Commonly used drugs can lead to gingival changes including hyperplasia overgrowth and gingivitis. Currently, more than 20 prescription medications are associated with gingival enlargement,1 and an estimated 5% of the elderly outpatient population in the united states is taking these medications. The possible potential therapeutic targets for drug induced. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. Gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows. Increase in the size of the gingiva is a common feature of gingival disease. The term gingival overgrowth will be used for the remainder of this chapter. Treatment primarily consists of withdrawing the offending agent whenever possible, in addition to. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin.
Drug induced gingival overgrowth digo statpearls ncbi. Drug induced gingival overgrowth is a side effect associated principally with 3 types of drugs. Medication induced gingival enlargement patients who take certain medications may develop gingival enlargement. The management of drug induced gingival overgrowth dr. Hereditary gingival fibromatosis can occur as an isolated.
Druginduced 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. Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. 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. Appearance of gingival enlargement is clinically and histologically similar in these three drugs. The impact of antiepileptic drugs on the condition of the. Anticonvulsants, calcium channel blockers and immunosuppressants are the most reported medications resulting in gingival enlargement. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Drug induced gingival enlargement is the term now used to describe medicationrelated gingival hypertrophy or hyperplasia, a condition commonly induced by three main classes of drugs.
Medications taken for certain conditions can cause gingival hyperplasia. Druginduced gingival overgrowth digo is a wellrecognized adverse effect of certain systemic medications. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. Phenytoininduced gingival overgrowth management with. Digo is a common clinical problem that often requires intervention. Interdisciplinary approach in the management of medically. A gingival pocket presents when the marginal gingiva experiences an edematous reaction, whether due to localized irritation and subsequent inflammation, systemic issues, or drug induced gingival hyperplasia. To the right is an example caused by the cardiovascular drug nifedipine. Druginduced enlargement is associated with a patients genetic predisposition, and the presence of existing plaque or gingival inflammation. The most common forms of gingival enlargement are induced by systemic drugs, including the antiseizure drug phenytoin, the immunosuppressor cyclosporine, and nifedipine.
Amlodipine, calcium channel blocker, gingival overgrowth, gum hyperplasia. Drug induced gingival enlargement normally begins at the interdental papillae and is more frequently found in the anterior segments of the jaws though it often involves all the surfaces of teeth and is generalized in its distribution. The underlying mechanism behind drug induced gingival enlargement involves inflammatory and non. Learn the shocking truth about uterine fibroids, drugs and surgeries. Calcium channel blocker induced gingival hyperplasia. Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Interdisciplinary approach in the management of medically compromised patient with drug induced gingival enlargement. The management requires a proper understanding of case and a multidisciplinary approach including medical, surgical and supportive care. Druginduced gingival enlargement consists of soft tissue growth that begins between the teeth and increases in all directions. The pathogenesis of drug induced gingival enlargement is uncertain and there appears to be no unifying hypothesis that links together the three commonly implicated drugs. Drug induced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig.
It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants. Fibroblast, collagen, druginduced gingival overgrowth, growth factor, cellular cultures. Phenytoin induced gingival overgrowth is a well known and frequently reported gingival lesion, which was first detected in 1939. Magnification of an existing inflammation initiated by dental plaque 2. 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. It affects the quality of life as well as creates the plaque retentive area in oral cavity which may further enhance the disease progression.
Drug induced gingival overgrowth remains the most widespread unwanted effect. A rare case report of amlodipineinduced gingival enlargement. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque induced gingival inflammation and reduce. Pdf drug induced gingival enlargement researchgate. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and. Druginduced gingival gum overgrowth occurs as a side effect of some systemic medications. Hormones are specificregulatory molecules that modulate a host of body functions. Dilantin is a hydantoin that was introduced by merritt and putnam 68 in 1938 for the treatment of all forms of epilepsy, except petit mal seizures. Mcdonnell, dds, and robert p langlais, ba, dds, ms, san antonio, texas university of texas health science center at san antonio dental school and wilford hall medical center certain aniiconvulsants, cyclosponne, and a variety of calcium channel blockers have been shown to produce clinically and histologically similar gingival. They can be categorized based on their etiopathogenesis, location, size, extent, etc. A closely related term is epulis, denoting a localized.
Jan 17, 2015 gingival overgrowth, gingival hyperplasia, gingival enlargement and gingival hypertrophy are terms that are used interchangeably and incorrectly in the literature. Although few cases of amlodipine induced hyperplasia have been reported, the present case is interesting as it occurred with a low dose of amlodipine 5 mg and. 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. Management of druginduced gingival enlargement australian. The purpose of this article is to report a case of drug induced gingival enlargement due to oral contraceptives, managed by nonsurgical periodontal therapy. Interdisciplinary approach in the management of medically compromised patient with druginduced gingival enlargement. Drug induced gingival enlargement by rajesh hosadurga. There are no specific bacteria or risk factors other than poor plaquebiofilm control associated with these gingival diseases. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. This is a temporary file and hence do not link it from a website, instead link the url of this page if you wish to link the pdf file. Gingival enlargement is the overgrowth of the gingiva characterized by an expansion and accumulation of the connective tissue with occasional presence of increased number of cells. 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. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Gingival enlargement induced by felodipine resolves with a.
His physical appearance was normal and no hormonal abnormalities were observed. Gingival enlargement is a wellknown conscquence ot the administration of some anticonvulsants, immunosuppressants. Drugs associated with ge can be grouped into anticonvulsant drugs phenytoin 3 5, potent immunosuppressants cyclosporin 6 8, and. Accepted current terminology for this condition is gingival enlargement and gingival overgrowth. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Treatment modalities for druginduced gingival enlargement. There were no other significant systemic or medical findings. The coadministration of phenytoin and other antiepileptic drugs, which increases. Histologically, the features of a drug induced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium. Drug induced gingival overgrowth usually occurs within the first 3 months of starting drug therapy at a dose of 10 mgday and begins as an enlargement of the interdental papilla. Druginduced gingival overgrowth usually occurs within the first 3 months of starting the medication and begins as an enlargement of the interdental papilla 3. Drug induced gingival enlargement mainly occurs as a side effect with three main groups of drugs e. Gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics.
Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. December 15, 2006 email to a colleague synonyms and related keywords. Treatment of drug induced gingival enlargement is based on the clinical features. Gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Gingival enlargement is one of the frequent features of gingival diseases. Regardless of the etiology, when gingival hyperplasia occurs, greater than normal the measurement in a prepathological. Druginduced gingival enlargement occurs on intake of three types of drugs.
Drug induced gingival enlargement periodontal disease. Among the drug induced gingival enlargement, phenytoin dilantin gingival enlargement is the earliest and commonly reported. 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. Oral contraceptives that contain estrogen andor progesterone are associated with gingival enlargement. Druginduced gingival enlargement is the term now used to describe medicationrelated gingival hypertrophy or hyperplasia, a condition commonly induced by three main classes of drugs. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Drug induced gingival overgrowth remains the most widespread unwanted effect of systemic medication on the periodontal tissues. Its true incidence in the general population is unknown. On the cellular and molecular mechanisms of druginduced. Drug induced gingival overgrowth is a common complication of the continuous use of medications, such as anticonvulsant phenytoin, antihypertensive calcium channel blockers nifedipine, and immunosuppressant cyclosporinea therapy 1. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Incidence of phenytoin induced gingival overgrowth in epileptic children. Differential diagnosis includes drug induced gingival enlargement. 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.
The overgrowth generally starts as painless enlargement of the papilla and proceeds to include the gingival margin, eventually developing to cover a substantial portion of the crown of the tooth. The three most common classes of medications implicated in drug. Literature is also available on gingival overgrowth secondary to therapy with several drugs like phenobarbitone, primidone, carbamazepine, sodium valproate, mephenytoin,1. Several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Review of literature concerning etiology, pathogenesis and management of antiepileptic drug induced gingival enlargement.
Drug induced gingival enlarge t cell apoptosis free 30. Pathogenesis of phenytoin induced gingival enlargement. Nonsurgical management of nifedipine induced gingival. Drug induced gingival enlargement publish your masters. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. A simple and effective treatment alternative in an. Academy report 1424 a n increasing number of medications are associated with gingival enlargement. Introduction gingival overgrowth is a kind of painless condition, regarded as enormous enlargement. Oral contraceptives induced gingival overgrowth a clinical. Gingival enlargement is an increase in the size of the gingiva gums. No traumatic habit or removable prosthesis was associated with the enlargement, nor was there any extraoral pathology.
Gingival enlargement ge, also known as gingival overgrowth or hyperplasia, has a multifactorial aetiology including inflammation, neoplastic conditions, systemic disorders, and medications. The expression gingival hyperplasia abnormal increase in the number of normal cells in a the drugs mainly associated with go are. Among the calcium channel blockers, n efidipine, a first generation dihydropyridines, has shown the incidence of induced gingival enlargement as. Surgical management of gingival overgrowth pocket dentistry. Shortly thereafter, its relationship with gingival enlargement was reported. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Conservative management of amlodipine induced gingival. Many terms have been used to describe gingival overgrowth go. Gingival overgrowth, gingival hyperplasia, gingival enlargement and gingival hypertrophy are terms that are used interchangeably and incorrectly in the literature. It is thought that fibroblasts are primarily responsible. In addition, fibrotic gingival enlargement has been reported and is believed to be the result of a genetic predisposition for example hereditary or familial gingival enlargement. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. The management requires a proper understanding of case and a multidisciplinary approach including me supportive care.
Nov 30, 2018 cyclosporine induced gingival enlargement is more vascularized than the phenytoin enlargement, occurs in approximately 30% of patients receiving the ding, is more frequent in children, and its magnitude appears to be related more to the plasma concentration than to the patients periodontal status. 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. Drug induced gingival overgrowth anna dongari, dds, ms howard t. In contrast to inflammatory gingival enlargement, the gum tissues in such cases are typically firm, nontender, pale pink in color, and do not bleed easily. Among calcium channel blockers, nifedipine causes gingival hyperplasia in about. Druginduced gingival hyperplasia, druginduced gingival. Treatment of gingival enlargement by dr harshavardhan patwal.
Druginduced gingival enlargement druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. The enlargement can be inflammatory,fibrotic or a combination of both. Drug induced gingival overgrowth is frequently associated with three particular drugs. A study on gingival enlargement and folic acid levels in. It is an unwanted side effect of certain systemic drugs given for nondental treatment. Hereditary, drug induced, and idiopathic gingival overgrowth have been reported. Management of drug induced gingival overgrowth major reenesh m1, colonel sk rath2, lieutnant colonel manish mukherjee3 abstract. To get the facts on exactly how to eliminate your uterine fibroids from the root 100% naturally and permanently and achieve lasting freedom from pcos related symptoms without spending your hardearned money on drugs and over the counters. Gingival overgrowth causes both physical and psychological distress. Phenytoin, a drug used for the management of epilepsy, and other anticonvulsants such as sodium.
Drug induced gingival enlargement, a common adverse drug reaction in patients treated with anticonvulsants, calcium channel blockers and immunosuppressant. Gingival enlargement is a concern to patient both in terms of esthetics and functions. Anticonvulsants, immunosuppressants, and calcium channel blockers. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. Druginduced gingival hyperplasia clinical presentation. The gingival enlargement can be localised around one tooth, but is more. Jun, 2019 hereditary gingival fibromatosis hgf, also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. Hereditary gingival fibromatosis hgf, also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. Gingival enlargement an overview sciencedirect topics. The incidence of cyclosporin induced gingival overgrowth varies between 2550% depending upon drug dosage, plasma concentration, duration of therapy, method of assessing gingival enlargement, underlying periodontal status, age of the patient, medical status and genetic predisposition to be responders or non responders.
580 1390 315 789 1010 529 1236 457 135 1373 659 739 161 1147 423 967 887 1078 849 1278 755 253 312 696 1029 192 1477 101 1108 1108 616 1420 1369 606 1162 1355 1316 677 1085 359