Pdf gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics find, read and. The druginduced gingival enlargement could be detected clinically as early as months following the initial dose of ccb. If the enlargement is drug induced, drug substitution should be considered with the plaque control measures. Furthermore, male rats are more susceptible than females to nifedipine. Changes in gingival contour seen in druginduced gingival overgrowth may also be exacerbated by plaqueinduced gingival inflammation, through a mechanism of mechanical and chemical chronic irritation. Treating patients with druginduced gingival overgrowth. Miranda, brunet, roset, berini, farre, mendieta 10 performed a cross sectional study and compared the nifedipineinduced gingival growth to controls who had never received the drug.
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. Gingival hyperplasia hypertrophy is a rather common condition. Gingival overgrowth may have multiple causes, however drugs assumption is the most common 1,2. This case reports unusual defects of amlodipine induced gingival overgrowth, with a. In severe cases, the excess tissue may cover the crowns of the teeth, thus causing functional, esthetic, and periodontal problems, such as bone loss and bleeding, due to the presence of. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Gingival overgrowth is well known side effect of calcium channel blocker, anti convulsant drugs and immunosuppressants which adversely affect speech, mastication, tooth eruption, and esthetics. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Seymour ra, thomason jm, ellis js 1996 the pathogenesis of drug induced gingival overgrowth. However, drug variables and concomitant medication do impact upon the expression of gingival overgrowth. 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. Drugs are the commonest reason behind gingival enlargement. Drug induced gingival overgrowth digo statpearls ncbi.
Druginduced gingival overgrowth digo is attributed mainly to the prolonged use of calcium channel blocking agents, anticonvulsants, and anticalcineurin inhibitors. Unusual clinical presentation of generalised gingival. To the right is an example caused by the cardiovascular drug nifedipine. Review article druginduced gingival overgrowth and its tentative pharmacotherapy hiroko matsumotoa,b, reiri takeuchia, makiko onoc, yoshiaki akimotob,c, naomi kobayashid, akira fujiid,e, adepartment of oral molecular pharmacology, nihon university school of dentistry at matsudo, matsudo, chiba 2718587, japan bresearch institute of oral science, nihon university school of dentistry at. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. The mechanism behind druginduced gingival hyperplasia involves inflammatory and noninflammatory pathways figure 8. Mcs have become a recent concern in drug induced gingival overgrowth digo, an unwanted outcome of systemic medication. Pdf drug induced gingival overgrowth balasubramanian. Pdf druginduced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction adr in. Mcs have become a recent concern in druginduced gingival overgrowth digo, an unwanted outcome of systemic medication. The management of digo depends on the severity of the disease and includes surgical intervention and plaque control. Phenytoininduced gingival overgrowth management with.
Histologically, the features of a druginduced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium. A wide range of causes have been attributed to gingival overgrowth. Gingival fibromatosis is a rare and heterogeneous group of disorders that develop as slowly progressive, local or diffuse enlargements within marginal and attached gingiva or interdental papilla. In severe cases, the excess tissue may cover the crowns of the teeth, thus causing functional, esthetic, and periodontal problems, such as bone loss and bleeding, due to the presence of pseudopockets. Jan 28, 20 mast cells mcs are multifunctional effector cells that were originally thought to be involved in allergic disorders. The management of drug induced gingival overgrowth dr. Highpower diode laser on management of druginduced. Such increased volume of gingiva may compromise normal oral functions, aesthetics in addition. After 1 week, the gingival condition improved and the case. Mavrogiannis m, ellis js, thomason jm, seymour ra 2006 the management of drug induced gingival. Although nifedipine is a calcium channel blocker which.
Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response. Most 86% drug induced gingival overgrowth is neither serious 5 nor painful. This study assesses for the presence and localization of connective tissue growth factor ctgf in drug. Clinical manifestation of gingival enlargement frequently appears within 1 to 3 months after initiation of treatment with the associated medication. Prevalence and clinical aspects of druginduced gingival. Druginduced enlargement is associated with a patients genetic predisposition. Medicationinduced gingival enlargement patients who take certain medications may develop gingival enlargement. 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. Druginduced gingival overgrowth digo is a wellrecognized adverse effect of certain systemic medications. The three main classes of drugs inducing gingival overgrowth are anticonvulsants, immunosuppressive, and antihypertensive agents 3,57. Calcium channel blockerinduced gingival enlargement. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol.
Druginduced gingival overgrowth digo is a disfiguring side effect of anti convulsants, calcineurin inhibitors, and calcium channel blocking. Even drug variables such as dose, duration of therapy, serum and salivary concentration appear to be. With the consent of the patient and her physician, complete scaling and root planing was performed, along with a prescription of a 0. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Now it is known that they contain an array of mediators with a multitude of effects on many other cells. Druginduced gingival overgrowth remains the most widespread unwanted effect. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Mast cells mcs are multifunctional effector cells that were originally thought to be involved in allergic disorders.
Although amlodipine is considered a safe drug, it may induce gingival overgrowth for some individuals, inducing then, an aesthetic prejudice for the patient and causing serious managerial problems for clinicians. Drugs associated with gingival overgrowth can be c at e g o rized broadly into three major groups according to their therapeutic actions, namely anticonvulsants. Gingival overgrowth is well documented side effect associated with three major classes of drugs viz, anticonvulsants, calcium channel blockers, and immunosuppressants. 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. If the enlargement is drug induced, drug substitution should be considered with the. Druginduced gingival overgrowth is a tissuespecific condition and is. Most 86% druginduced gingival overgrowth is neither serious 5 nor painful. Periodontal management of cyclosporin ainduced gingival. 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 druginduced gingival enlargement. 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.
The identificatioin of risk factors associated with both the prevalence and severity of drug. 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. Amlodipine induced gingival overgrowth, unusual defect and. Druginduced gingival overgrowth has been recognised. What is the millers class for gingival recession that extends beyond the mucogingival junction with no interproximal attachment loss. A diagnosis of generalized druginduced gingival enlargement superimposed with chronic periodontitis was made. Individualized treatment plan for gingival enlargement. Mavrogiannis m, ellis js, thomason jm, seymour ra 2006 the management of druginduced gingival. The pathogenesis and mechanisms responsible for this condition are not fully understood.
Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. The possible potential therapeutic targets for drug induced. Drug induced gingival overgrowth anna dongari, dds, ms howard t. Because the texture and appearance of the affected gingiva may be irre gular and b ulbous, patients with gingi val overgrowth may require special modif ications in the deli very of dental hygiene. Despite our greater understanding of pathogenesis of drug induced gingival overgrowth. Savage nw, daly cg 2010 gingival enlargements and localized gingival overgrowths. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. 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. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use.
Druginduced gingival overgrowth will most likely occur on. Seymour ra, thomason jm, ellis js 1996 the pathogenesis of druginduced gingival overgrowth. Pdf drug induced gingival enlargement researchgate. Dec 24, 2001 however, drug variables and concomitant medication do impact upon the expression of gingival overgrowth.
The purpose of this article is to report a case of drug induced gingival enlargement due to oral contraceptives, managed by nonsurgical periodontal therapy. Drug induced overgrowth commonly occurs following medications prescribed for non dental causes. Despite our greater understanding of pathogenesis of drug induced gingival overgrowth digo, its treatment still remains a challenge for the periodontists and treatment is still largely limited to maintenance of improved level of oral hygiene and surgical removal of overgrown tissue. Mechanism of druginduced gingival overgrowth revisited. This case reports unusual defects of amlodipineinduced gingival overgrowth, with a. 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 overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs.
Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Druginduced gingival overgrowth is a side effect associated with 3 types of drugs. Gingival overgrowth is a common side effect of phenytoin, termed phenytoininduced gingival overgrowth pigo. Gingival overgrowth may present as an unaesthetic sight to the patient and also to others. Several conflicting theories have been proposed to explain the fibroblasts function in gingival overgrowth. Gingival overgrowth is a common side effect of phenytoin, termed phenytoin induced gingival overgrowth pigo. Druginduced gingival overgrowth anna dongari, dds, ms howard t.
Drug induced gingival overgrowth is a side effect associated with 3 types of drugs. Although the overgrowth does not seem to affect edentulous areas, 19. Pdf download for molecular and clinical aspects of druginduced. Druginduced gingival overgrowth definition many terms have been used to describe gingival overgrowth. Gingival enlargement is the overgrowth of the gingiva characterized by an expansion and accumulation of the connective tissue with occasional presence of increased number of cells. Gingival hyperplasia hypertrophy is a rather common. Gingival overgrowth is a side effect of certain medications. The first case of phenytoininduced gingival enlargement was reported in 1939 by kimball. The most fibrotic druginduced lesions develop in response to therapy with phenytoin, the least fibrotic.
Influence of mast cells in druginduced gingival overgrowth. It is an absolute enigma to a clinician to diagnose the etiology of the overgrowth. Unusual clinical presentation of generalised gingival enlargement a report of 3 cases smitha rani thada, vineetha r, keerthilatha m pai. Management of drug induced gingival overgrowth major reenesh m1, colonel sk rath2, lieutnant colonel manish mukherjee3 abstract. 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. In addiction, drug induced gingival overgrowth may be associated with a patients genetic predisposition 3,4. Etiology of druginduced gingival overgrowth gingival overgrowth is caused by three categories of drugs.
When patients are in combination therapy, in which two or more drugs are known to cause gingival enlargement, then, which should be attributed to the diagnosis of digo, is a puzzle. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue. A patient with druginduced gingival enlargement is characterized by granular or pebbly surface, with the enlarged papillae extending facially andor lingually, obscuring the adjacent tissue and tooth surfaces. Aspects of druginduced gingival enlargement prevalence the prevalence of gingival overgrowth varies with drugs. To determine whether amlodipine alters the fibrotic response, we investigated its effects on treated gingival fibroblast gene expression as compared with untreated cells. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. The mechanism behind drug induced gingival hyperplasia involves inflammatory and noninflammatory pathways figure 8. Prevalence and severity of amlodipine induced gingival overgrowth. Drugs, medications and periodontal disease british. In addiction, druginduced gingival overgrowth may be associated with a patients genetic predisposition 3,4. The expression and the severity of this tissuespecific condition are influenced by a variety of factors, mainly drug and periodontal variables. All of the following are ways of characterizing the resistance of a material to permanent deformation except druginduced gingival overgrowth will most likely occur on the interdental papillae of which area. Treatment modalities for druginduced gingival enlargement.
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