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. Gingival enlargement induced by drugs springerlink. A heightened gingival response to plaque during pregnancy results in pregnancyassociated gingivitis 14. Pregnancy induced gingival enlargementa case report t. Gingival hyperplasia and hypertrophy are histologic terms used often to describe the clinical appearance of gingival enlargement, an increase in the size or thickness of the gingiva.
The term hyperplasia refers to an increased number of normal cells in a normal arrangement, and hypertrophy describes an increase in the size of. A closely related term is epulis, denoting a localized. Commentary this is a clear documentation of druginduced gingival hyperplasia. The aim of this study was to investigate the role of nickel in orthodontic treatment induced gingival hyperplasia. Gingival enlargement or hypertrophy are the two other terms used to describe the condition. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use.
Gingival hyperplasia may be which of the following has the poorest prognosis. 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. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. Management of druginduced gingival enlargement australian. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. 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. 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 and. Apr 09, 2018 the drug induced gingival enlargement is caused primarily by three classes of drugs. It is more prevalent in male children and adolescents.
Since gingival overgrowth is a druginduced 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. Feb 29, 2016 gingival enlargement ge, also known as gingival overgrowth or hyperplasia, has a multifactorial aetiology including inflammation, neoplastic conditions, systemic disorders, and medications. Essential facts about gingival hyperplasia and how to manage. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Drugs associated with ge can be grouped into anticonvulsant drugs phenytoin 3 5, potent immunosuppressants cyclosporin 6 8, and. Gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. Molecular aspects of druginduced gingival overgrowth. It is an unwanted side effect of certain systemic drugs given for nondental treatment.
Calcium channel blockerinduced gingival hyperplasia is rare and is not welldocumented. Gingival hyperplasia is an enlargement or overgrowth of the gum tissue, also known as the gingiva, around the necks of the teeth. This article has summarized observations and results of controlled laboratory and clinical studies of druginduced gingival hyperplasia associated with phenytoin, cyclosporine, and nifedipine use. Gingival hyperplasia, also known as gingival enlargement, is a swelling of the gum tissue gingiva. The prevalence of drug induced gingival hyperplasia varies according to the type of medication, but the clinical and microscopic appearance of the lesion is similar. Drug induced gingival overgrowth is a side effect associated with 3 types of drugs. Drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally. One such example is when the patients gingival tissues show signs of druginduced 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. The main oral side effect that is induced by amlodipine is gingival overgrowth 11,12. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. The aim of this study was to investigate the role of nickel in orthodontic treatmentinduced gingival hyperplasia. The mean dose of amlodipine reported to cause goia in most of the subjects is 5 mgday. Phenytoininduced gingival overgrowth management with. The patient is kidney transplant and receive immunosuppressive medication cyclosporine for 10 months to prevent transplant rejection. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders.
Because the texture and appearance of the affected gingiva may be irre gular and b ulbous, patients with gingi val overgrowth may require special modif ications in the deli very of dental hygiene. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. However the severity of goia is supposed to be related to the concentration of amlodipine in oral fluids. Gingival hyperplasia will occur due to increase in the connective tissue extracellular matrix. 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. Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. 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. In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a. December 15, 2006 email to a colleague synonyms and related keywords. The term hyperplasia refers to an increased number of normal cells in a normal arrangement, and. It is unclear exactly why some people experience druginduced gingival hyperplasia while others do not. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81.
Unusual clinical presentation of generalised gingival. It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants. The drug induced gingival enlargement is caused primarily by three classes of drugs. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. 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. Drug induced gingival enlargement, a common adverse drug reaction in patients treated with anticonvulsants, calcium channel blockers and immunosuppressant. It is unclear exactly why some people experience drug induced gingival hyperplasia while others do not. One of the main drugs associated with go is the antiepileptic. Druginduced 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. Studies reveal that drug induced gingival overgrowth. Hyperplasia specifically means an increase in the number of cells in the gum tissue. Gingival overgrowth that is induced by amlodipine goia must be stimulated by a threshold concentration of amlodipine. Pregnancy induced gingival enlargementa case report. The prevalence and severity of cyclosporin and nifedipineinduced gingival overgrowth. 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. Aug 12, 2014 a heightened gingival response to plaque during pregnancy results in pregnancyassociated gingivitis 14. Gingival enlargement can be caused by a number of various stimuli, and treatment is based on the underlying cause and pathologic changes. 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. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. 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. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Certain drugs in the body fluid might limit the population of plaque. 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. Anticonvulsants responsible for causing drug induced gingival enlargement. Gingival enlargement ge, also known as gingival overgrowth or hyperplasia, has a multifactorial aetiology including inflammation, neoplastic conditions, systemic disorders, and medications. Drug induced gingival enlargementsignssymptomscauses.
Gingival hyperplasia causes and complications in children. Gingival hyperplasia induced by nifedipine, an arterial vasodilating drug. Anticonvulsants, calcium channel blockers and immunosuppressants are the most reported medications resulting in gingival enlargement. Druginduced gingival overgrowth is a side effect associated with 3 types of drugs. Gingival enlargement an overview sciencedirect topics. Gingival hyperplasia is a manifestation of overgrown, sometimes inflamed gums surrounding the teeth. Ellis js, seymour ra, steele jg, robertson p, butler tj, thomason jm. The management requires a proper understanding of case and a multidisciplinary approach including me supportive care. Gingival hyperplasia associated with nifedipine therapy. Gingival hyperplasia associated with nifedipine letter. Gingival hyperplasia is a disease in which the gum tissues overgrow abnormally. This increase in gingival cells has many different causes, but one of the most common is druginduced gingival hyperplasia. Drugrelated gingival hyperplasia is a cutaneous condition characterized by enlargement of the gums noted during the first year of drug treatment. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases.
Localized gingival enlargement in a 27year old pregnant patient 15. Although gingival overgrowth has been traditionally recognised as an adverse effect of. 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. Gingival enlargement may cause discomfort, interfere with speech or chewing, result in halitosis bad odour to the breath and it may look unsightly. 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 nickel concentration in gingival tissues with and without overgrowth, histopathology of gingival overgrowths, and epithelial cell proliferation response to different nickel concentrations were analysed. The labial and lingual gingival tissues in the anterior sextants are the most severe involved areas with gingival hyperplasia goi3. Gingival enlargement induced by felodipine resolves with a. A rare case report of amlodipineinduced gingival enlargement. The gingival hyperplasia gradually improved over the following several months. Microscopic view of gingival enlargement in pregnant patient showing abundance of blood vessels and interspersed inflammatory cells 16.
Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract. Read on to learn the facts about the condition, what causes it and how it is. Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Gingival hyperplasia associated with the administration of amlodipine to dogs with degenerative valvular disease 20042008. Gingival enlargement is an increase in the size of the gingiva gums. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Druginduced gingival hyperplasia clinical presentation. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use.