function, immune activity, microbial composition, and connective tissue metabolism within the periodontium.

The findings suggest that hormonal changes do not directly initiate gingival disease but act as modifying factors that increase tissue susceptibility to local irritants, particularly dental plaque. Understanding these mechanisms is essential for improving prevention and clinical management of hormonally influenced gingival conditions.

References

Agrawal, A. A. (2015). Gingival enlargements: Differential diagnosis and review of literature. World Journal of Clinical Cases, 3(9), 779–788. https://doi.org/10.12998/wjcc.v3.i9.779

Bali, D., Pandit, N., Grover, V., Gugnani, S., & Ranjan, A. (2023). A systematic approach to the diagnosis of gingival enlargements. Journal of Oral Health and Community Dentistry, 17(2), 66–74. https://doi.org/10.5005/jp-journals-10062-0170

Castro, M. M. L., Ferreira, M. K. M., Prazeres, I. E. E., de Oliveira Nunes, P. B., Magno, M. B., Rösing, C. K., Maia, L. C., & Lima, R. R. (2021). Is the use of contraceptives associated with periodontal diseases? A systematic review and meta-analyses. BMC Women’s Health, 21(1), Article 48. https://doi.org/10.1186/s12905-021-01180-0

Cornejo Ulloa, P. E., Krom, B. P., Schoonmade, L. J., & Van Der Veen, M. H. (2024). Sex steroid hormones: An overlooked yet fundamental factor in oral homeostasis in humans. Frontiers in Endocrinology, 15, Article 1400640. https://doi.org/10.3389/fendo.2024.1400640

Cornejo Ulloa, P., Krom, B. P., & Van Der Veen, M. H. (2021). Sex steroid hormones as a balancing factor in oral host microbiome interactions. Frontiers in Cellular and Infection Microbiology, 11, Article 714229. https://doi.org/10.3389/fcimb.2021.714229

Di Stefano, M., Polizzi, A., Santonocito, S., Romano, A., Lombardi, T., & Isola, G. (2022). Impact of oral microbiome in periodontal health and periodontitis: A critical review on prevention and treatment. International Journal of Molecular Sciences, 23(9), Article 5142. https://doi.org/10.3390/ijms23095142

Dieterle, M. P., Husari, A., Steinberg, T., Wang, X., Ramminger, I., & Tomakidi, P. (2021). From the matrix to the nucleus and back: Mechanobiology in the light of health, pathologies, and regeneration of oral periodontal tissues. Biomolecules, 11(6), Article 824. https://doi.org/10.3390/biom11060824

Epulis: A narrative review of epidemiology, clinical features, pathogenesis, and management. (2025). Oral Health and Preventive Dentistry, 23(1), 507–524. https://doi.org/10.3290/j.ohpd.c_2258

Goh, R. S., Peh, W. M., & Keng, C. G. H. (2025). Pyogenic granuloma gravidarum: A case report. Case Reports in Women’s Health, 46, Article e00716. https://doi.org/10.1016/j.crwh.2025.e00716

Ionaș, T. H., Ionaș, M., Chicea, R., Dădârlat, D. A., & Ștef, L. (2025). Assessing the oral microbiome in women of reproductive age: A narrative review. Clinics and Practice, 15(11), Article 206. https://doi.org/10.3390/clinpract15110206

Jafri, Z., Bhardwaj, A., Sawai, M., & Sultan, N. (2015). Influence of female sex hormones on periodontium: A case series. Journal of Natural Science, Biology and Medicine, 6(3), 146. https://doi.org/10.4103/0976-9668.166124

Jawed, S. T. M., & Tul Kubra Jawed, K. (2025). Understanding the link between hormonal changes and gingival health in women: A review. Cureus. https://doi.org/10.7759/cureus.85270

Kanmaz, M. G., Kanmaz, B., & Buduneli, N. (2025). Periodontal manifestations of diseases/conditions related with female sex steroid hormones. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 22(3), 403–408. https://doi.org/10.38136/jgon.1618476

Khodorovskyi, G., Panina, L., & Shchurko, T. (2021). Hormone-associated metabolic disorders of the oral cavity organs in women of reproductive age. Problems of Endocrine Pathology, 78(4), 127–134. https://doi.org/10.21856/j-PEP.2021.4.17

Kim, Y. G., Lee, S. M., Bae, S., Park, T., Kim, H., Jang, Y., Moon, K., Kim, H., Lee, K., Park, J., Byun, J.-S., & Kim, D.-Y. (2021). Effect of aging on homeostasis in the soft tissue of the periodontium: A narrative review. Journal of Personalized Medicine, 11(1), Article 58. https://doi.org/10.3390/jpm11010058

Kulkarni, S., Zope, S., Suragimath, G., Varma, S., & Kale, A. (2022). Female sex hormones and periodontal health: Assessment of knowledge and awareness among women of Western Maharashtra. Annals of Dental Specialty, 10(4), 49–55. https://doi.org/10.51847/xL2Ee7GX7P

Mariotti, A. (1994). Sex steroid hormones and cell dynamics in the periodontium. Critical Reviews in Oral Biology and Medicine, 5(1), 27–53. https://doi.org/10.1177/10454411940050010201

Madhuri, M., Tagar, M. R., Memon, S., Saman, S., Irfan, N., & Ghauri, M. Q. K. (2024). Characterization of gingival epulis lesions: A histological and morphological approach. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University, 20(4), 652–657. https://doi.org/10.48036/apims.v20i4.1113

Meshram, M., Durge, K., & Shirbhate, U. (2023). An overview of oral pyogenic granuloma and its management: A case report. Cureus, 15(11), Article e48305. https://doi.org/10.7759/cureus.48305

Naruishi, K. (2022). Biological roles of fibroblasts in periodontal diseases. Cells, 11(21), Article 3345. https://doi.org/10.3390/cells11213345

Palanisamy, S. (2025). The impact of estrogen on periodontal tissue integrity and inflammation—A mini review. Frontiers in Dental Medicine, 6, Article 1455755. https://doi.org/10.3389/fdmed.2025.1455755

Rajanikanth, B., Moogla, S., Suragimath, G., Pai, B. J., Walvekar, A., & Kumar, R. (2012). Localized gingival enlargement—A diagnostic dilemma. Indian Journal of Dentistry, 3(1), 44–48. https://doi.org/10.1016/S0975-962X(12)60013-6

Reeves, J. (2025). The impact of female hormones on the periodontium—A narrative review. International Journal of Dental Hygiene, Article idh.12908. https://doi.org/10.1111/idh.12908

Sathish, A. K., Varghese, J., & Fernandes, A. J. (2022). The impact of sex hormones on the periodontium during a woman’s lifetime: A concise-review update. Current Oral Health Reports, 9(4), 146–156. https://doi.org/10.1007/s40496-022-00321-0

Savage, N., & Daly, C. (2010). Gingival enlargements and localized gingival overgrowths. Australian Dental Journal, 55(s1), 55–60. https://doi.org/10.1111/j.1834-7819.2010.01199.x

Tilakaratne, A., Soory, M., Ranasinghe, A. W., Corea, S. M. X., Ekanayake, S. L., & De Silva, M. (2000). Periodontal disease status during pregnancy and 3 months post-partum, in a rural population of Sri-Lankan women. Journal of Clinical Periodontology, 27(10), 787–792. https://doi.org/10.1034/j.1600-051x.2000.027010787.x

Trackman, P. C., & Kantarci, A. (2004). Connective tissue metabolism and gingival overgrowth. Critical Reviews in Oral Biology & Medicine, 15(3), 165–175. https://doi.org/10.1177/154411130401500305

Whitaker, S. B., Bouquot, J. E., Alimario, A. E., & Whitaker, T. J. (1994). Identification and semiquantification of estrogen and progesterone receptors in pyogenic granulomas of pregnancy. Oral Surgery, Oral Medicine, Oral Pathology, 78(6), 755–760. https://doi.org/10.1016/0030-4220(94)90092-2

Downloads

Published

2026-07-03

How to Cite

Suszczyńska, A., Wojtanowska, E. ., Mazur, M., Kozicka, J., Wiatr, A., Ziomek, P., & Tomoń, N. . (2026). HORMONALLY INDUCED GINGIVAL ENLARGEMENT: FOCUS ON EPULIS - A NARRATIVE REVIEW. International Journal of Innovative Technologies in Social Science, 1(3(51). https://doi.org/10.31435/ijitss.3(51).2026.6189

Most read articles by the same author(s)