Several mechanisms are involved in the development of gingival overgrowth. These gingival overgrowths are usually treated by various modalities namely substitution of drugs, surgical, and nonsurgical treatment. A nonselective beta blocker propranolol induced gingival hyperplasia is a very rare oral drug reaction. Gingival hyperplasia induced by nifedipine 73 ultrastructural studies5 imply that an in crease in acid mucopolysaccharide pro duction into extracellular space causes the hyperplastic response. 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. As the tissue enlarges it develops a characteristically thickened and lobulated appearance.
Clocheret k, dekeyser c, carels c, willems g 2003 idiopathic gingival hyperplasia and orthodontic treatment. Gingival overgrowth is caused by three categories of drugs. Some medications like phenobarbital may cause gingival hyperplasia in dogs and is very well documented in humans. The hyperplasia is most often associ ated with an inflammatory response2,h. Gingival hyperplasia in dogs symptoms, causes, diagnosis. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. Regardl ess of its cause, gingival enlar gement can cause problems in controlling pl aque, chewing, teething, speech and aesthetics 1. Gingival hyperplasia in a patient with hypertension. The prevalence and severity of druginduced gingival hyperplasia in patients receiving tacrolimus has been shown to be approximately half of the cyclosporine. 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. Gingival enlargement is an increase in the size of the gingiva gums. 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. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement.
Hyperplasia specifically means an increase in the number of cells in the gum tissue. Several conflicting theories have been proposed to. 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. In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a.
Thermal necrosis of gingival ti sue, bone,and teeth can result when these methods are used improperly figure4. Jun 22, 2016 risk factors for drug induced gingival overgrowth differences in the prevalence of the drug induced gingival enlargement suggests that there is a variable gingival response in patients taking these drugs. Gingival enlargements are also seen in several blood dyscrasias e. Phenytoininduced gingival overgrowth management with. 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. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Gingival enlargement an overview sciencedirect topics. Since this short dph plasma halflife in the rat may be related to failure of the drug to induce gingival hyperplasia, further studies utilized skf 525a to inhibit drug metabolism. Many patients medicated with the drugs implicated in. The management of drug induced gingival hyperplasia in. In chronic fibrotic gingival hyperplasia chronic fibrosis which resembles scarring eventually covers the teeth. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally.
Apr 09, 2018 the outlook for the drug induced gingival enlargement is good. Current strategies in clinical practice combine treatments with these. Gingival hyperplasia profile definition gingivalhyperplasiaisdefinedasanenlarge mentofthegingivathatisnoninflammatory, producedbyfactorsotherthanlocalirritation. Drug induced gingival overgrowth has not been reported with any of these drugs. The labial and lingual gingival tissues in the anterior sextants are the most severe involved areas with gingival hyperplasia goi3.
One of the main drugs associated with go is the antiepileptic. 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. The condition though is recurrent but with thorough and meticulous maintenance of the mouth and teeth health through modification of the drug regime, selfcare and dentist care, drug induced gingival enlargement can be successfully treated. Gingival enlargement induced by drugs springerlink. Shortly thereafter, its relationship with gingival enlargement was reported. 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. 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. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Druginduced gingival overgrowth is an adverse drug reaction mainly. A wide range of causes have been attributed to gingival overgrowth. Digo is a common clinical problem that often requires intervention. Drug induced gingival enlargement consists of soft tissue growth that begins between the teeth and increases in all directions. Futhermore, within the group of patients that develop this unwanted.
Several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Rigorous hygienic measures may retard its progress and diminish its extent6,8. Management of druginduced gingival enlargement australian. Drug induced gingival enlargement periodontal disease. These two processes overlap and may be triggered by similar disorders fig. There are several causes of gingival enlargement and they can be grouped into four categories. Inflammatory gingival enlargement, also synonymous with the terms gingival hyperplasia or gingival hypertrophy, can be defined as an abnormal growth of gingival tissues. Calcium channel blockerinduced gingival enlargement. Jan 26, 2016 this feature is not available right now. The reported case is an exemplification of a progressive gingival enlargement caused by a drug induced and complicated by inflammatory changes due to. Brunet l, miranda j, farre m, berini l, mendieta c 1996 gingival enlargement induced by drugs. Here, we present a case of nifedipineinduced gingival enlargement and discuss the reason for the enlargement. Although gingival overgrowth has been traditionally recognised as an adverse effect of.
In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone absorption. Case report untypical amlodipine induced gingival hyperplasia vericapavlic, 1 ninazubovic, 1 sanjailic, 2 andtijanaadamovic 3. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Gingival hyperplasia may be which of the following has the poorest prognosis. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth.
Unfortunately, there are over 20 different drugs that can lead to symptoms. Gingival overgrowth caused by olmesartan medoxomil. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing. Treatment of druginduced gingival overgrowth by fullmouth. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Jun 17, 20 drug induced gingival overgrowth is a common finding in the modern era. December 15, 2006 email to a colleague synonyms and related keywords. View the article pdf and any associated supplements and figures for a period of 48 hours. The best prognosis for new attachment reattachment of periodontal ligament is in a salicylates for postoperative pain can affect coagulation of blood by the most objective measurement of successful scaling and root planing is 1. Gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics.
In acute reactive gingival hyperplasia the gums are red, boggy, and bleed easily with minor trauma. The present case report describes a case of long standing gingival. 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. Treating patients with druginduced gingival overgrowth. Photograph showing gingival hyperplasia of the 15 years boy. Marked gingival hyperplasia induced by nifedipine sciencedirect. Propranololinduced gingival hyperplasia with nager syndrome. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. The enlargement can be inflammatory,fibrotic or a combination of both.
A correlation is found between phenytoin, cyclosporine, and nifedipine therapy and gingival hyperplasia. 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. The possible potential therapeutic targets for drug induced. Studies reveal that drug induced gingival overgrowth. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. The prevalence of druginduced gingival hyperplasia varies according to the type of medication, but the clinical and microscopic appearance of the lesion is similar. Gingival hyperplasia is an enlargement or overgrowth of the gum tissue, also known as the gingiva, around the necks of the teeth. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. In cases of drug induced gingival enlargement, the medication causing the problem should be changed to one that does. 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.
Gingival hyperplasia hypertrophy is a rather common. Gingival hyperplasia and hypertrophy are histologic terms used often to describe the clinical appearance of gingival enlargement. Druginduced gingival overgrowth definition many terms have been used to describe gingival overgrowth. Drug induced gingival hyperplasia is an abnormal enlargement of the gingival tissues, which can occur as a side effect of cyclosporine a, following renal transplantation. However, even after the change in immunosuppressant medication from cyclosporine to tacrolimus, calcium channel blocker may be continued. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue. Gingival hyperplasia, also known as gingival enlargement, is a swelling of the gum tissue gingiva. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin. Clinical report systemic and clinical treatment of. Druginduced gingival hyperplasia clinical presentation. Jul 25, 2011 pathogenesis of phenytoin induced gingival overgrowth. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome.
The management of drug induced gingival hyperplasia in mentally retarded patients with hemophilia. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. The medications that americans take daily, both over the counter and prescription, have a major impact on dental health. Its true incidence in the general population is unknown. Mechanism of cyclosporin ainduced gingival hyperplasia. Amlodipine induced gingival overgrowth, unusual defect and. Regression of nifedipine induced gingival hyperplasia following switch to a same class calcium. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Gingival hyperplasia is a manifestation of overgrown, sometimes inflamed gums surrounding the teeth. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients.
Gingival enlargement can be caused by a number of various stimuli, and. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque induced gingival inflammation and reduce. Druginduced gingival overgrowth remains a significant problem for the periodontologist. Oct 26, 2012 gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. The correlation between phenytoin, cyclosporine, and nifedipine therapy and gingival hyperplasia is discussed, and effective oral hygiene procedures used as preventive measures are evaluated in the context of several clinical studies. Gingival hyperplasia typically refers to the increase in the number of cells, whereas gingival hypertrophy deals with the increase in cell size.
Drug induced overgrowth commonly occurs following medications prescribed for non dental causes. Gingival hyperplasia hypertrophy is a rather common condition. Read on to learn the facts about the condition, what causes it and how it is. Certain drugs in the body fluid might limit the population of plaque bacteria or may alter their metabolism. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. The relationship of 5,5diphenylhydantoin metabolism to. Pdf drug induced gingival enlargement researchgate. Drug induced gingival overgrowth is a side effect associated with 3 types of drugs. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract.
The presence of plaque and gingival inflammation appears to exacerbate go irrespective of the initiating drug. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. 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. Indeed the term responders and nonresponders appears in the literature. The gums may appear swollen or infected, or it may simply look like your gums are overgrowing over your teeth and are their normal color. Unusual clinical presentation of generalised gingival enlargement a report of 3 cases smitha rani thada, vineetha r, keerthilatha m pai.
Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. 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. The american academy of periodontology aap states that gingival overgrowth may be minimized with ap. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Common drug induced gingival o vergrowths there is an ever increasing number of medications which may induce ove r gr o wth of the gi n gi va, although a large range of pat h o l o g ical and idiopat h i c reactions can also result in gingival overgrowth. Essential facts about gingival hyperplasia and how to manage. Severe enlargement of the interdental papillae on a patient taking the immunosuppressant cyclosporine and the calcium channel blocker amlodipine. Gingival enlargement and its treatment authorstream. A rare case report of amlodipineinduced gingival enlargement. Drug related gingival hyperplasia is a cutaneous condition characterized by enlargement of the gums noted during the first year of drug treatment. 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. Prevalence and clinical aspects of druginduced gingival. 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. Gingival enlargement can be induced by three main causes stemming from 1 inflammation, 2 medication, and 3 systemic disease. 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 hyperplasia. The differential diagnosis of gingival hyperplasia includes calcium channel blockers, cyclosporine, familial gingival fibromatosis, gingivitis, leukemia, phenytoin, scurvy, trench mouth, valproic acid. Gingiva hyperplasia an overview sciencedirect topics. Treatment of drug induced gingival enlargement is based on the clinical features. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Drug halflife was found to be significantly shorter 052 hr than reported by other investigators for man 429 hr. Anticonvulsants, calcium channel blockers and immunosuppressants are the most reported medications resulting in gingival enlargement. Drug induced gingival enlargementsignssymptomscauses. Unusual clinical presentation of generalised gingival. Risk factors druginduced gingival overgrowth request pdf. Individualized treatment plan for gingival enlargement. This is a clear documentation of drug induced gingival hyperplasia.
There are very few reports of amlodipine induced gingival enlargement at a dose of 5 mg. The gingival hyperplasia, with its potential aesthetic implication complicated by inflammatory changes due to plaque accumulation, presents an affliction for patients and health professionals. There are scant reports of amlodipine induced gingival hyperplasia, whereas there are several reports of such adverse effect induced by nifedipine,24 a first generation calcium channel blocker. Case report untypical amlodipineinduced gingival hyperplasia. These microscopic distinctions are both indicative of a disease process. This increase in gingival cells has many different causes, but one of the most common is druginduced gingival hyperplasia. Top causes of gingival enlargement and treatment options. 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 patient is kidney transplant and receive immunosuppressive medication cyclosporine for 10 months to prevent transplant rejection.