She had no significant family history, medical history, and denied of taking any medication, which could have induced gingival enlargement. The paper presents such few cases and reviews how much a same hormone at different age and stage shows an exaggerated gingival response to plaque.Ī 15-year-old girl reported to the Department of Periodontics with a complain of swollen gums, which initiated 2 years back and gradually progressed to the extent that it caused difficulty in mastication and speech. As a result to these effects, an exaggerated inflammatory response of periodontal tissues may be seen during puberty, pregnancy and at the postmenopausal stage with the variation in the level of sex steroid hormone at different lifetimes. Estrogen and progesterone also has effect on the microcirculatory system, producing the following changes: Swelling of endothelial cells and periocytes of the venules, adherence of granulocytes and platelets to vessel walls, formation of microthrombi, disruption of perivascular mast cells, enhanced vascular permeability and vascular proliferation. Progesterone, in particular, has been shown to stimulate the production of the inflammatory mediator, prostaglandin E2 and enhance the accumulation of polymorphonuclear leukocytes in the gingival sulcus and down regulates interleukin 6 production by human gingival fibroblasts.

These hormones may alter immunologic factors and responses, including antigen expression and presentation, cytokine production as well as the expression of apoptotic factors and cell death.

The action of the hormones on these cells changes the effectiveness of the epithelial barrier to bacterial insult and collagen maintenance and repair. Estrogen can influence the cytodifferentiation of stratified squamous epithelium as well as the synthesis and maintenance of fibrous collagen. Sex steroid hormones directly and indirectly exert influences on cellular proliferation, differentiation and growth in target tissues. These changes not only affect other parts of the body, but also have significant influence on oral tissues as the receptors for estrogen and progesterone have been demonstrated in the gingiva, on the periosteal fibers, scattered fibroblasts of the lamina propria and also on periodontal ligament fibroblasts and osteoblasts proving the direct action of sex hormones on periodontal tissues. The variation in the level of female sex hormones estrogen and progesterone are responsible for various physiological changes in females at specific phases of their life.

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