This patient had been prescribed various drugs due to the prevailing cardiac condition. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. An investigation on gingival hyperplasia induced by nifedipine eslami m1, baghaii f2, jalayer nadery n. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Gingival enlargement and its treatment authorstream. Gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows. What are 5 common features between all drug induced gingival enlargement. Gingival enlargement is a wellknown conscquence ot the administration of some anticonvulsants, immunosuppressants.
Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Druginduced gingival overgrowth is a common complication of the continuous use of medications, such as anticonvulsant phenytoin, antihypertensive calcium channel blockers nifedipine, and immunosuppressant cyclosporinea therapy. List 4 tx options for drug induced gingival enlargement. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Academy report 1424 a n increasing number of medications are associated with gingival enlargement. Druginduced gingival enlargement dige associated with chronic use of the aed phenytoin was first reported in 1939 by kimball. Druginduced gingival hyperplasia clinical presentation. Gingival enlargement is one of the frequent features of gingival diseases. Dental plaqueinduced gingival diseases classification of gingival diseases is a significant part of an intraoral examination. Reports about the possible etiological mechanisms of druginduced gingival overgrowth have been suggested 1, 2, 3 such as an imbalance in collagen. It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants.
Phenytoin activates smad3 phosphorylation and periostin. There are several types available, which will be discussed further down but two of the most important ones are the one induced by. 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 enlargements generalised pocket dentistry. Gingivitis is a non destructive disease that causes inflammation of the gums. Drug induced gingival overgrowth digo statpearls ncbi. Health, general anticonvulsants health aspects chronic myeloid leukemia case studies gingivitis care and treatment causes of diagnosis gum diseases nifedipine complications and side. The role of nickel accumulation and epithelial cell proliferation in orthodontic treatment induced gingival overgrowth. 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. Gingival enlargement is an increase in the size of the gingiva gums.
Other factors related to this condition are hereditary, malignancies and those resulting from adverse effects associated with systemic administration of certain drugs. Magnification of an existing inflammation initiated by dental plaque 2. Druginduced enlargement is associated with a patients genetic predisposition, and the presence of existing plaque or gingival inflammation. Some of the variation in incidence of gingival enlargement can be attributed to differences between study populations and methods of classifying its severity. The various diffuse gingival enlargement extending include drug induced or can be a syndromes associated with it are rutherfurd more on the facial and buccal aspect of manifestation of a genetic disorder. What is the most likely diagnosis if patient has htn. Preexisting gingival inflammation induced by dental plaque seems to be a favorable. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. A rare case report of amlodipineinduced gingival enlargement. Learn the shocking truth about uterine fibroids, drugs and surgeries. Nonplaqueinduced gingival lesions classification of gingival diseases is a significant part of an intraoral examination. The pathogenesis of drug induced gingival enlargement is uncertain and there appears to be no unifying hypothesis that links together the three commonly implicated drugs. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms also called plaque that is attached to tooth surfaces, termed plaque induced gingivitis. Many terms have been used to describe gingival overgrowth go.
Aug 12, 2014 gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows. Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaquerelated inflammation and drug therapy. Druginduced gingival gum overgrowth occurs as a side effect of some systemic medications. Pathogenesis of phenytoininduced gingival overgrowth. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders.
Phenytoin induced gingival overgrowth is a well known and frequently reported gingival lesion, which was first detected in 1939. Digo is a common clinical problem that often requires intervention. Gingival enlargement induced by drugs springerlink. Druginduced gingival enlargement dige is a fibrotic condition associated with systemic. Management of druginduced gingival enlargement australian. This condition is also known as gingival overgrowth, hypertrophic gingivitis or gingival hypertrophy. Hereditary gingival fibromatosis also referred to as idiopathic gingival hyperplasia, elephantiasis gingivae etc. Both genetically and pharmacologically induced forms of gingival enlargement exist. Clinically, the onset is consistent with the eruption of permanent dentition. Unilateral gingival enlargement an unusual case report. Amlodipine is being widely used because of its safety profile and duration of action. Furthermore, causes of congenital gingival enlargement include hereditary and metabolic disorders, such the fetal valproate syndrome.
Gingival hyperplasia hypertrophy is a rather common. Gingival hyperplasia characterized by slowly progressive, non hemorrhagic, fibrous enlargement of maxillary and mandibular gingival. Nifedipine induced gingival hyperplasia in patients and its probable relationship with age. Druginduced gingival hyperplasia, druginduced gingival. One of the main drugs associated with go is the antiepileptic. The role of nickel accumulation and epithelial cell proliferation in orthodontic treatmentinduced gingival overgrowth. The prevalence of gingival enlargement induced by calcium. I treatment of druginduced gingival enlargement with er. Jan 15, 2015 the treatment of gingival enlargement is based on an understanding of the cause and underlying pathologic changes of this condition see chapter 16. Some of the variation in incidence of gingival enlargement can be attributed to differences between study populations and. Management of amlodipineinduced gingival enlargement. It is an unwanted side effect of certain systemic drugs given for nondental treatment. 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 purpose of this article is to report a case of drug induced gingival enlargement due to oral contraceptives, managed by nonsurgical periodontal therapy.
Phenytoin induced gingival overgrowth management with periodontal treatment. Gingivitis is a nondestructive disease that causes inflammation of the gums. Amlodepine induced gingival enlargement presentation of a. Gingival enlargement can be caused by a number of various stimuli. Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Systemic and clinical treatment of gingival hyperplasia. Oct 26, 2012 gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaque related inflammation and drug therapy. Gingival hyperplasia characterized by slowly progressive, nonhemorrhagic, fibrous enlargement of maxillary and mandibular gingival. Most likely, this may be related to the age of the population, the nature of the disease, and poor oral hygiene. Treatment of drug induced gingival enlargement is based on the clinical features.
Druginduced gingival enlargement is a well documented side effect with the use of phenytoin, cyclosporine and calcium channel blockers. Drug induced gingival hyperplasia has posed a serious concern for both patients and the clinician. Idiopathic gingival enlargement is a proliferative fibrous lesion of the gingival tissue that causes esthetic and functional problems. A closely related term is epulis, denoting a localized. Non surgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque induced gingival inflammation and reduce. The expression gingival hyperplasia abnormal increase in the number of normal cells in a normal arrangement in an organ or tissue, which increase in volume and gingival hypertrophy enlargement or overgrowth of an organ or part. Incidence of amlodipineinduced gingival overgrowth in the rural population of loni. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms also called plaque that is attached to tooth surfaces, termed plaqueinduced gingivitis.
In contrast to the inflammatory gingival enlargement, the drug induced gingival enlargement occurs when the patient consumes specific drugs. Gingival enlargement or gingival overgrowth go is one of the most important clinical features of gingival pathology. This case report describes the management of gingival overgrowth in a hypertensive patient taking amlodipine. This is strictly a clinical description of the condition and avoids the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival hyperplasia. Clinically plaque induced gingival enlargement usually presents as enlarged gingival contours due to edema or color changes to red and or bluish red hue, bleeding on probing and increased exudates from gingiva. Case report a 18 year old male patient reported to the dept of oral. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaqueinduced gingival inflammation and reduce. Amlodepine induced gingival enlargement presentation of. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. List 4 tx options for drug induced gingival enlargement hematologic disorders.
A patients diagnosis and treatment rely on proper classification of gingival diseases. In most cases, the enlargement results because of local irritations. Surgical approach to druginduced gingival enlargement in renal transplant patients a case report. 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. Here, we present a case of nifedipineinduced gingival hyperplasia and draw the. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Gingival enlargements are quite common and may be either inflammatory, non inflammatory or a combination of both. To get the facts on exactly how to eliminate your uterine fibroids from the root 100% naturally and permanently and achieve lasting freedom from pcos related symptoms without spending your hardearned money on drugs and over the counters. The drug decreases collagen endocytosis through induction of a lower expression of 2 1integrin by. This case report addresses the diagnosis and treatment of a case of idiopathic gingival enlargement in a yearold female.
Unusual clinical presentation of generalized gingival enlargementa report of 3 cases. There are several causes of gingival enlargement and they can be grouped into four categories. Cyclosporin is an immunosuppressant which has been reported to cause gingival. Treatment of druginduced gingival enlargement with er. There are several types available, which will be discussed further down but two of the most important ones are the one induced by different medication and the one.
The first of these cases was additionally diabetic and also gave a history of angina 3 years back. Drug induced gingival overgrowth remains the most widespread unwanted effect of systemic medication on the periodontal tissues. Nonplaque induced gingival lesions npigl encompass a group of pathologies that are not primarily caused by plaque and usually do not disappear after plaque removal, even when the severity of. The nonplaque induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. An investigation on gingival hyperplasia induced by nifedipine. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. In the syndrome consist of the association of upper and lower jaw figc. Gingival enlargement, the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease.
Hereditary gingival fibromatosisis a rare 1 in 750,000 hereditary condition characterized by. Although gingival overgrowth has been traditionally recognised as an adverse effect of. Chairman of our department treated her previously for same lesion in 2008. Its true incidence in the general population is unknown.
Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Treatment of gingival enlargement pocket dentistry. Treatment of druginduced gingival enlargement is based on the clinical features. Gingival hyperplasia modified by medications are commonly.
Unusual clinical presentation of generalised gingival enlargement. Gingival hyperplasia treatment, symptoms, causes, pictures. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Know the causes, signs, symptoms, treatment, prognosis and epidemiology of drug induced gingival enlargement. S28s45 june 2018 with 50 reads how we measure reads. Druginduced gingival overgrowth remains the most widespread unwanted effect. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Gingival enlargement an overview sciencedirect topics.
Phenytoin induced gingival enlargement affects at least 4050% of patients who use the drug for longer than 3months. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Cyclosporine induced gingival enlargement is more vascularised than the phenytoin enlargement. Gingival hyperplasia is a medical condition in which the gums increase in size. This chapter aims to provide an overview of the causes, features and management of generalised gingival swellings, which involve the free andor attached gingiva and may also extend to the nonkeratinised lining oral mucosa. A large number of drugs are associated with gingival overgrowths, of which amlodipine a frequently used antihypertensive is a common offender. Druginduced gingival enlargement druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Phenytoininduced gingival overgrowth management with.
However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Overgrowth can be observed varying in extent and severity. Pdf subgingival microbiome of experimental gingivitis. Combined treatment for a combined enlargement ncbi. The simplified taxonomy of gingival conditions includes. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Gingival overgrowth caused by olmesartan medoxomil. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy.
1142 186 1029 1180 1145 413 244 1303 300 518 1354 1018 758 1247 714 1085 614 89 1328 737 676 237 849 321 692 334 346 246 273 227 924 772 213