The drug induced gingival enlargement is caused primarily by three classes of drugs. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Druginduced gingival overgrowth gingival overgrowth is a welldocumented and unwanted side effect, associated principally with the calcium channel blockers, phenytoin and ciclosporin table 31. Routine blood test came within the normal limit and no bony changes were seen in opg. Pdf druginduced gingival overgrowth is a common finding in the modern era. Aspects of druginduced gingival enlargement prevalence the prevalence of gingival overgrowth varies with drugs. Druginduced 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.
Gingival hyperplasia or druginduced gingival overgrowth. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. Anticonvulsants, immunosuppressants, and calcium channel blockers. Gingival enlargement is a multifactorial condition characterised by abnormal increase in size of the gingiva. Drug induced gingival enlargement periodontal disease. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Jan 17, 2015 drug induced gingival overgrowth gingival overgrowth is a welldocumented and unwanted side effect, associated principally with the calcium channel blockers, phenytoin and ciclosporin table 31. 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. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Management of druginduced gingival enlargement australian. Propranololinduced gingival hyperplasia with nager syndrome.
Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. The possible potential therapeutic targets for drug induced. Nonsurgical management of nifedipine induced gingival. Druginduced enlargement is associated with a patients genetic predisposition. Drug induced gingival enlarge free download as powerpoint presentation. Druginduced gingival overgrowth anna dongari, dds, ms howard t. Its true incidence in the general population is unknown. On the cellular and molecular mechanisms of druginduced. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Anticonvulsants responsible for causing drug induced gingival enlargement.
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. Drug induced gingival overgrowth digo abstract europe pmc. Druginduced gingival overgrowth is an adverse drug reaction mainly described with three. Academy report 1424 a n increasing number of medications are associated with gingival enlargement. 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. Gingival swelling is pink, firm and lobulated especially in cyclosporine induced gingival enlargement. A 45 year old male is presented with severe drug induced gingival enlargement, moderate bone loss and reduced dentition. I treatment of druginduced gingival enlargement with er. Drug induced gingival enlargement intelligent dental. The management of drug induced gingival overgrowth dr. Gingival enlargement may also lead to bleeding and foul odour from the oral cavity.
Medicationinduced gingival enlargement patients who take certain medications may develop gingival enlargement. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. Often affect the gingival on the labial front surface of the anterior teeth. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Commonly used drugs can lead to gingival changes including hyperplasia overgrowth and gingivitis. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. 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. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin. Drug induced gingival enlargement occurs on intake of three types of drugs. Histologically, the features of a druginduced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy.
A nonselective beta blocker propranololinduced gingival hyperplasia is a very rare oral drug reaction. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. 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. Thirtytwo patients with nifedipine induced gingival enlargement, twelve with p. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Drug induced gingival enlargementsignssymptomscauses. Commentary this is a clear documentation of druginduced gingival hyperplasia.
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. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. 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. Drug induced gingival enlargements are unwanted adverse effect of some drugs such as cyclosporine, phenytoin and calcium channel antagonists. Druginduced gingival enlargement druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. 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. 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. Treatment of druginduced gingival enlargement with er. Severe druginduced gingival enlargement and periodontitis. Miranda, brunet, roset, berini, farre, mendieta 10 performed a cross sectional study and compared the nifedipine induced gingival growth to controls who had never received the drug. Druginduced gingival overgrowth can occur in sites with minimal or no plaque, but it interferes with oral hygiene and may often lead to chronic inflammation, which complicates the enlargement.
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. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. As the condition progresses, the marginal and papillary. Druginduced gingival overgrowth is frequently associated with three particular drugs. Gingival overgrowth causes both physical and psychological distress. Gingival enlargement an overview sciencedirect topics. Prevalence and clinical aspects of druginduced gingival. Cyclosporin is an immunosuppressant which has been reported to cause gingival. A closely related term is epulis, denoting a localized.
Nonsurgical management of nifedipine induced gingival overgrowth. Medications taken for certain conditions can cause gingival hyperplasia. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. Gingival enlargement induced by drugs springerlink. 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. Gingival enlargement is a wellknown conscquence ot the administration of some anticonvulsants, immunosuppressants. A 18 year old male epileptic patient who was suffering from phenytoin induced gingival enlargement. The enlargement can be inflammatory,fibrotic or a combination of both. Calcium channel blockerinduced gingival hyperplasia is rare and is not welldocumented. Drug induced gingival overgrowth anna dongari, dds, ms howard t. Although few cases of amlodipineinduced hyperplasia have been reported, the present case is interesting as it occurred with a low dose of amlodipine 5 mg and.
The tissue enlargement begins as a painless, beadlike enlargement of the interdental papilla and can extend to involve the buccal and lingual. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Propranololinduced gingival hyperplasia with nager. The patient is kidney transplant and receive immunosuppressive medication cyclosporine for 10 months to prevent transplant rejection. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. The first druginduced gingival enlargements reported were those produced by phenytoin dilantin. Drug induced gingival overgrowth is frequently associated with three particular drugs.
In patients presenting with periodontitis and gingival. 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. Current strategies in clinical practice combine treatments with these inhibitors and receptor. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. Gingival enlargement is one of the frequent features of gingival diseases. 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. To the right is an example caused by the cardiovascular drug nifedipine. What is gingival enlargementcausessymptomstreatment. Surgical management of gingival overgrowth pocket dentistry. Histologically, the features of a drug induced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium.
Gingival enlargement is an increase in the size of the gingiva gums. 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. The gingival hyperplasia gradually improved over the following several months. Apr 09, 2018 the drug induced gingival enlargement is caused primarily by three classes of drugs. Three classes of drugs known to cause ge are anticonvulsants, antihypertensives specifically calciumchannel blockers, and immunosuppressants 2,3. Pdf druginduced gingival overgrowth digo remains a significant problem for the. 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. Druginduced gingival hyperplasia clinical presentation. Pdf treatment of druginduced gingival overgrowth by fullmouth. Gingival enlargement ge is a condition in which the size of the gingiva increases, which can be caused by inflammation, systemic disease, or certain medications. 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 most fibrotic druginduced lesions develop in response to therapy with phenytoin, the least. 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.
Drugs are the commonest reason behind gingival enlargement. Gingival enlargement definition of gingival enlargement by. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. Gingival enlargement definition of gingival enlargement. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Drug induced gingival enlargement by rajesh hosadurga. 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. December 15, 2006 email to a colleague synonyms and related keywords. Gingival swelling is made up mainly of fibrous tissue. The labial and lingual gingival tissues in the anterior sextants are the most. 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. Medication induced gingival enlargement patients who take certain medications may develop gingival enlargement. 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.
Surgical management of druginduced gingival overgrowth digo. Gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Gingival enlargement and its treatment authorstream. A rare case report of amlodipineinduced gingival enlargement. Know the causes, symptoms, treatment, classification and epidemiology of gingival enlargement. Druginduced gingival overgrowth is a wellestablished adverse event. Drug induced gingival enlarge t cell apoptosis free. Its symptoms and treatment when certain over the counter or prescription drugs are taken for prolonged period of time, they may have impact on dental health.
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. A nonselective beta blocker propranolol induced gingival hyperplasia is a very rare oral drug reaction. There are no specific bacteria or risk factors other than poor plaquebiofilm control associated with these gingival diseases. Shortly thereafter, its relationship with gingival enlargement was reported. Gingival enlargement is the most common adverse drug drug effect in the young adults and children. 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 awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and. Gingival enlargement or overgrowth is associated side effect with many classes of drugs. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications.
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