The identificatioin of risk factors associated with both the prevalence and severity of drug. Clinical manifestation of gingival enlargement frequently appears within 1 to 3 months after initiation of treatment with the associated medication. Furthermore, male rats are more susceptible than females to nifedipine. Calcium channel blockerinduced gingival enlargement. Drugs are the commonest reason behind gingival enlargement. The possible potential therapeutic targets for drug induced.
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. Druginduced gingival hyperplasia digh is a periodontal side effects of certain drugs, causing swelling, bleeding, and problems with chewing, aesthetics, and pronunciation. This case reports unusual defects of amlodipine induced gingival overgrowth, with a. Gingival overgrowth is a side effect of certain medications. The management of digo depends on the severity of the disease and includes surgical intervention and plaque control. Most 86% druginduced gingival overgrowth is neither serious 5 nor painful.
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. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of. 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. Etiology of druginduced gingival overgrowth gingival overgrowth is caused by three categories of drugs. However, drug variables and concomitant medication do impact upon the expression of gingival overgrowth. Individualized treatment plan for 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. Gingival overgrowth may have multiple causes, however drugs assumption is the most common 1,2. Highpower diode laser on management of druginduced. Mcs have become a recent concern in druginduced gingival overgrowth digo, an unwanted outcome of systemic medication. Druginduced gingival overgrowth is a side effect associated with 3 types of drugs. 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. Pdf druginduced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction adr in. Druginduced gingival overgrowth definition many terms have been used to describe gingival overgrowth. Medicationinduced gingival enlargement patients who take certain medications may develop gingival enlargement. Gingival overgrowth may present as an unaesthetic sight to the patient and also to others.
This case reports unusual defects of amlodipineinduced gingival overgrowth, with a. Pdf download for molecular and clinical aspects of druginduced. Gingival overgrowth is a common side effect of phenytoin, termed phenytoininduced gingival overgrowth pigo. 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. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. 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. The three main classes of drugs inducing gingival overgrowth are anticonvulsants, immunosuppressive, and antihypertensive agents 3,57. Histologically, the features of a druginduced overgrowth are a fibrotic or expanded connective tissue and an enlarged gingival epithelium. 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. Mechanism of druginduced gingival overgrowth revisited. Drug induced overgrowth commonly occurs following medications prescribed for non dental causes.
What is the millers class for gingival recession that extends beyond the mucogingival junction with no interproximal attachment loss. In addiction, druginduced gingival overgrowth may be associated with a patients genetic predisposition 3,4. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Gingival overgrowth is well documented side effect associated with three major classes of drugs viz, anticonvulsants, calcium channel blockers, and immunosuppressants. Seymour ra, thomason jm, ellis js 1996 the pathogenesis of druginduced 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. Drugs, medications and periodontal disease british. To the right is an example caused by the cardiovascular drug nifedipine. Molecular and clinical aspects of druginduced gingival overgrowth. Amlodipine induced gingival overgrowth, unusual defect and. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. Pdf drug induced gingival enlargement researchgate. Prevalence and clinical aspects of druginduced gingival. This study assesses for the presence and localization of connective tissue growth factor ctgf in drug. Dec 24, 2001 however, drug variables and concomitant medication do impact upon the expression of gingival overgrowth. Although the overgrowth does not seem to affect edentulous areas, 19. Druginduced gingival overgrowth digo is a disfiguring side effect of anti convulsants, calcineurin inhibitors, and calcium channel blocking. A wide range of causes have been attributed to gingival overgrowth.
The mechanism behind drug induced gingival hyperplasia involves inflammatory and noninflammatory pathways figure 8. In addiction, drug induced gingival overgrowth may be associated with a patients genetic predisposition 3,4. With the consent of the patient and her physician, complete scaling and root planing was performed, along with a prescription of a 0. Although nifedipine is a calcium channel blocker which. 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. Mavrogiannis m, ellis js, thomason jm, seymour ra 2006 the management of drug induced gingival. 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. 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. The expression and the severity of this tissuespecific condition are influenced by a variety of factors, mainly drug and periodontal variables. 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. 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. 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. Unusual clinical presentation of generalised gingival.
The first case of phenytoininduced gingival enlargement was reported in 1939 by kimball. 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. To determine whether amlodipine alters the fibrotic response, we investigated its effects on treated gingival fibroblast gene expression as compared with untreated cells. Gingival overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs. 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. The mechanism behind druginduced gingival hyperplasia involves inflammatory and noninflammatory pathways figure 8. If the enlargement is drug induced, drug substitution should be considered with the plaque control measures. Pdf gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics find, read and. Gingival hyperplasia hypertrophy is a rather common. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth.
Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. Drug induced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Gingival overgrowth is a common side effect of phenytoin, termed phenytoin induced gingival overgrowth pigo. Molecular aspects of druginduced 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. It is an absolute enigma to a clinician to diagnose the etiology of the overgrowth.
Phenytoininduced gingival overgrowth management with. 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 gingival overgrowth is a side effect associated with 3 types of drugs. Management of drug induced gingival overgrowth major reenesh m1, colonel sk rath2, lieutnant colonel manish mukherjee3 abstract. Unusual clinical presentation of generalised gingival enlargement a report of 3 cases smitha rani thada, vineetha r, keerthilatha m pai. Drug induced gingival overgrowth anna dongari, dds, ms howard t.
Mavrogiannis m, ellis js, thomason jm, seymour ra 2006 the management of druginduced gingival. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Druginduced gingival overgrowth will most likely occur on. Druginduced gingival overgrowth digo is attributed mainly to the prolonged use of calcium channel blocking agents, anticonvulsants, and anticalcineurin inhibitors. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. In more severe cases, it can cause high mobility and detachment of the teeth due to alveolar bone absorption. 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. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Mcs have become a recent concern in drug induced gingival overgrowth digo, an unwanted outcome of systemic medication. Treatment modalities for druginduced gingival enlargement. Jan 28, 20 mast cells mcs are multifunctional effector cells that were originally thought to be involved in allergic disorders. Pdf drug induced gingival overgrowth balasubramanian.
Even drug variables such as dose, duration of therapy, serum and salivary concentration appear to be. Druginduced gingival overgrowth is a tissuespecific condition and is. The management of drug induced gingival overgrowth dr. Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response. Influence of mast cells in druginduced gingival overgrowth. 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. A diagnosis of generalized druginduced gingival enlargement superimposed with chronic periodontitis was made. Now it is known that they contain an array of mediators with a multitude of effects on many other cells.
Mast cells mcs are multifunctional effector cells that were originally thought to be involved in allergic disorders. Aspects of druginduced gingival enlargement prevalence the prevalence of gingival overgrowth varies with drugs. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Treating patients with druginduced gingival overgrowth.
Gingival hyperplasia hypertrophy is a rather common condition. Several conflicting theories have been proposed to explain the fibroblasts function in gingival overgrowth. Prevalence and severity of amlodipine induced gingival overgrowth. 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. Savage nw, daly cg 2010 gingival enlargements and localized gingival overgrowths. Druginduced gingival overgrowth anna dongari, dds, ms howard t. Druginduced gingival overgrowth remains the most widespread unwanted effect.
After 1 week, the gingival condition improved and the case. The most fibrotic druginduced lesions develop in response to therapy with phenytoin, the least fibrotic. If the enlargement is drug induced, drug substitution should be considered with the. Such increased volume of gingiva may compromise normal oral functions, aesthetics in addition. Druginduced enlargement is associated with a patients genetic predisposition. Druginduced gingival overgrowth has been recognised.
Seymour ra, thomason jm, ellis js 1996 the pathogenesis of drug induced gingival overgrowth. The pathogenesis and mechanisms responsible for this condition are not fully understood. 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. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Despite our greater understanding of pathogenesis of drug induced gingival overgrowth. Drug induced gingival overgrowth digo statpearls ncbi. Most 86% drug induced gingival overgrowth is neither serious 5 nor painful.
1131 505 375 339 1389 1374 105 1581 1381 302 132 469 524 463 539 1109 204 929 902 1377 683 725 1470 1531 1272 1653 822 546 617 753 31 718 1108 1124