Hereditary gingival fibromatosis can occur as an isolated. 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. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Pdf drug induced gingival enlargement researchgate. Jul 09, 2014 the mainstay treatment for gingival hyperplasia depends on treating the underlying cause.
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. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous. There are some risk factors that appear to contribute to the likelihood of this condition. Castration prevents calcium channel blockerinduced gingival hyperplasia in beagle dogs. This increase in gingival cells has many different causes, but one of the most common is druginduced gingival hyperplasia. Hereditary gingival fibromatosis hgf, also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth.
Druginduced gingival gum overgrowth occurs as a side effect of some systemic medications. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. 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.
Druginduced gingival hyperplasia, druginduced gingival. The mainstay treatment for gingival hyperplasia depends on treating the underlying cause. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The first drug induced gingival enlargements reported were those produced by phenytoin dilantin. Accepted current terminology for this condition is gingival. Gingival hyperplasia, also known as gingival enlargement, is a swelling of the gum tissue gingiva.
For drug induced gingival hyperplasia, the doctor will change the drug so as to significantly reduce the risk of gingival hyperplasia. The american academy of periodontology aap states that gingival overgrowth may be minimized with ap. Conditioned enlargement pregnancy puberty vitamin c deficiency plasma cell gingivitis nonspecific. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Increase in the size of the gingiva is a common feature of gingival disease. Management of druginduced gingival enlargement australian. 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. Drug induced overgrowth commonly occurs following medications prescribed for non dental causes. Review of literature concerning etiology, pathogenesis and management of antiepileptic drug induced gingival enlargement.
A rare case report of amlodipineinduced gingival enlargement. It is unclear exactly why some people experience drug induced gingival hyperplasia while others do not. Gingival enlargement or hypertrophy are the two other terms used to describe the condition. 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. Many terms have been used to describe gingival overgrowth go. Gingival hyperplasia in a cat taking cyclosporine for feline. 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. Drug induced gingival overgrowth digo statpearls ncbi. Gingival hyperplasia or druginduced gingival overgrowth.
A gingival pocket presents when the marginal gingiva experiences an edematous reaction, whether due to localized irritation and subsequent inflammation, systemic issues, or drug. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. Commentary this is a clear documentation of druginduced gingival hyperplasia. Hereditary, drug induced, and idiopathic gingival overgrowth have been reported. Gingival overgrowth, hypertrophic gingivitis, gingival. If it is drug induced gingival hyperplasia, withdrawal of offending drug or substituting the drug may effectively reduce the overgrowth of gums. Pathogenesis of phenytoininduced gingival overgrowth. Shortly thereafter, its relationship with gingival enlargement was reported. Unusual clinical presentation of generalised gingival. Gingival enlargement an overview sciencedirect topics.
Pdf gingival enlargement is an increase in the size or inflammation of the gingiva. Gingival enlargement can be caused by a number of factors, including inflammatory. It is an unwanted side effect of certain systemic drugs given for nondental treatment. Regardless of the etiology, when gingival hyperplasia occurs, greater than normal the measurement in a prepathological state. Gingival overgrowth is caused by three categories of drugs.
Treating patients with druginduced gingival overgrowth. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. 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. Gingival enlargement and its treatment authorstream. Although ciclosporininduced gingival overgrowth lesions exhibit principally the presence of inflammation and little fibrosis, nifedipine and especially phenytoin. In severe form of gingival hyperplasia, surgery may be required to trim the overgrowth of gums. Druginduced gingival overgrowth or enlargement occurs in. Molecular and clinical aspects of druginduced gingival overgrowth. 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. 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. Severe enlargement of the interdental papillae on a patient taking the immunosuppressant cyclosporine and the calcium channel blocker amlodipine.
Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome. One of the main drugs associated with go is the antiepileptic. Druginduced gingival overgrowth anna dongari, dds, ms howard t. Anticonvulsants are drugs that can modify the gingival tissues response to inflammatory processes in the presence of dental plaque, inducing gingival overgrowth.
If the enlargement of the gingiva is caused by systemic condition, the underlying cause should be treated. Medication induced oral changes neil medical group. Differential diagnosis includes drug induced gingival enlargement. Druginduced gingival hyperplasia clinical presentation. Calcium channel blockerinduced gingival hyperplasia is rare and is not welldocumented.
Systemic and clinical treatment of gingival hyperplasia. Rather than getting gingival recession, they get hyperplasia. Appearance of gingival enlargement is clinically and histologically similar in these three drugs. 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. Furthermore, causes of congenital gingival enlargement include hereditary and. The prevalence and severity of cyclosporin and nifedipine induced gingival overgrowth. Athiban raj saveetha dental college, saveetha unversity, chennai, india abstract.
The expression gingival hyperplasia abnormal increase in the number of normal cells in a the drugs mainly associated with go are. Figure 2a shows phenytoin induced gingival overgrowth compared with other druginduced gingival overgrowths fig. Druginduced enlargement is associated with a patients genetic predisposition, and the presence of existing plaque or gingival inflammation. Gingival hyperplasia in a cat taking cyclosporine for feline l ympho cti as. Drug induced gingival hyperplasia the drugs that have been associated with overgrowth fall into three categories. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of. Various degrees of gingival overgrowth may occur in individuals taking diphenylhydantoin, a drug used widely in the treatment of epilepsy. A closely related term is epulis, denoting a localized. Surgical management of druginduced gingival overgrowth digo. Accepted current terminology for this condition is gingival enlargement and gingival overgrowth. Gingival enlargement is an increase in the size of the gingiva gums.
Gingival hyperplasia is a disease in which the gum tissues overgrow abnormally. 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 for the treatment of seizures. It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Several mechanisms are involved in the development of gingival overgrowth. It occurs as a side effect following the administration of drugs used mainly for nondental treatments. 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. Gingival hyperplasia is something that should be corrected as soon as you notice it. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque induced gingival inflammation and reduce.
Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Mcdonnell, dds, and robert p langlais, ba, dds, ms, san antonio, texas university of texas health science center at. December 15, 2006 email to a colleague synonyms and related keywords. Drug induced gingival enlargement publish your masters. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Dilantin is a hydantoin that was introduced by merritt and putnam 68 in 1938 for the treatment of all. Nifedipine induced gingival hyperplasia in pregnancy. Systemic diseases causing gingival enlargement leukemia granulomatous diseases wegeners granulomatosis. Essential facts about gingival hyperplasia and how to. 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. Treatment modalities for druginduced gingival enlargement. Gingival hyperplasia hypertrophy is a rather common condition. Furthermore, causes of congenital gingival enlargement include. Treatment of drug induced gingival enlargement is based on the clinical features.
Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. 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. Since gingival overgrowth is a druginduced increase in extracellular matrix proteins, the treatment is based on discontinuing the. Conditioned enlargement pregnancy puberty vitamin c deficiency plasma cell gingivitis nonspecific conditioned enlargement granuloma pyogenicum b. The gingival hyperplasia gradually improved over the following several months. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. It is unclear exactly why some people experience druginduced. Phenytoin, a drug used for the management of epilepsy.
Druginduced gingival enlargement consists of soft tissue growth that begins between the teeth and increases in all directions. A rare adverse drug reaction syed ahamed raheel, omar bashar kujan, bassel tarakji, dilshad umar, salah ibrahim j adv pharm technol. Mar 26, 2019 several causes of gingival hyperplasia are known, and the most recognized is drug induced gingival enlargement. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Treatment of druginduced gingival enlargement is based on the clinical features. 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. Propranololinduced gingival hyperplasia with nager syndrome.
Drug induced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Hyperplasia specifically means an increase in the number of cells in the gum tissue. 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. If it is drug induced gingival hyperplasia, withdrawal of offending drug or substituting the drug may. 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.
Druginduced gingival hyperplasia is an abnormal enlargement of the gingival tissues, which can occur as a side effect of cyclosporine a, following renal transplantation. Phenytoin, a drug used for the management of epilepsy, and other anticonvulsants such as sodium. Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Digo is a common clinical problem that often requires intervention. This article has summarized observations and results of controlled laboratory and. Jun, 2019 hereditary gingival fibromatosis hgf, also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. Gingival hyperplasia associated with the administration of amlodipine to dogs with degenerative valvular disease 20042008. Drug induced gingival enlargement is the term now used to describe medicationrelated gingival hypertrophy or hyperplasia, a condition commonly induced by three main classes of drugs.
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