Drug-Induced Gingival Enlargement

Drug-Induced Gingival Enlargement

Question. Classify gingival enlargement. Give a detailed account of the enlargement caused by drugs.

Answer.

“Understanding the role of medications in causing gingival enlargement: Q&A explained”

Gingival Enlargement Caused By Drugs

• Drug-related gingival enlargement is an abnormal growth of gingival tissue that is secondary to the use of systemic medication.
• Drug-related gingival enlargement is a misnomer because neither the epithelium nor the cells inside the connective tissue undergo hyperplasia or hypertrophy
• An increase in the size of the gingiva is due to the increased amount of extracellular matrix, mainly collagen.
• Strong association of drug-induced gingival enlargement is related to three drugs, i.e., cyclosporine, phenytoin, and nifedipine
  All the drugs causing gingival enlargement lead to calcium dysregulation, which disrupts normal collagen phagocytosis and the remodeling process.
• Prevalence related to the use of phenytoin is 50%, while cyclosporine and nifedipine produce changes in 25%
• The degree of drug-induced gingival enlargement is related significantly to the patient’s susceptibility and level of oral hygiene.
• The degree of drug-induced gingival hyperplasia is higher in smokers.
• Dilantin sodium was the first drug reported to cause gingival enlargement.

“Importance of studying drug-induced gingival enlargement for better oral health: Questions explained”

Clinical Features

• Phenytoin is commonly given to young patients, so it induces a problem in people younger than 25 years of age.
• Patients taking calcium channel blockers are middle-aged age and cyclosporine has a broad age range.
• As any of the drug is used for 1 to 3 months enlargement occur in interdental papillae and spread to the tooth surface. Anterior and facial segments are more frequently involved areas. Enlargement is painless.
• In extensive cases of hyperplasia, the gingiva covers almost the complete crown surface.
• If there is extension of the gingiva lingually and occlusally, this can interfere with speech and mastication.
• Edentulous areas are usually not affcted but hyperplasia is seen under poorly maintained dentures as well as around the implants.
• Non­gingival soft tissue growths that look like pyogenic granulomas are seen in allogenic bone marrow transplant recipients who are taking cyclosporine for graft versus host disease.
• Enlarged gingiva is normal in color and is firm, it has a smooth, stippled, or granular surface.
• If inflammation occurs affected gingiva is dark red and edematous, surface become friable, bleeds easily and occasionally ulcerated.

“Common challenges in diagnosing drug-induced gingival enlargement effectively: FAQs provided”

Histopathology

• Gingival overgrowth caused by phenytoin shows redundant tissue of normal composition.
• Gingival overgrowth caused by cyclosporine shows an increased amount of collagen per unit volume with normal density of fibroblasts.
• The overlying surface epithelium shows elongation of rete ridges with long extension in the underlying lamina propria.
• Patients with secondary inflammation show increased vascularity and increased chronic inflammatory cell infiltrate composed of lymphocytes and plasma cells.

“Steps to explain causes of drug-induced gingival enlargement: Medications vs genetics: Q&A guide”

Treatment

• Discontinue the offending medication, which leads to regression in the size of the gingiva.
• If drug substitution can be done, then cyclosporine is replaced with tacrolimus; phenytoin with carbamazepine, lamotrigine, gabapentin, etc, and nifedipine with atenolol.
• Professional cleaning, frequent re­evaluation, and home plaque control are done.
• Systemic or topical folic acid is beneficial in some cases.
• Cyclosporine-induced gingival hyperplasia resolves after a short course of metronidazole or azithromycin.
• When objectionable alterations are present and all other interventions fail, gingivectomy is the treatment of choice.