Treatment of druginduced gingival enlargement is based on the clinical features. In two patients, it was possible to control this side effect adequately by optimising oral hygiene and dental plaque control. Enlargement create pesudopocket resulting in plaque accumulation giving a clinical picture of. The inflammation is often caused by plaque buildup on the teeth from food, bacteria, and poor hygiene practices. Surgical therapy was carried out to provide a good. Unusual clinical presentation of generalized gingival. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Gingival hyperplasia can occur as a direct result of inflammation. Plaque accumulation on teeth causes gingival inflammation and its resultant enlargement. Drugs that cause gingival hyperplasia are classified by the american academy of periodontology as a dental plaque induced gingival disease, as evidence suggests that existing gingival inflammation may be necessary for its development and that proper plaque control and effective oral hygiene can lessen its severity or potentially prevent its. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. In contrast, some other nonplaqueinduced gingival conditions that may present in the younger age groups were omitted, e. High plaque scores and gingival inflammation are important etiologic factors in exacerbating drug induced gingival enlargement irrespective of the causative medication.
Loe 1965 performed a study on gingivitis where 12 healthy individuals with. Druginduced go is frequently noticed as a side effect with the use of various medications. 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. Based on the results of this study, it is important to note that 0. Plaque the severity of gingival enlargement in patients taking these medications correlates well with poor plaque control17 and is commensurate with the degree of plaque induced in. This, in turn, can lead to destruction of the gingival tissues, which may progress to destruction of the periodontal attachment apparatus. Unusual clinical presentation of generalised gingival. Drugs that cause gingival hyperplasia are classified by the american academy of periodontology as a dental plaqueinduced gingival disease, as evidence suggests that existing gingival inflammation may be necessary for its development and that proper plaque control and effective oral hygiene can lessen its severity. This is a result of the patient not accomplishing effective oral hygiene. Dental plaqueinduced gingival diseases classification of gingival diseases is a significant part of an intraoral examination. Gingivitis can lead to the more serious disorder known as periodontitis. Phenytoininduced severe gingival overgrowth in a child.
There are numerous causes, of which the primary one is pathogenic microorganisms in the crevices between the gums. Phenytoin is one of the most common drugs associated with gingival overgrowth. Medications that are mainly implicated are anticonvulsants such as phenytoin and calcium channel blockers ccbs such a amlodipine, a newer agent of dihydropyridine derivative, is a. Calcium channel blockerinduced gingival enlargement.
Is dental plaque the only etiological factor in amlodipine. Gingival enlargement or overgrowth go is a common complication of the anticonvulsant drug phenytoin pht. The pathogenesis of drug induced gingival enlargement is uncertain and there appears to be no unifying hypothesis. Further investigations are required to develop appropriate management strategies to prevent recurrence of digo. Gingivitis can be best described as a bacterial infection of the gingival tissue caused by plaque biofilm at the gingival margin. The first case of phenytoininduced gingival enlargement was reported in 1939 by kimball. Gingival overgrowth go was earlier called as gingival hyperplasia or gingival hypertrophy. Pgo may vary from mild to severe and does not seem. Clinical methods to assess the presence and severity of plaque. The plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps. Gingival enlargement definition of gingival enlargement. Gingival disease definition of gingival disease by the free. Non plaqueinduced 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 enlargement can be inflammatory,fibrotic or a combination of both.
In the 1999 international workshop for a classification of periodontal diseases and conditions, druginfluenced gingival enlargements have been identified and added as a subcategory under the section dental plaqueinduced gingival diseases. Jun 20, 2018 the simplified taxonomy of gingival conditions includes. The pathogenesis of druginduced gingival enlargement is. It commences as a papillary enlar gement which is more pronounced on the labial aspect of the gingival than the palatal or lingual surfaces. Gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Alternatively fibroblasts from young patients may be more susceptible to the drug. Their primary etiology is bacterial plaque, which can initiate destruction of the gingival tissues and periodontal attachment apparatus. Calcium channel blocker induced gingival enlargement. Drugs that cause gingival hyperplasia introduction. Periodontal management of phenytoin induced gingival. Plaqueinduced gingivitis is inflammation of the gingiva resulting from bacteria located at the gingival margin. Congenital gingival hyperplasia in a neonate with foetal valproate syndrome. Digo is a common clinical problem that often requires intervention.
Gingivitis and periodontitis are the two major forms of in flammatory diseases affecting the periodontium. Go is evident in almost half of the patients receiving pht therapy. Gingivitis is a nondestructive disease that causes inflammation of the gums. 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.
Magnification of an existing inflammation initiated by dental plaque 2. The cause of plaqueinduced gingivitis is bacterial plaque, which acts to initiate the bodys host response. Extent and severity may cause functional disturbance with speech, mastication and psychological problems. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. Verapamil induced gingival enlargement in cluster headache. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. The gingival enlargement observed may be localized or generalized and is an inflammatory response that occurs when plaque collection of food debris and bacteria accumulates on the teeth.
Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Gingival enlargement is an increase in the size of the gingiva gums. 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. The simplified taxonomy of gingival conditions includes. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Gingivitis associated with dental plaque only gingivitis can be best described as a bacterial infection of the gingival tissue caused by plaque biofilm at the gingival margin. High plaque scores and gingival inflammation are important etiologic factors in exacerbating druginduced gingival enlargement irrespective of the causative medication. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. Gingival enlargement is known side effect of certain medications like anticonvulsants, calcium channel blockers and immunosuppressant. Gingival overgrowth may vary from isolated mild enlargement of interdental papilla or a uniform enlargement which may affect either one or both jaws. Nifedipineinduced gingival enlargement a systematic. The appropriate intervention is crucial for the prevention of periodontitis. Therefore a more comprehensive list of the nonplaqueinduced gingival conditions that may present in.
Dental plaqueinduced gingival diseases are characterized as gingivitis associated with dental plaque only with or without other local contributing factors. Dental plaqueinduced gingival conditions murakami 2018. The gingiva may appear red, shiny or spongy, at times associated with spontaneous bleeding and ulcerations. 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. To the right is an example caused by the cardiovascular drug nifedipine. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Management of amlodipineinduced gingival enlargement by. A patients diagnosis and treatment rely on proper classification of gingival diseases. Pgo may vary from mild to severe and does not seem to be dose dependant. There are many factors causal or modifying involved in gingival overgrowth. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. One of the main drugs associated with go is the antiepileptic. Underlying medi cal problem is an important determinant of cyclosporine induced gingival overgrowth. The nonplaqueinduced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic.
However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Verapamil is an effective prophylactic treatment for cluster headaches and, therefore, is widely used. Chronic inflammatory gingival enlargement associated with. The rftnthcfm treatment of plaqueinduced gingivitis, chronic. 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. Gingival enlargement is one of the frequent features of gingival diseases. Patients with significant gingival enlargement have been observed to have greater plaque scores and papillary bleeding indices 9. Druginduced gingival enlargement or overgrowth occurs mainly in humans but also sporadically in dogs and cats fig. Plaqueinduced gingivitis definition of plaqueinduced. Therefore a more comprehensive list of the non plaque induced gingival conditions that may present in young patients is shown in table 61.
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. About one billion adults are hypertensive globally and. 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. In contrast, some other non plaque induced gingival conditions that may present in the younger age groups were omitted, e. 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. Medicationinduced gingival enlargement patients who take certain medications may develop gingival enlargement. This report describes four patients with cluster headache who developed gingival enlargement after initiating treatment with verapamil. Phenytoininduced severe gingival overgrowth in a child bmj.
Gingivitis is prevalent at all ages of dentate population and is considered to the most common form of periodontal disease. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Drugs that cause gingival hyperplasia pdf free pdf epub. Certain gingival diseases that are modified substantially by the use of systemic medications are now well recognized. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Factors in amlodipine induced gingival overgrowth e611 introduction hypertension, a silent killer is one of the most important modifiable risk factors for cardiovascular and associated conditions like stroke, dementia, ischemic heart disease, vision loss, heart and kidney failures 1. The rftnthcfm treatment of plaqueinduced gingivitis. The present case report describes a successful management of phenytoin induced gingival enlargement in year old female by combined. In two patients, it was possible to control this side effect adequately by optimising oral hygiene and dental plaque.
Bleeding is a primary symptom, and other symptoms include swelling, redness, pain, and difficulty in chewing. Plaque induced gingivitis is inflammation of the gingiva resulting from bacteria located at the gingival margin. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Phtinduced gingival overgrowth pgo is more common in children than in adults and affects both males and females equally. 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. Inflammatory enlargement, the most common condition induced by the accumulation of plaque. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaqueinduced gingival inflammation and reduce. Severe druginduced gingival enlargement and periodontitis. While plaqueinduced gingivitis is one of the most common human in. Gingival enlargement an overview sciencedirect topics. The progression is usually slow and painless, although in advanced cases gingival bleeding and oral malodor can arise, indicating an oral infection secondary to periodontal disease figure 1.
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