1. Epithelial Changes

• Slight to moderate hyperkeratosis

• Thickening of the spinous layer (acanthosis)

2. Connective Tissue

• Fibrosis of underlying tissue

• Marked fibroblastic proliferation

• Increased collagen content

3. Vascular Changes

• Increase in number of capillaries

• Mild vascular proliferation

4. Inflammatory Component

• Slight chronic perivascular inflammation

Depends on:

• Local plaque accumulation

• Oral hygiene status

5. Overall Histologic Pattern

Combination of:

• Drug-induced fibrotic enlargement

• Superimposed inflammatory changes

(when plaque is present)

📌 Key Insight: This explains why gingival enlargement appears more fibrotic in some patients and more inflamed in others, depending on individual hygiene and plaque levels.