Anticonvulsants responsible for causing drug induced gingival enlargement. A classification is proposed, based on the etiology. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Butler rt, kalkwarf kl, kaldahl wb j am dent assoc 1987 jan.
Its true incidence in the general population is unknown. Risk factors for drugs induced gingival overgrowth. Gingival enlargement ge, also known as gingival overgrowth or hyperplasia, has a multifactorial aetiology including inflammation, neoplastic conditions, systemic disorders, and medications. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone absorption. Phenytoininduced gingival overgrowth management with. In early stages, this gingival enlargement is usually located in the area. 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. Gingival enlargement and its treatment authorstream. Gingival hyperplasia may not be avoidable due to genetics, illness or your medications, but by maintaining an aggressive oral health and maintenance regime, seeing your doctor or dentist regularly and inspecting your gums regularly will have an enormous impact. Gingival hyperplasia will occur due to increase in the connective tissue extracellular matrix. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation.
A highly vascular connective tissue occurs histologically with focal accumulation of inflammatory cells, primarily plasma cells. It is unclear exactly why some people experience druginduced gingival hyperplasia while others do not. 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. 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.
Oct 26, 2012 gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. I treatment of druginduced gingival enlargement with er. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Read on to learn the facts about the condition, what causes it and how it is. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Although anticonvulsants, calcium channel blocking agents, and. Picture of oral health problems gingival hyperplasia. Commentary this is a clear documentation of druginduced gingival hyperplasia. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611.
Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. Gingival hyperplasia is found among people who take clonidine, especially for people who are male, 5059 old also take medication aspirin, and have pain. Drug induced gingival hyperplasia can cause functional difficulties, disfigurement and delayed permanent teeth eruption. 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. 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. It is a slowgrowing tumor that is caused as a side effect of certain drugs. Gingival hyperplasia or druginduced gingival overgrowth. Reports about the possible etiological mechanisms of druginduced gingival overgrowth have been suggested 1, 2, 3 such as an imbalance in collagen. Systemic and clinical treatment of gingival hyperplasia. Amlodipineinduced gingival hyperplasia scielo espana. It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants. 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. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Gingival hyperplasia may be which of the following has the poorest prognosis.
December 15, 2006 email to a colleague synonyms and related keywords. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. An increase in size of the gingiva is a common feature of gingival disease. Gingival hyperplasia is an enlargement or overgrowth of the gum tissue, also known as the gingiva, around the necks of the teeth. Essential facts about gingival hyperplasia and how to manage.
Introduction gingival enlargement or gingival overgrowth are the current terms for all medicationrelated gingival lesions, previously known as gingival hyperplasia or gingival. The gingival hyperplasia gradually improved over the following several months. Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Management of drug induced gingival enlargement aust prescr 2003.
The labial and lingual gingival tissues in the anterior sextants are the most severe involved areas with gingival hyperplasia goi3. Drug induced gingival enlargementsignssymptomscauses. Drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Gingival enlargement induced by drugs springerlink. Essential facts about gingival hyperplasia and how to. Medically induced gingival hyperplasia or gingival overgrowth is a reactionary phenomenon that occurs because of several types of therapeutic agents. Gingival enlargement induced by felodipine resolves with a. 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.
Gingival hyperplasia causes and complications in children. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. It is more prevalent in male children and adolescents. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Gingival enlargement is one of the frequent features of gingival diseases. First documented in dental literature in 1939 as a side effect of phenytoin, this condition starts with a mild swelling or enlargement that, if left untreated, progresses rapidly. Amlodipine induced side effects are headache, dizziness, edema, flushing, palpitations, and rarely gingival hyperplasia. Druginduced gingival fibromatosis is a common benign condition of the gums.
Digo may be caused by a variety of conditions or prescribed medications andor. Gingival hyperplasia refers to the pathological growth of excess or redundant gingival tissue as a result of an increase in the number of cells. 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. Such gingival enlargement can be exaggerated by hormonal effects, as found in puberty and. Gingival enlargement can be caused by a number of various stimuli, and treatment is based on the underlying cause and pathologic changes. Picture of gingival hyperplasia from phenytoin gingival hyperplasia from phenytoin is a condition that causes overgrowth of gum tissue. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. Preexisting gingival inflammation induced by dental plaque seems to be a favorable.
Jul 19, 2017 druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. The patient is kidney transplant and receive immunosuppressive medication cyclosporine for 10 months to prevent transplant rejection. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. Druginduced gingival overgrowth is a wellestablished adverse event. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. The drug induced gingival enlargement is caused primarily by three classes of drugs. The accepted current terms for this condition are gingival enlargement and gingival overgrowth. Surgical management of druginduced gingival overgrowth digo. Department of oral and maxillofacial surgery, county hospital, slageise, and epilepsy hospital, dianalund denmark.
There are some risk factors that appear to contribute to the likelihood of this condition. This disorder has been recognized since 1939, 1 shortly after the introduction of phenytoin 2 for the control of epileptic seizures. It is unclear exactly why some people experience drug induced gingival hyperplasia while others do not. 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. Certain drugs in the body fluid might limit the population of plaque. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. 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. A rare case report of amlodipineinduced gingival enlargement. International journal of contemporary medicine surgery and radiology.
In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a. Picture of oral health problems gingival hyperplasia from. Drugs associated with ge can be grouped into anticonvulsant drugs phenytoin 3 5, potent immunosuppressants cyclosporin 6 8, and. Medically induced gingival hyperplasia sciencedirect. Management of druginduced gingival enlargement australian.
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. In most cases, alternative drugs are given, in order to avoid this side. The tissue overgrowth is made up predominantly of collagen, and may therefore be a useful model for analysis of fibrosis and some other connective tissue abnormalities. The presence of plaque and gingival inflammation appears to exacerbate go irrespective of the initiating drug. 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. 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 an overview sciencedirect topics. This article has summarized observations and results of controlled laboratory and clinical studies of druginduced gingival hyperplasia associated with phenytoin, cyclosporine, and nifedipine use. Although gingival overgrowth has been traditionally recognised as an adverse effect of. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. The mechanism by which this medication causes this side effect is unknown, the gum tissue overgrowth occurs in almost everyone who takes phenytoin. Studies reveal that drug induced gingival overgrowth. Gingival hyperplasia hypertrophy is a rather common. Gingival hyperplasia is a condition when the gum tissue becomes enlarged and gingival cells increase in number.
Introduction gingival enlargement or gingival overgrowth are the current terms for all medicationrelated gingival lesions, previously known as. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Apr 09, 2018 the drug induced gingival enlargement is caused primarily by three classes of drugs. The term gingival hyperplasia is inappropriate because enlargement does not result from an increase in the number of cells but rather an increase in extracellular tissue volume.
Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. These are strictly clinical descriptive terms, and they avoid the erroneous pathologic connotations of terms used in the past, such as hypertrophic gingivitis and gingival hyperplasia. On the cellular and molecular mechanisms of druginduced. By contrast, gingival overgrowth refers to an increase in gingival volume due to an excessive accumulation of extracellular matrix proteins. There is acanthosis of the epithelium and deep ep treatment of druginduced gingival enlargement with er.
Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Background drug induced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Amlodipineinduced gingival hyperplasia in chronic renal failure. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone. Calcium channel blockerinduced gingival hyperplasia is rare and is not welldocumented. Druginduced gingival overgrowth, 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 for the treatment of seizures 2, 3, 4 this gingival overgrowth has also been reported in the adult. Drugrelated gingival hyperplasia is a cutaneous condition characterized by enlargement of the gums noted during the first year of drug treatment. 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. Druginduced gingival hyperplasia clinical presentation. Apr 10, 2015 gingival hyperplasia will occur due to increase in the connective tissue extracellular matrix. One of the main drugs associated with go is the antiepileptic.
Several conflicting theories have been proposed to. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. Various degrees of gingival overgrowth may occur in individuals taking diphenylhydantoin, a drug used widely in the treatment of epilepsy. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally. This study is created by ehealthme based on reports of 46,204 people who have side effects when taking clonidine from the food and drug administration fda, and is updated regularly. Most commonly, gingival overgrowth is a plaqueinduced inflammatory process, which can be modified by systemic disease or medications. Management of druginduced gingival enlargement aust prescr 2003. Drug induced gingival overgrowth, 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 for the treatment of seizures 2, 3, 4 this gingival overgrowth has also been reported in the adult. Druginduced gingival hyperplasia is a serious concern both for the patient and the clinician.
It is an unwanted side effect of certain systemic drugs given for nondental treatment. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. 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. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of.
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