Top causes of gingival enlargement and treatment options. Pdf gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics find, read and. The american academy of periodontology aap states that gingival overgrowth may be minimized with ap. Management of phenytoin induced gingival overgrowth. If the enlargement of the gingiva is caused by systemic condition, the underlying cause should be treated. Laser treatment of the enlarged gingival tissues is similar to the technique described above figures 6a, 6b and 6c. Druginduced gingival hyperplasia is an abnormal enlargement of the gingival tissues, which can occur as a side effect of cyclosporine a, following renal transplantation.
Definition gingival hyperplasia is defined as an enlargement of the gingiva that is noninflammatory, produced by factors other than local irritation, and the result of an increased number of cells. The mechanism behind drug induced gingival hyperplasia involves inflammatory and noninflammatory pathways figure 8. Druginduced enlargement is associated with a patients genetic. Gingival overgrowth go, also known as gingival hyperplasia secondary to drugs, was first reported in the dental literature in the early 1960s in institutionalized epileptic children who were receiving therapy with phenytoin dilantin. Molecular and clinical aspects of druginduced gingival overgrowth. Perio board questions for final flashcards quizlet.
Phenytoin, a drug used for the management of epilepsy, and other anticonvulsants such as sodium. A wide range of causes have been attributed to gingival overgrowth. Druginduced gingival overgrowth definition many terms have been used to describe gingival overgrowth. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. Atsushi niimi had reported that the concentration of cyclosporin a was much higher in dental plaque than in blood and other tissues 5. These microscopic distinctions are both indicative of a disease process. The three pharmaceutical agents that most commonly have an effect on gingival fibroblast proliferation are phenytoin dilantin. Many terms have been used to describe gingival overgrowth go. Drug induced gingival enlargement drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Hyperplasia specifically means an increase in the number of cells in the gum tissue. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use.
Jan 14, 2014 silverstain et al 1995 nifidepine induced gingival enlargements has been reported around dental implants yoon angela et al in 2006 myeloid sarcoma occurring concurrently with drug induced gingival enlargement frederic duffau in 2007 gingival enlargement originating from medication and tooth migration 48. Drug induced overgrowth commonly occurs following medications prescribed for non dental causes. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Patients diagnosed with early to moderate gingival overgrowth with stable allograft function were included in the study. Drug induced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction adr in patients treated with anticonvulsants, immunosuppressants, and. Since gingival overgrowth is a druginduced increase in extracellular matrix proteins, the treatment is based on discontinuing the offending medication if at. This paper presents a case of pigo hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. This case report documents a case of gingival enlargement associated with periodontitis in a patient under pheytoin sodium for the past 15 years, along with brief. Pdf gingival enlargement is an increase in the size or inflammation of the gingiva. Gingival hyperplasia is a common disorder associated with phenytoin and cyclosporine therapy. Gingiva hyperplasia an overview sciencedirect topics. Gingival hyperplasia is a disease in which the gum tissues overgrow abnormally.
Amlodipine induced gingival overgrowth, unusual defect and. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Gingival overgrowth, hypertrophic gingivitis, gingival. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. The gingival hyperplasia, with its potential aesthetic implication complicated by inflammatory changes due to plaque accumulation, presents an affliction for patients and health professionals. Calcium channel blockerinduced gingival hyperplasia. Gingival enlargement can be induced by three main causes stemming from 1 inflammation, 2 medication, and 3 systemic disease. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract. Recognition and treatment of amlodipine norvasc induced.
Gingival enlargement is an increase in the size of the gingiva gums. Gingival enlargement usually develops in a susceptible individual within a few months of starting the medication. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Azithromycin nayer aboelsaad1, una elshinnawi adel bakr. In such cases, overgrown gums may need to be surgically removed. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone absorption. Since gingival overgrowth is a drug induced increase in extracellular matrix proteins, the treatment is based on discontinuing the offending medication if at preop view of the maxilla of a fiveyearold wheaton terrier with generalized idiopathic gingival hyperplasia. Several conflicting theories have been proposed to. Brunet l, miranda j, farre m, berini l, mendieta c 1996 gingival enlargement induced by drugs. The prevalence of druginduced gingival hyperplasia varies according to the type of medication, but the clinical and microscopic appearance of the lesion is similar. Silverstain et al 1995 nifidepine induced gingival enlargements has been reported around dental implants yoon angela et al in 2006 myeloid sarcoma occurring concurrently with drug induced gingival enlargement frederic duffau in 2007 gingival enlargement originating from medication and tooth migration 48. This is a clear documentation of drug induced gingival hyperplasia.
Druginduced gingival overgrowth is a tissuespecific condition and is. Druginduced gingival hyperplasia digh is an iat rogenic dental disorder that is characterized by gums that are enlarged and inflamed, and bleed readily upon prob ing. Gingival overgrowth, also known as gingival hyperplasia, has been well described in the literature. However, induction of this condition by calcium channel. Although the mechanism of drug related gingival hyperplasia is not well understood, some risk factors for the condition include the duration of drug use and poor oral hygiene. Drug induced gingival hyperplasia but if we can use its effects on gingiva through local application initiatively, it will bring us enormous benefits. This increase in gingival cells has many different causes, but one of the most common is druginduced gingival hyperplasia. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Phenytoin and cyclosporine a specifically regulate macrophage phenotype and expression of plateletderived growth factor and interleukin1 in vitro and in vivo. Gingival overgrowth is caused by three categories of drugs. There are several drugs that have been associated with gingival overgrowth the increase in matrix protein form of enlargement including phenytoin derivatives, calcium channel blockers and cyclosporine. The most recognized cause is drug induced gingival enlargement from phenytoin dilantin, which is commonly used to treat patients with epileptic seizures. Gingival hyperplasia is an enlargement or overgrowth of the gum tissue, also known as the gingiva, around the necks of the teeth.
Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Those drugs whose pharmacodynamics are clearly established and which affect the rate of periodontal disease activity, may provide information on the mechanisms of periodontal destruction. Pdf drug induced gingival enlargement researchgate. As gingival enlargement develops, it affects the normal oral hygiene. Phenytoin, a drug used for the management of epilepsy. A furosemide b digoxin c cyclosporin d nifedipine e lidocaine. Drug induced gingival enlargement periodontal disease. Amlodipine with or without acei is the most commonly used antihypertensive medication in dogs and cats due to safety and efficacy. Although ciclosporininduced gingival overgrowth lesions exhibit principally the presence of inflammation and little fibrosis, nifedipine and especially phenytoin. Brief reports calcium channel blockerinduced gingival. Gingival enlargement an overview sciencedirect topics. Introduction gingival overgrowth may have multiple causes, however drugs assumption is the most common 1,2.
Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Patients will not develop drug induced gingival hyperplasia simply because they do not brush their teeth, but poor oral health in general does play a role in both the frequency and severity of this condition. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone. Druginduced gingival hyperplasia clinical presentation. Clinical report systemic and clinical treatment of. Which of the following heart medications can cause gingival hyperplasia. Drug related gingival hyperplasia is a cutaneous condition characterized by enlargement of the gums noted during the first year of drug treatment. Drugs and the periodontium seymour 1988 journal of. Dec 25, 2011 drug induced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction adr in patients treated with anticonvulsants, immunosuppressants, and calcium channel blockers. Gingival hyperplasia in a patient with hypertension. Unusual clinical presentation of generalised gingival enlargement a report of 3 cases smitha rani thada, vineetha r, keerthilatha m pai. On the cellular and molecular mechanisms of druginduced. Gingival enlargement is the overgrowth of the gingiva characterized by an expansion and accumulation of the connective tissue with occasional presence of increased.
Dilantin is a hydantoin, introduced by merrill and putnam80 in 1938 lor the treatment of all forms of epilepsy, except petit mal shortly thereafter, its relationship with gingival. Management of druginduced gingival enlargement australian. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Druginduced gingival hyperplasia, druginduced gingival. Gingival hyperplasia is something that should be corrected as soon as you notice it. Surgical treatment is often the most reliable option and scalpel gingivectomy remains the treatment of choice, but the apically displaced flap may be more suitable surgical approach to the treatment of drug induced gingival enlargement. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Jul 19, 2017 drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Drug induced gingival enlargement consists of soft tissue growth that begins between the teeth and increases in all directions. In cases of drug induced gingival enlargement, the medication causing the problem should be changed to one that does not induce gingival enlargement. In addiction, drug induced gingival overgrowth may be associated with a patients. The enlargement can be inflammatory,fibrotic or a combination of both.
The gums appear lobulated from papillary enlarge ment, and the tooth crowns may be partially covered by hyperplastic tissue. As the tissue enlarges it develops a characteristically thickened and lobulated appearance. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Gingival hyperplasia hypertrophy is a rather common. It occurs as a side effect following the administration of drugs. Table 2 grading systems for severity of phenytoin induced gingival overgrowth angelopoulos and goaz 3 modified ziskin 57 addys modification of harris and evalt rating 58 grade definition grade definition grade definition 0 no hyperplasia, normal gingiva 0 no changes a. Unusual clinical presentation of generalised gingival.
The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue. Treatment of druginduced gingival overgrowth by fullmouth disinfection. Gingival hyperplasia typically refers to the increase in the number of cells, whereas gingival hypertrophy deals with the increase in cell size. This article has summarized observations and results of controlled laboratory and clinical studies of drug induced gingival hyperplasia associated with phenytoin, cyclosporine, and nifedipine use. Rather than getting gingival recession, they get hyperplasia. Gingival hyperplasia or gingival enlargement, the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases.
Clocheret k, dekeyser c, carels c, willems g 2003 idiopathic gingival hyperplasia and orthodontic treatment. A generalized increase in the fibrous component of the gingiva in patients who have been taking longterm doses of phenytoin, cyclosporine, and nifedipine. Unfortunately, there are over 20 different drugs that can lead to symptoms. No hyperplasia 1 hyperplastic gingiva covering the cervical third or. It is an increase in the size of the gingival tissues and thus the term overgrowth is many times used in place of the term hyperplasia. Drug induced gingival overgrowth is frequently associated with three particular drugs. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Gingival hyperplasia, also known as gingival enlargement, is a swelling of the gum tissue gingiva. A rare case report of amlodipineinduced gingival enlargement. Among calcium channel blockers, nifedipine causes gingival hyperplasia in about 10% of patients, whereas the incidence of amlodipine, a third generation calcium channel blocker, induced gingival hyperplasia is very limited. The presence of plaque and gingival inflammation appears to exacerbate go irrespective of the initiating drug. Pdf download for molecular and clinical aspects of druginduced. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Druginduced gingival overgrowth digo, also referred to as druginduced. Drug induced gingival overgrowth digo statpearls ncbi.
The differential diagnosis of gingival hyperplasia includes calcium channel blockers, cyclosporine, familial gingival fibromatosis, gingivitis, leukemia, phenytoin, scurvy, trench mouth, valproic acid. These patients had been taking either cyclosporine or tacrolimus for more than 6. Drug induced gingival hyperplasia was reclassified in 1999 by app as a dental plaque induced gingival disease. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. The reported case is an exemplification of a progressive gingival enlargement caused by a drug induced and complicated by inflammatory changes due to. Druginduced gingival gum overgrowth occurs as a side effect of some systemic medications.
Severe enlargement of the interdental papillae on a patient taking the immunosuppressant cyclosporine and the calcium channel blocker amlodipine. Those changes were defined as gingival hyperplasia or gingival hypertrophy, but today the widelyspread term, which refers to all types of druginduced lesions is gingival overgrowth. It occurs as a side effect following the administration of drugs used mainly for nondental treatments and thus, the overgrowth cannot be explained as a variation of the intended pharmacological action of the drug. As such, and because of few equivalent alternatives, the occurrence of gingival hyperplasia will not preclude the use of amlodipine. There are very few reports of amlodipine induced gingival enlargement at a dose of 5 mg. Gingival enlargement or hypertrophy are the two other terms used to describe the condition.
Phenytoininduced gingival overgrowth management with. Molecular aspects of druginduced gingival overgrowth. December 15, 2006 email to a colleague synonyms and related keywords. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin.
Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. This is strictly a clinical description of the condition and avoids the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival. For drug induced gingival hyperplasia, the doctor will change the drug so as to significantly reduce the risk of gingival hyperplasia. Gingival hyperplasia hypertrophy is a rather common condition. This case reports unusual defects of amlodipine induced gingival overgrowth, with a large gingival mass that almost completely disappeared only after. Individualized treatment plan for gingival enlargement. Drug induced gingival hyperplasia is a welldocu mented and widely recognized side effect of longterm phenytoin therapy. His current mediations include cyclosporine 125 mg bid and amlodipine 5 mg qd as well as cellcept, aspirin, and allopurinol for gout. Aug 12, 2014 these are strictly clinical descriptive terms and to avoid the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival hyperplasia. Regression of nifedipine induced gingival hyperplasia following switch to a same class calcium. Jan 26, 2016 this feature is not available right now. Certain drugs in the body fluid might limit the population of plaque bacteria or may alter their metabolism. The expression gingival hyperplasia abnormal increase in the number of normal cells in a the drugs mainly associated with go are. Treating patients with druginduced gingival overgrowth.