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. Recognition and treatment of amlodipine norvasc induced. Azithromycin nayer aboelsaad1, una elshinnawi adel bakr. Gingival overgrowth is caused by three categories of drugs. Molecular aspects of druginduced gingival overgrowth. Druginduced gingival hyperplasia clinical presentation. Treatment of druginduced gingival overgrowth by fullmouth disinfection. There are several drugs that have been associated with gingival overgrowth the increase in matrix protein form of enlargement including phenytoin derivatives, calcium channel blockers and cyclosporine. Gingival hyperplasia is an enlargement or overgrowth of the gum tissue, also known as the gingiva, around the necks of the teeth. Druginduced gingival overgrowth definition many terms have been used to describe gingival overgrowth. In such cases, overgrown gums may need to be surgically removed. Surgical treatment is often the most reliable option and scalpel gingivectomy remains the treatment of choice, but the apically displaced flap may be more suitable surgical approach to the treatment of drug induced gingival enlargement. Those drugs whose pharmacodynamics are clearly established and which affect the rate of periodontal disease activity, may provide information on the mechanisms of periodontal destruction.
December 15, 2006 email to a colleague synonyms and related keywords. Brunet l, miranda j, farre m, berini l, mendieta c 1996 gingival enlargement induced by drugs. 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. Many terms have been used to describe gingival overgrowth go.
Drug induced gingival hyperplasia was reclassified in 1999 by app as a dental plaque induced gingival disease. Gingival hyperplasia is a common disorder associated with phenytoin and cyclosporine therapy. No hyperplasia 1 hyperplastic gingiva covering the cervical third or. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin. A furosemide b digoxin c cyclosporin d nifedipine e lidocaine. Introduction gingival overgrowth may have multiple causes, however drugs assumption is the most common 1,2. Management of druginduced gingival enlargement australian. The prevalence of druginduced gingival hyperplasia varies according to the type of medication, but the clinical and microscopic appearance of the lesion is similar. Severe enlargement of the interdental papillae on a patient taking the immunosuppressant cyclosporine and the calcium channel blocker amlodipine. Druginduced enlargement is associated with a patients genetic. However, induction of this condition by calcium channel.
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. Brief reports calcium channel blockerinduced gingival. Atsushi niimi had reported that the concentration of cyclosporin a was much higher in dental plaque than in blood and other tissues 5. Gingival hyperplasia in a patient with hypertension. Unusual clinical presentation of generalised gingival. 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. 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. Gingival enlargement an overview sciencedirect topics. This case reports unusual defects of amlodipine induced gingival overgrowth, with a large gingival mass that almost completely disappeared only after. Pdf download for molecular and clinical aspects of druginduced. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. 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 three pharmaceutical agents that most commonly have an effect on gingival fibroblast proliferation are phenytoin dilantin.
Unfortunately, there are over 20 different drugs that can lead to symptoms. This case report documents a case of gingival enlargement associated with periodontitis in a patient under pheytoin sodium for the past 15 years, along with brief. If the enlargement of the gingiva is caused by systemic condition, the underlying cause should be treated. In cases of drug induced gingival enlargement, the medication causing the problem should be changed to one that does not induce gingival enlargement. Which of the following heart medications can cause gingival hyperplasia. Phenytoin, a drug used for the management of epilepsy.
Gingival hyperplasia typically refers to the increase in the number of cells, whereas gingival hypertrophy deals with the increase in cell size. Drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. 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 enlargement is the overgrowth of the gingiva characterized by an expansion and accumulation of the connective tissue with occasional presence of increased. Druginduced gingival hyperplasia, druginduced gingival. This increase in gingival cells has many different causes, but one of the most common is druginduced gingival hyperplasia. The gums appear lobulated from papillary enlarge ment, and the tooth crowns may be partially covered by hyperplastic tissue. Gingival hyperplasia or gingival enlargement, the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. The american academy of periodontology aap states that gingival overgrowth may be minimized with ap. 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. Drug induced gingival overgrowth is frequently associated with three particular drugs. Pdf gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics find, read and.
For drug induced gingival hyperplasia, the doctor will change the drug so as to significantly reduce the risk of gingival hyperplasia. Gingival enlargement can be induced by three main causes stemming from 1 inflammation, 2 medication, and 3 systemic disease. Patients diagnosed with early to moderate gingival overgrowth with stable allograft function were included in the study. Laser treatment of the enlarged gingival tissues is similar to the technique described above figures 6a, 6b and 6c. Phenytoininduced gingival overgrowth management with. The most recognized cause is drug induced gingival enlargement from phenytoin dilantin, which is commonly used to treat patients with epileptic seizures. Gingival enlargement usually develops in a susceptible individual within a few months of starting the medication. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. 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. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Gingival hyperplasia is a disease in which the gum tissues overgrow abnormally. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome.
Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Gingival hyperplasia, also known as gingival enlargement, is a swelling of the gum tissue gingiva. Management of phenytoin induced gingival overgrowth. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. This is a clear documentation of drug induced gingival hyperplasia. Clinical report systemic and clinical treatment of. Druginduced gingival hyperplasia is an abnormal enlargement of the gingival tissues, which can occur as a side effect of cyclosporine a, following renal transplantation. Gingiva hyperplasia an overview sciencedirect topics. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions.
Certain drugs in the body fluid might limit the population of plaque bacteria or may alter their metabolism. Druginduced gingival overgrowth digo, also referred to as druginduced. Gingival overgrowth go, 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. Perio board questions for final flashcards quizlet. It occurs as a side effect following the administration of drugs. On the cellular and molecular mechanisms of druginduced.
Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Clocheret k, dekeyser c, carels c, willems g 2003 idiopathic gingival hyperplasia and orthodontic treatment. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. 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. Drug induced gingival hyperplasia is a welldocu mented and widely recognized side effect of longterm phenytoin therapy. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. A wide range of causes have been attributed to gingival overgrowth. 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. Regression of nifedipine induced gingival hyperplasia following switch to a same class calcium. The reported case is an exemplification of a progressive gingival enlargement caused by a drug induced and complicated by inflammatory changes due to.
Jan 26, 2016 this feature is not available right now. These microscopic distinctions are both indicative of a disease process. As such, and because of few equivalent alternatives, the occurrence of gingival hyperplasia will not preclude the use of amlodipine. Amlodipine with or without acei is the most commonly used antihypertensive medication in dogs and cats due to safety and efficacy. Druginduced gingival gum overgrowth occurs as a side effect of some systemic medications. As gingival enlargement develops, it affects the normal oral hygiene. Drug induced overgrowth commonly occurs following medications prescribed for non dental causes. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Gingival hyperplasia profile definition gingivalhyperplasiaisdefinedasanenlarge mentofthegingivathatisnoninflammatory, producedbyfactorsotherthanlocalirritation. The presence of plaque and gingival inflammation appears to exacerbate go irrespective of the initiating drug. Hyperplasia specifically means an increase in the number of cells in the gum tissue. His current mediations include cyclosporine 125 mg bid and amlodipine 5 mg qd as well as cellcept, aspirin, and allopurinol for gout. Drug induced gingival enlargement periodontal disease.
In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. These patients had been taking either cyclosporine or tacrolimus for more than 6. Since gingival overgrowth is a druginduced increase in extracellular matrix proteins, the treatment is based on discontinuing the offending medication if at. Drug induced gingival overgrowth digo statpearls ncbi. Gingival hyperplasia is something that should be corrected as soon as you notice it. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone absorption. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Individualized treatment plan for gingival enlargement. Gingival overgrowth, hypertrophic gingivitis, gingival. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. Drug induced gingival enlargement consists of soft tissue growth that begins between the teeth and increases in all directions. Table 2 grading systems for severity of phenytoin induced gingival overgrowth angelopoulos and goaz 3 modified ziskin 57 addys modification of harris and evalt rating 58 grade definition grade definition grade definition 0 no hyperplasia, normal gingiva 0 no changes a.
Treating patients with druginduced gingival overgrowth. The differential diagnosis of gingival hyperplasia includes calcium channel blockers, cyclosporine, familial gingival fibromatosis, gingivitis, leukemia, phenytoin, scurvy, trench mouth, valproic acid. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. The gingival hyperplasia, with its potential aesthetic implication complicated by inflammatory changes due to plaque accumulation, presents an affliction for patients and health professionals. Gingival enlargement or hypertrophy are the two other terms used to describe the condition. The enlargement can be inflammatory,fibrotic or a combination of both. Drug related gingival hyperplasia is a cutaneous condition characterized by enlargement of the gums noted during the first year of drug treatment. A rare case report of amlodipineinduced gingival enlargement.
Pdf drug induced gingival enlargement researchgate. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue. Druginduced gingival hyperplasia digh is an iat rogenic dental disorder that is characterized by gums that are enlarged and inflamed, and bleed readily upon prob ing. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. 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. Molecular and clinical aspects of druginduced gingival overgrowth. Top causes of gingival enlargement and treatment options. Druginduced gingival overgrowth is a tissuespecific condition and is. Phenytoin and cyclosporine a specifically regulate macrophage phenotype and expression of plateletderived growth factor and interleukin1 in vitro and in vivo. 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. As the tissue enlarges it develops a characteristically thickened and lobulated appearance. Several conflicting theories have been proposed to. Definition gingival hyperplasia is defined as an enlargement of the gingiva that is noninflammatory, produced by factors other than local irritation, and the result of an increased number of cells.
Drugs and the periodontium seymour 1988 journal of. Although ciclosporininduced gingival overgrowth lesions exhibit principally the presence of inflammation and little fibrosis, nifedipine and especially phenytoin. There are very few reports of amlodipine induced gingival enlargement at a dose of 5 mg. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications.
In addiction, drug induced gingival overgrowth may be associated with a patients. Pdf gingival enlargement is an increase in the size or inflammation of the gingiva. Gingival overgrowth, also known as gingival hyperplasia, has been well described in the literature. The mechanism behind drug induced gingival hyperplasia involves inflammatory and noninflammatory pathways figure 8. Gingival enlargement is an increase in the size of the gingiva gums. 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 hyperplasia hypertrophy is a rather common. Unusual clinical presentation of generalised gingival enlargement a report of 3 cases smitha rani thada, vineetha r, keerthilatha m pai. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract. Calcium channel blockerinduced gingival hyperplasia. 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.
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