This uncommon condition is characterized by extensive and often severe gingival hyperplasia. Gingival enlargement may precede or follow tooth eruption and teeth in the affected areas are sometimes completely covered by firm, pale gingiva (Figure 4.1). Occasionally there is a familial history and the condition may be associated with hypertrichosis, coarse, thickened tissues and other abnormalities1, 2. Microscopy shows coarse bundles of sparsely cellular collagen, often with areas of myxomatous change (Figures 4.2 and 4.3). Inflammatory infiltration is usually minimal. The covering epithelium shows mild acanthosis, and mild keratosis may also be seen.