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