Molecular and clinical aspects of druginduced gingival overgrowth. It is an unwanted side effect of certain systemic drugs given for nondental treatment. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Learn the shocking truth about uterine fibroids, drugs and surgeries. In most cases, the enlargement results because of local irritations. Nonsurgical management of amlodipine induced gingival. The possible potential therapeutic targets for drug induced.
Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. Gingival hyperplasia hypertrophy is a rather common. Gingival enlargement also known as gingival hyperplasia, gingival hypertrophy, gingival overgrowth, hypertrophic gingivitis which is caused with the increase in the size of gingiva is called as gingival enlargement. Case report drug substitution and nonsurgical therapy in. Druginduced gingival overgrowth is an adverse drug reaction mainly described with three. Severe enlargement of the interdental papillae on a patient taking the immunosuppressant cyclosporine and the calcium channel blocker amlodipine. Treatment of druginduced gingival enlargement is based on the clinical features. It occurs as a side effect following the administration of drugs. The first of these cases was additionally diabetic and also gave a history of angina 3 years back. Phenytoininduced gingival overgrowth management with.
Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Druginduced gingival gum overgrowth occurs as a side effect of some systemic medications. Gingival enlargement in these patients is not due to increase in the number of periodontal cells but due to an increase in. Cyclosporineinduced gingival hyperplasia in 28 yearold male renal transplanted patient disscusion cyclosorin a csa is a powerful immunosuprssant widely used for prevention of transplant rejection as well as for management of a number of autoimmune conditions such as rheumatoid arthritis 7 cya is usually administered orally. Cyclosporin is an immunosuppressant which has been reported to cause gingival.
Reports about the possible etiological mechanisms of druginduced gingival overgrowth have been suggested 1, 2, 3 such as an imbalance in collagen. Gingival enlargement is a wellknown conscquence ot the administration of some anticonvulsants, immunosuppressants. The mechanism through which these medications trigger a connective tissue response are still poorly understood. This report describes two rare cases of extreme medicationinduced gingival enlargement leading to a loss of dentition. The drug induced gingival enlargement is caused primarily by three classes of drugs. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. Drug induced gingival enlargement periodontal disease. Received 19 march 2007, revised manuscript accepted 30 october 2007. Case report gingival enlargement induced by felodipine resolves with a conventional periodontal treatment and drug modification nabilkhzam, 1 davidbailey, 1 helens. Hereditary gingival fibromatosisis a rare 1 in 750,000 hereditary condition characterized by. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and.
Periodontitis and the medicationrelated ge exacerbated and accelerated one another and resulted in extensive loss of dentition, severely affecting function and esthetics. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. Gingival enlargement classificationdental health tips. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. 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 management requires a proper understanding of case and a multidisciplinary approach including me supportive care. This patient had been prescribed various drugs due to the prevailing cardiac condition. The incidence rate of phenytoininduced gingival overgrowth ranges from 3% to 93%, but 50% of patients on longterm therapy are prone to develop gingival overgrowth. Know the causes, signs, symptoms, treatment, prognosis and epidemiology of drug induced gingival enlargement. Management of amlodipineinduced gingival enlargement. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaqueinduced gingival inflammation and reduce. Gingival enlargement induced by drugs springerlink. Other factors related to this condition are hereditary, malignancies and those resulting from adverse effects associated with systemic administration of certain drugs.
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. This condition is also known as gingival overgrowth, hypertrophic gingivitis or gingival hypertrophy. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Druginduced gingival enlargement druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Drugs like phenobarbital, cyclosporine, phenytoin, nifedipine, valproate, tacrolimus, verapamil, and amlodipine are the anticonvulsants that are known to cause gingival overgrowth by hampering the fibroblast functions. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Drug induced gingival enlargementsignssymptomscauses.
Druginduced gingival overgrowth is frequently associated with three particular drugs. Treatment of gingival enlargement pocket dentistry. Healthy gums are pale pink or pigmented, and wrap tightly around the neck of the teeth. Since inflammation is the prerequisite for gingival overgrowth, mast cells and its protease enzymes. Case report a 18 year old male patient reported to the dept of oral. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Gingival hyperplasia is a medical condition in which the gums increase in size. 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. Gingival enlargement and its treatment authorstream. Gingival enlargement is an unwanted adverse effect of some drugs such. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue, which increase in volume and gingival hypertrophy enlargement or overgrowth of an organ or part.
Gingival enlargement associated with nifedipine was first reported in 1980s and is very rarely reported to be associated with amlodipine and felodipine. Gingival enlargement an overview sciencedirect topics. This druginduced overgrowth is noticed initially in the papillary region and during the course of the process involves the margins and the gingival attachment. There are several causes of gingival enlargement and they can be grouped into four categories. The treatment of gingival enlargement is based on an understanding of the cause and underlying pathologic changes of this condition see chapter 16. Article information, pdf download for the management of druginfluenced gingival. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Clinical photos, management and histologic findings are presented. Gingival hyperplasia or druginduced gingival overgrowth. Anticonvulsants responsible for causing drug induced gingival enlargement. Gingival diseases modified by medications classification of gingival diseases is a significant part of an intraoral examination.
Gingival enlargement is one of the frequent features of gingival diseases. Severe druginduced gingival enlargement and periodontitis. Histologically, the features of a druginduced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium. Conclusion inspite of a myriad of etiology, gingival enlargements can often be diagnosed by a careful history e.
Introductiondruginfluenced gingival enlargement dige is a. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Although gingival overgrowth has been traditionally recognised as an adverse effect of. Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Drug induced gingival enlargement, a common adverse drug reaction in patients treated with anticonvulsants, calcium channel blockers and immunosuppressant.
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 the overgrowth of the gingiva characterized by an expansion and accumulation of the connective tissue with occasional presence of increased number of cells. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Druginduced gingival hyperplasia clinical presentation.
Gingival enlargement or gingival overgrowth go is one of the most important clinical features of gingival pathology. 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. Management of druginduced gingival enlargement australian. Druginduced 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. Case report gingival enlargement induced by felodipine. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Anticonvulsants, calcium channel blockers and immunosuppressants are the most reported medications resulting in gingival enlargement. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. There are several types available, which will be discussed further down but two of the most important ones are the one induced by. Digo is a common clinical problem that often requires intervention. Nonsurgical management of nifedipine induced gingival.
Gingival enlargement is an increase in the size of the gingiva gums. Chairman of our department treated her previously for same lesion in 2008. Gingival enlargements are quite common and may be either inflammatory, non inflammatory or a combination of both. This type of gingival enlargement is sometimes termed drug induced gingival. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement.
Gingival hyperplasia treatment, symptoms, causes, pictures. Gingival overgrowth is caused by three categories of drugs. Druginduced gingival enlargement occurs on intake of three types of drugs. Incidence of amlodipineinduced gingival overgrowth in the rural population of loni.
Archives of orofacial sciences 2007 2, 6164 61 case report amlodipineinduced gingival overgrowth. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Management of drug induced gingival overgrowth major reenesh m1, colonel sk rath2, lieutnant colonel manish mukherjee3 abstract. Surgical management of druginduced gingival overgrowth digo. Antihypertensive drugs in the calcium channel blocker group are extensively used in elderly patients. The role of nickel accumulation and epithelial cell proliferation in orthodontic treatmentinduced gingival overgrowth. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. Gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. As the condition progresses, the marginal and papillary. Many terms have been used to describe gingival overgrowth go. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders.
Gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics. Treating patients with druginduced gingival overgrowth. Amlodepine induced gingival enlargement presentation of. Anticonvulsants, immunosuppressants, and calcium channel blockers. Most likely, this may be related to the age of the population, the nature of the disease, and poor oral hygiene. Some of the variation in incidence of gingival enlargement can be attributed to differences between study populations and.
Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Current strategies in clinical practice combine treatments with these inhibitors and receptor. Phenytoin induced gingival enlargement affects at least 4050% of patients who use the drug for longer than 3months. Gingival overgrowth causes both physical and psychological distress. Its true incidence in the general population is unknown. It was also proved that increased drug dosage showed increased gingival enlargement, so the physician can consider altering the dose of nifedipine or combine it. 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. Druginduced gingival hyperplasia, druginduced gingival. Many terms have been used to describe gingival overgrowth. In contrast to the inflammatory gingival enlargement, the drug induced gingival enlargement occurs when the patient consumes specific drugs. Gingival enlargements are of special concern to the patient and the dentist because they pose problems that involve plaque control, function including mastication, tooth eruption, and speech, and aesthetics.
1363 577 717 214 1429 1570 472 1445 1536 75 317 95 1029 599 871 456 432 840 37 1635 2 1009 277 656 1166 688 716 1022 265 295 449