Puberty-Associated Gingival Enlargement Exacerbated by Polycystic Ovary Syndrome: A Case Report.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting reproductive-aged women, characterised by metabolic abnormalities, polycystic ovaries, hyperandrogenism, and chronic anovulation. This pathology has been attributed to hormonal imbalances, including elevated levels of insulin, growth hormone (GH), ghrelin, LEAP-2, GnRH, LH/FSH ratio (>2:1), androgenic hormones, and estrogen. While puberty-associated gingival enlargement is primarily triggered by dental plaque, systemic hormonal fluctuations can significantly exacerbate the tissue response.

Case presentation: A 17-year-old female presented with spontaneous gingival bleeding and generalized gingival overgrowth persisting for one year. Clinical examination revealed fair oral hygiene and extensive inflammatory swelling of the marginal, interdental, and attached gingiva with bleeding upon probing, but no evident bone loss. Medical evaluation confirmed PCOS based on irregular menses, weight gain, acne, elevated serum testosterone, an increased LH/FSH ratio, hyperinsulinemia, and polycystic ovarian morphology. Initial management consisted of non-surgical periodontal therapy, including scaling, root planing, and oral hygiene instructions combined with gynaecological care for PCOS, which successfully reduced acute inflammation. Residual fibrotic enlargement was subsequently treated via surgical gingivectomy and gingivoplasty. Postoperative healing was uneventful, yielding satisfactory functional, aesthetic, and periodontal outcomes.

Conclusions: This case highlights that PCOS may contribute to or exacerbate gingival enlargement through hormonal and inflammatory alterations rather than being a direct etiological factor. Early interdisciplinary diagnosis and co-management between dental and medical professionals are crucial for optimizing both periodontal and systemic health outcomes in adolescent patients.