Druginduced gingival overgrowth gingival overgrowth is a welldocumented and unwanted side effect, associated principally with the calcium channel blockers, phenytoin and ciclosporin table 31. Histologically, the features of a drug induced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium. Nonsurgical management of nifedipine induced gingival. Drug induced gingival enlarge free download as powerpoint presentation. Thirtytwo patients with nifedipine induced gingival enlargement, twelve with p. Management of druginduced gingival enlargement australian. Three classes of drugs known to cause ge are anticonvulsants, antihypertensives specifically calciumchannel blockers, and immunosuppressants 2,3. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Druginduced gingival overgrowth anna dongari, dds, ms howard t. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. A closely related term is epulis, denoting a localized.
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. Gingival enlargement or overgrowth is associated side effect with many classes of drugs. Propranololinduced gingival hyperplasia with nager syndrome. Routine blood test came within the normal limit and no bony changes were seen in opg. Drug induced gingival enlargements are unwanted adverse effect of some drugs such as cyclosporine, phenytoin and calcium channel antagonists.
Drug induced gingival overgrowth anna dongari, dds, ms howard t. 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. Gingival enlargement may also lead to bleeding and foul odour from the oral cavity. Drug induced gingival enlargement periodontal disease. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. December 15, 2006 email to a colleague synonyms and related keywords. 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 18 year old male epileptic patient who was suffering from phenytoin induced gingival enlargement.
Prevalence and clinical aspects of druginduced gingival. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Commonly used drugs can lead to gingival changes including hyperplasia overgrowth and gingivitis. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Propranololinduced gingival hyperplasia with nager. Gingival enlargement induced by drugs springerlink. Pdf druginduced gingival overgrowth digo remains a significant problem for the. Academy report 1424 a n increasing number of medications are associated with gingival enlargement. A 45 year old male is presented with severe drug induced gingival enlargement, moderate bone loss and reduced dentition. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. The labial and lingual gingival tissues in the anterior sextants are the most. 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.
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. Gingival swelling is made up mainly of fibrous tissue. 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. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. 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 patient is kidney transplant and receive immunosuppressive medication cyclosporine for 10 months to prevent transplant rejection. What is gingival enlargementcausessymptomstreatment. Druginduced enlargement is associated with a patients genetic predisposition. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Gingival enlargement and its treatment authorstream. Severe druginduced gingival enlargement and periodontitis. 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. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and.
This article has summarized observations and results of controlled laboratory and clinical studies of druginduced gingival hyperplasia associated with phenytoin, cyclosporine, and nifedipine use. Surgical management of gingival overgrowth pocket dentistry. Druginduced gingival enlargement druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Drug induced gingival enlargement occurs on intake of three types of drugs. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. 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 is a multifactorial condition characterised by abnormal increase in size of the gingiva. Its true incidence in the general population is unknown. Gingival enlargement is the most common adverse drug drug effect in the young adults and children.
Drug induced gingival enlargementsignssymptomscauses. Drug induced gingival enlarge t cell apoptosis free. Druginduced gingival overgrowth is frequently associated with three particular drugs. Drug induced gingival enlargement intelligent dental.
Gingival overgrowth causes both physical and psychological distress. Phenytoininduced gingival overgrowth management with. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Treatment of druginduced gingival enlargement with er. I treatment of druginduced gingival enlargement with er. Apr 09, 2018 the drug induced gingival enlargement is caused primarily by three classes of drugs. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. Histologically, the features of a druginduced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium.
Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. A nonselective beta blocker propranolol induced gingival hyperplasia is a very rare oral drug reaction. 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. Pdf treatment of druginduced gingival overgrowth by fullmouth. On the cellular and molecular mechanisms of druginduced.
Current strategies in clinical practice combine treatments with these inhibitors and receptor. 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 is one of the frequent features of gingival diseases. Cyclosporin is an immunosuppressant which has been reported to cause gingival. Gingival swelling is pink, firm and lobulated especially in cyclosporine induced gingival enlargement. 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. Druginduced gingival hyperplasia clinical presentation. The management of drug induced gingival overgrowth dr. 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. Know the causes, symptoms, treatment, classification and epidemiology of gingival enlargement. Nonsurgical management of nifedipine induced gingival overgrowth. 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. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. As the condition progresses, the marginal and papillary. The first druginduced gingival enlargements reported were those produced by phenytoin dilantin. Anticonvulsants responsible for causing drug induced gingival enlargement. 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 drug induced gingival enlargement is caused primarily by three classes of drugs. There are no specific bacteria or risk factors other than poor plaquebiofilm control associated with these gingival diseases. 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. To the right is an example caused by the cardiovascular drug nifedipine. Drug induced gingival overgrowth is frequently associated with three particular drugs.
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. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Surgical management of druginduced gingival overgrowth digo. 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. Gingival enlargement definition of gingival enlargement. The gingival hyperplasia gradually improved over the following several months. A rare case report of amlodipineinduced gingival enlargement. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. Gingival hyperplasia or druginduced gingival overgrowth.
Pdf druginduced gingival overgrowth is a common finding in the modern era. Gingival enlargement definition of gingival enlargement by. A nonselective beta blocker propranololinduced gingival hyperplasia is a very rare oral drug reaction. Calcium channel blockerinduced gingival hyperplasia is rare and is not welldocumented. 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. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. 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. Medication induced gingival enlargement patients who take certain medications may develop gingival enlargement. 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. 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. Druginduced gingival overgrowth is a wellestablished adverse event.
Often affect the gingival on the labial front surface of the anterior teeth. 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. Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. Drugs are the commonest reason behind 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. Gingival enlargement an overview sciencedirect topics. 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. 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. Druginduced gingival overgrowth is an adverse drug reaction mainly described with three. Shortly thereafter, its relationship with gingival enlargement was reported. The enlargement can be inflammatory,fibrotic or a combination of both. The most fibrotic druginduced lesions develop in response to therapy with phenytoin, the least. Aspects of druginduced gingival enlargement prevalence the prevalence of gingival overgrowth varies with drugs. 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. Drug induced gingival enlargement by rajesh hosadurga. Commentary this is a clear documentation of druginduced gingival hyperplasia. Medications taken for certain conditions can cause gingival hyperplasia.
Anticonvulsants, immunosuppressants, and calcium channel blockers. Although gingival overgrowth has been traditionally recognised as an adverse effect of. Medicationinduced gingival enlargement patients who take certain medications may develop gingival enlargement. Gingival enlargement is an increase in the size of the gingiva gums. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin. In cases with secondary gingival inflammation, the gingiva is bluishred in colour, with a lobulated surface and a tendency for bleeding. Gingival enlargement is a wellknown conscquence ot the administration of some anticonvulsants, immunosuppressants. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract. Drug induced gingival overgrowth digo abstract europe pmc. 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. A 45 year old male is presented with severe druginduced gingival enlargement, moderate bone loss and reduced dentition. 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. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement.
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