Phenytoin-Induced Gingival Enlargement
Write notes on dilantin sodium gingival enlargement.
Answer. Gingival Enlargement is also known as phenytoin-induced gingival enlargement.
Dilantin is an anticonvulsant drug which is widely used in the control of epilepsy and various other convulsive disorders.
“Importance Of Oral Hygiene In Preventing Gingival Enlargement”
Gingival Enlargement Clinical Features
- Overgrowth of gingiva becomes apparent in first three months as dilantin dosage is rapid in first year
- The enlargement starts as a painless, bead-like enlargement of facial and lingual gingival margins and interdental papillae.
- As condition progresses, the marginal and papillary enlargement unite and develop into a massive tissue fold covering considerable portion of crown and may interfere with occlusion.
- When uncomplicated by inflammation, the lesion is mulberry shape, firm, pale pink and resilient with a minutely lobulated surface with no tendency to bleed.
“Risk Factors For Developing Phenytoin-Induced Gum Swelling”
- Enlargement appears to project beneath the gingival margin from which it is separated by linear groove.
- The hyperplasia is generalized throughout the mouth but is more severe in maxillary and mandibular anterior region.
- The presence of enlargement will result in secondary inflammatory process that complicates gingival hyperplasia caused by drug.
- Secondary inflammatory changes produce red or bluish red discoloration and results in increased tendency towards bleeding.
Gingival Enlargement Treatment
“Early Signs Of Phenytoin-Related Gingival Problems”
Gingival Enlargement Pathogenesis
It is suggested that there are different subpopulation of fibroblasts in gingival tissue some of which synthesize large amount of high activity fibroblasts and others, which are only capable of low activity fibroblasts. So, Hassell suggested that high activity fibroblasts are sensitive to dilantin which causes increase in collagen production.
Gingival Enlargement Management
Gingival Enlargement Management First Step
- Oral hygiene reinforcement, chlorhexidine gluconate rinses, scaling and root planning.
- Possible drug substitution: When it is attempted it is necessary to allow at least a period of 6 to 12 months between discontinuation of offending drug and possible resolution of gingival enlargement.
“Understanding The Role Of Phenytoin In Gingival Enlargement”
- Professional recalls.
- Azithromycin decreases the severity of cyclosporine induced gingival enlargement.
- Folic acid supplementation significantly decreases the incidence of gingival overgrowth.
- Periodic recall visits.
“Difference Between Phenytoin-Induced And Other Gum Enlargements”
Gingival Enlargement Management Second Step
- If enlargement persists after following the above steps: Surgical therapy is indicated. There are two surgical options available based on feature it presents.
- Small areas of enlargement with no attachment loss or bone loss and has good keratinized tissue, gingivectomy is treatment of choice.
- Large areas of enlargement with presence of osseous defects and limited keratinized, gingival, periodontal flop surgery are indicated.
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