![]() This may require frequent visits for monitoring of progress. Rhodus DMD, MPH, in Little and Falace's Dental Management of the Medically Compromised Patient (Eighth Edition), 2013 Treatment Planning Considerationsīecause gingival overgrowth is associated with phenytoin administration, every effort should be made to maintain a patient at an optimal level of oral hygiene. The swelling is aggravated if oral hygiene is poor there is a positive correlation between the severity of overgrowth and gingival inflammation, plaque score, calculus accumulation and pocket depths.Įxcessive body hair growth (hypertrichosis) is commonly associated. There is no correlation between the extent of overgrowth and the drug dose, its serum level, or the age and gender of the patient. Older lesions may become red if inflamed. The enlargement is characteristically firm, pale, and tough with coarse stippling, but these features may take several years to develop. The earlier lesions may be softer and redder, sometimes giving the impression of ‘bubbling up’ behind the existing papillae. The enlargement rarely affects edentulous sites. 12.2), which may later involve the marginal and even attached gingiva. Papillae are firm, pale and enlarge to form false vertical clefts ( Fig. ▪ĭrug-induced gingival swelling usually starts interdentally, the palatal and lingual gingiva being usually involved less than buccal and labial gingiva. Increased numbers of fibroblasts containing strongly sulphated mucopolysaccharides may be demonstrated histochemically their cytoplasm contains numerous secretory granules, suggesting an increased production of acid mucopolysaccharides. ▪Ĭalcium-channel blockers (especially nifedipine): which are mainly used as anti-hypertensive agents. ▪Ĭiclosporin (cyclosporin): an immunosuppressive drug particularly used to suppress the cell-mediated response after organ transplants, but only one-third of patients may be affected, more commonly children. Fibroblasts show increased mitotic activity, but are not increased in number, and the collagen fibre component is not increased. Histology shows marked thickening of epithelium with long overgrowths into the connective tissue. Phenytoin: which is used mainly for the control of grand mal epilepsy. Causal drugs may include the following: ▪ The multidrug resistance 1 (MDR1) gene may modify the inflammatory response to drugs and thereby play a role in the pathogenesis. Surgical removal of excess gingival tissue may be considered for severe or refractory cases. Some studies have noted improvement of cyclosporine-associated gingival overgrowth after a short course of azithromycin, and other studies have suggested that folic acid may be helpful for the prevention and treatment of drug-induced gingival overgrowth. Plaque control (i.e., with professional cleaning, frequent recall visits, oral hygiene reinforcement, and chlorhexidine rinse) also is beneficial. Discontinuation of the offending medication or substitution of another suitable drug may cease progression and, possibly, induce some regression. Some patients experience problems with speech, mastication, and aesthetics. The tissue exhibits varying degrees of fibrosis and inflammation, and the mucosal surface may appear lobulated, smooth, granular, pebbly, or papillary. With progression, there may be more diffuse gingival overgrowth, with envelopment of part or all of the adjacent tooth crowns. The gingival enlargement often begins in the interdental papillae, especially in the anterior and facial segments. Many cases of drug-induced gingival overgrowth develop within the first 1 to 3 months of starting drug treatment in addition, a second peak has been described after 12 months of treatment. In addition, genetic factors likely play a role, as evidenced by increased or decreased susceptibility in association with certain histocompatibility leukocyte antigen (HLA) types and other genetic polymorphisms. Poor plaque control appears to be an important cofactor. ![]() ![]() Proposed underlying mechanisms are related to disrupted cellular calcium gradients, altered fibroblast function, elevated proinflammatory cytokines, and reduced matrix metalloproteinases the end result is increased extracellular matrix (rather than true cellular hyperplasia or hypertrophy). Also, some studies have implicated oral contraceptives and antibiotics. It is best recognized in association with phenytoin, cyclosporine, and nifedipine, although associations with other anticonvulsants, immunosuppressants, and calcium channel blockers have been noted as well. Gingival overgrowth may be an adverse effect of various systemic medications. Chi DMD, in Color Atlas of Oral and Maxillofacial Diseases, 2019 Drug-Induced Gingival Overgrowth (Drug-Related Gingival Hyperplasia) Figs. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |