Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Originally published in veterinary practice news, october 2016 download as a pdf 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. Chronic inflammatory gingival enlargement associated with. Druginduced gingival overgrowth is a side effect associated with 3 types of drugs. It was reported in the early 1960s in dental literature and is sometimes referred to as drug induced gingival enlargement or overgrowth or. It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants. Laser treatment of the enlarged gingival tissues is similar to the technique described above figures 6a, 6b and 6c.
Drug induced gingival enlargement periodontal disease. Drug induced gingival overgrowth is a side effect associated with 3 types of drugs. Drug induced gingival overgrowth digo abstract europe pmc. Drugs that cause gingival hyperplasia are classified by the american academy of periodontology as a dental plaqueinduced gingival disease, as evidence suggests that existing gingival inflammation may be necessary for its development and that proper plaque control and effective oral hygiene can lessen its severity or potentially prevent its occurrence altogether. Treating patients with druginduced gingival overgrowth.
Apr 25, 2019 in addiction, druginduced gingival overgrowth may be associated with a patients genetic predisposition 3,4. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. For drug induced gingival hyperplasia, the doctor will change the drug so as to significantly reduce the risk of gingival hyperplasia. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Druginduced gingival overgrowth digo, also referred to as. An update on the mechanisms of phenytoin induced gingival. The prevalence and severity of cyclosporin and nifedipineinduced gingival overgrowth. Pdf drug induced gingival enlargement researchgate. The presence of plaque and gingival inflammation appears to exacerbate go irrespective of the initiating drug.
It is unclear exactly why some people experience druginduced gingival hyperplasia while others do not. This condition is also known as gingival overgrowth, hypertrophic gingivitis or gingival hypertrophy. Gingival hyperplasia in a cat taking cyclosporine for feline l ympho cti as. Treatment of druginduced gingival enlargement is based on the clinical features. The prevalence of druginduced gingival hyperplasia varies according to the type of medication, but the clinical and microscopic appearance of the lesion is similar. Calcium channel blockerinduced gingival hyperplasia is rare and is not welldocumented. Severe druginduced gingival enlargement and periodontitis. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Molecular aspects of druginduced gingival overgrowth. It occurs as a side effect following the administration of drugs. Mar 26, 2019 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.
A gingival pocket presents when the marginal gingiva experiences an edematous reaction, whether due to localized irritation and subsequent inflammation, systemic issues, or drug induced gingival hyperplasia. Three classes of drugs known to cause ge are anticonvulsants, antihypertensives specifically calciumchannel blockers, and immunosuppressants 2,3. Drugs that cause gingival hyperplasia pdf free pdf epub. Gingival hyperplasia is something that should be corrected as soon as you notice it. In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a. Drugs that cause gingival hyperplasia are classified by the american academy of periodontology as a dental plaque induced gingival disease, as evidence suggests that existing gingival inflammation may be necessary for its development and that proper plaque control and effective oral hygiene can lessen its severity or potentially prevent its. A diode 810 laser was used to excise the gingival overgrowth. Top causes of gingival enlargement and treatment options. Drug induced gingival overgrowth digo statpearls ncbi. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. There are several drugs that have been associated with gingival overgrowth the increase in matrix protein form of enlargement including phenytoin. Drugs that cause gingival hyperplasia introduction. Calcium channel blockers nifedipine, amlodipine, etc. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use.
Jun 07, 20 systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. 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 enlarge free download as powerpoint presentation. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. 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.
The druginduced gingival overgrowth is a side effect of drugs used mainly for nondental treatment for which the gingival tissue is not the intended target organ. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. Druginduced gingival hyperplasia clinical presentation. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Molecular and clinical aspects of druginduced gingival overgrowth.
Oct 30, 2019 the drug induced gingival overgrowth is a side effect of drugs used mainly for nondental treatment for which the gingival tissue is not the intended target organ. There are several types available, which will be discussed further down but two of the most important ones are the one induced by. The term gingival overgrowth indicates histopathological diagnosis of gum enlargement and has multiple causes. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally. Regardless of the etiology, when gingival hyperplasia occurs, greater than normal the measurement in a prepathological.
Gingival hyperplasia in a cat taking cyclosporine for feline. Tenidap is a new antiinflammatory agent, which has been shown to inhibit igemediated nacetylglucosaminidase secretion from mast cells, release activated collagenase from neutrophils, inhibit leukotriene b 4 and prostanoid syntheses in human neutrophils, form 5lipoxygenase products in human subject, inhibit production of. It is an unwanted side effect of certain systemic drugs given for nondental treatment. Druginduced gingival overgrowth definition many terms have been used to describe gingival overgrowth. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. There are several causes of gingival enlargement and they can be grouped into four categories. Pdf druginduced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva. Medically induced gingival hyperplasia mayo clinic proceedings. Nov 14, 2019 the first case of phenytoin induced gingival enlargement was reported in 1939 by kimball. Druginduced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug. A patient with drug induced gingival enlargement is characterized by granular or pebbly surface, with the enlarged papillae extending facially andor lingually, obscuring the adjacent tissue and tooth surfaces. Gingival enlargement is an increase in the size of the gingiva gums. Gingival hyperplasia hypertrophy is a rather common condition. Management of druginduced gingival enlargement australian.
Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaqueinduced gingival inflammation and reduce. Gingival hyperplasia treatment, symptoms, causes, pictures. Gingival hyperplasia is a medical condition in which the gums increase in size. Dental plaqueinduced gingival conditions murakami 2018. Druginduced gingival hyperplasia, treatment with diode laser.
Jun 20, 2018 the revision of the 1999 classification system for dental plaque. Gingival hyperplasia or gingival overgrowth is a common occurrence in patients taking phenytoin, cyclosporine, or calcium channel blockers. 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. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Drug induced gingival enlarge t cell apoptosis free. Possible molecular mechanism of drug induced gingival hyperplasia. 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. Treatment modalities for druginduced gingival enlargement. A rare case report of amlodipineinduced gingival enlargement. Changing of antihypertensive drug and the execution of a professional treatment of oral hygiene did not allow the resolution of hyperplasia. Gingival hyperplasia is a condition when the gum tissue becomes enlarged and gingival cells increase in number.
Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract. A wide range of causes have been attributed to gingival overgrowth. 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. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone absorption. Rather than getting gingival recession, they get hyperplasia.
The three main classes of drugs inducing gingival overgrowth are anticonvulsants, immunosuppressive, and antihypertensive agents 3, 5, 6, 7. When treating patients with gingival overgrowth, dental hygienists need to be prepared to offer maintenance and prev entiv e therapy, emphasizing periodontal maintenance and patient education. These microscopic distinctions are both indicative of a disease process. Hence, patient education and information about the condition and its management are required. Drug induced overgrowth commonly occurs following medications prescribed for non dental causes. Drug induced gingival hyperplasia the drugs that have been associated with overgrowth fall into three categories. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. It is unclear exactly why some people experience drug induced gingival hyperplasia while others do not.
Several conflicting theories have been proposed to explain the fibroblasts function in gingival overgrowth. Since gingival overgrowth is a druginduced increase in extracellular matrix. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. There are some risk factors that appear to contribute to the likelihood of this condition. Drugs that cause gingival hyperplasia are classified by the american academy of periodontology as a dental plaqueinduced gingival disease, as evidence suggests that existing gingival inflammation may be necessary for its development and that proper plaque control and effective oral hygiene can lessen its severity or potentially prevent its. In cases of drug induced gingival enlargement, the medication causing the problem should be changed to one that does not induce gingival enlargement. 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. The management of druginfluenced gingival enlargement noha. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. 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.
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. Druginduced gingival hyperplasia, treatment with diode. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. 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. Commentary this is a clear documentation of druginduced gingival hyperplasia. Abvp and elizabeth mcmorran, drmedvet for the education center. Drug induced gingival enlargement intelligent dental. Although ciclosporininduced gingival overgrowth lesions exhibit principally the presence of inflammation and little fibrosis, nifedipine and especially phenytoin. Gingival hyperplasia associated with the administration of amlodipine to dogs with degenerative valvular disease 20042008. The gingival hyperplasia gradually improved over the following several months. Druginduced gingival hyperplasia in transplant recipients. Gingival enlargement can be induced by three main causes stemming from 1 inflammation, 2 medication, and 3 systemic disease. If the enlargement of the gingiva is caused by systemic condition, the underlying cause should be treated.
To determine whether amlodipine alters the fibrotic response, we investigated its effects on treated gingival fibroblast gene expression as compared with untreated cells. December 15, 2006 email to a colleague synonyms and related keywords. In such cases, overgrown gums may need to be surgically removed. High plaque scores and gingival inflammation are important etiologic factors in exacerbating drug induced gingival enlargement irrespective of the causative medication. Phenytoin and cyclosporine a specifically regulate macrophage phenotype and expression of plateletderived growth factor and interleukin1 in vitro and in vivo. Patients with significant gingival enlargement have been observed to have greater plaque scores and papillary bleeding indices 9. Digo is a common clinical problem that often requires intervention. The drug induced gingival overgrowth is a side effect of drugs used mainly for nondental treatment for which the gingival tissue is not the intended target organ. 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. The prevalence and severity of cyclosporin and nifedipine induced gingival overgrowth. Gingival hyperplasia typically refers to the increase in the number of cells, whereas gingival hypertrophy deals with the increase in cell size. Pdf gingival enlargement is an increase in the size or inflammation of the gingiva. This article has summarized observations and results of controlled laboratory and clinical studies of druginduced gingival hyperplasia associated with phenytoin, cyclosporine, and nifedipine use. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue.
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