Druginduced gingival enlargement was first reported in 1939 by kimball with chronic usage of the antiepileptic drug phenytoin pht mainly. However, the effects of newergeneration antiepileptic drugs on oral health have not yet been studied. The effects of antiepileptic drugs on oral health jcda. Phtinduced gingival overgrowth pgo is more common in children than in adults and affects both males and females equally. Silverstain et al 1995 nifidepine induced gingival enlargements has been reported around dental implants yoon angela et al in 2006 myeloid sarcoma occurring concurrently with drug induced gingival enlargement frederic duffau in 2007 gingival enlargement originating from medication and tooth migration 48. Of the predisposing factors associated with the gingival enlargement, selected anticonvulsant drug, calcium channel blockers and a potent immunosuppressant cyclosporine a have generated the most investigative attention in the scientific community. Clinical management of gingival enlargement caused by. Druginduced gingival overgrowth is frequently associated with three particular drugs. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Gingival enlargement is an increase in the size of the gingiva gums.
Patients taking carbamazepine or phenytoin had alveolar bone loss. Pdf gingival enlargement is an increase in the size or inflammation of the gingiva. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary phenomenon that occurs with the use of several types of therapeutic agents, including antiepileptic drugs. Brunet l1, miranda j, roset p, berini l, farre m, mendieta c.
Larger areas of gingival enlargement more than 6 teeth or areas where attachment loss and osseous defect are present should be treated by the flap technique, as should any situation in which the gingivectomy may create a mucogingival problem. Phenytoin is an anticonvulsant which is seen to cause gingival enlargement in human patients with a reported incidence of 50%. Materials and methods a crosssectional study was conducted and data from 59 patients taking antiepileptics. Clinical report systemic and clinical treatment of. One of the main drugs associated with go is the antiepileptic. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement. This disorder has been recognized since 1939, shortly after the introduction of phenytoin.
Gingival enlargement, gingival index, plaque index, and probing depth were measured to assess periodontal health. Medically induced gingival hyperplasia mayo clinic proceedings. This study aimed to assess the prevalence of gingival enlargement and seizurerelated orodental injuries among patients with epilepsy. Laser management of phenytoin induced gingival enlargement. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. Pdf prevalence and risk of gingival enlargement in patients.
In acute reactive gingival hyperplasia the gums are red, boggy, and bleed easily with minor trauma. Gingival enlargement is the term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary. Anticonvulsant, gingival overgrowth, gingival enlargement, phenytoin, drug induced gingival enlargement, drug induced gingival. Definition gingival hyperplasia is defined as an enlargement of the gingiva that is noninflammatory, produced by factors other than local irritation, and the result of an increased number of cells. Gingival hyperplasia, also known as gingival enlargement, is a swelling of the gum tissue gingiva. Pdf gingival enlargement is one of the frequent features of gingival diseases. Oral manifestations of tuberous sclerosis complex in a. Good oral hygiene may help to prevent the onset and development of gingival enlargement. The periodontal flap technique used for the treatment of. Gingival enlargement is a well recognized unwanted effect associated mainly with anticonvulsant drugs. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Although the association between phenytoin and gingival overgrowth is widely recognized, other anticonvulsant agents such as.
A thorough literature search of the pubmed embase web of science cochrane central database was conducted to identify the mechanisms involved in the process of phenytoininduced gingival overgrowth using the following keywords. Gingival enlargement or hyperplasia is an abnormal condition in which the gingiva presents changes in volume and ranges from a slight hyperplasia of the interdental papillae to a growth in which the dental crowns remain completely covered by the altered tissue. In this case, the patient did not have any history of seizures and was not taking any medication, thus the gingival enlargement was a result of tsc as opposed to being a side effect of the anticonvulsant medication. Gingival enlargement or overgrowth go is a common complication of the anticonvulsant drug phenytoin pht. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications.
Druginduced gingival enlargement is a frequent complication of phenytoin anticonvulsant therapy. Sodium valproate used as an antidepressant and anticonvulsant. A patients diagnosis and treatment rely on proper classification of gingival diseases. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Case report gingival enlargement induced by felodipine resolves with a conventional periodontal treatment and drug modification nabilkhzam, 1 davidbailey, 1 helens. Drug induced gingival enlargement is the term now used to describe medication related gingival hypertrophy or hyperplasia, a condition commonly induced by three main classes of drugs. Phenytoin and amlodipineinduced gingival overgrowth. Epilepsy is not a single diseaseit is a set of symptoms that may have different causes in different people. More than 20 prescription medications are associated with gingival overgrowth. Gingival enlargement an overview sciencedirect topics.
Gingival enlargement is a term now used to describe medicationrelated gingival overgrowth or gingival hyperplasia, a common reactionary phenomenon that occurs with use of several types of therapeutic agents, including aeds. Drugs associated with gingival enlargement can be broadly divided into three categories. Gingival enlargement is the most common adverse drug drug effect in the young adults and children receiving phenytoin as antiepileptic drug therapy. In a study of the prevalence and risk of gingival overgrowth in patients treated with anticonvulsant drugs, brunet et al. To the right is an example caused by the cardiovascular drug nifedipine. Nonsurgical management of nifedipine induced gingival. Gingival diseases modified by medications classification of gingival diseases is a significant part of an intraoral examination. A structured questionnaire was used to collect data on patients demographics, dental and oral hygiene practices, and medication history. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of.
Every case of gingival enlargement should be treated in a stepwise manner inclusive of consultation with patients physician, substitution of the drug, nonsurgical and surgical therapy. Phenytoininduced severe gingival overgrowth in a child. Atul anand bajoria, department of oral medicine and radiology, sri hasanamba dental college and hospital, hassan. We describe a unique case of massive phenytoininduced gingival overgrowth preventing the eruption of all teeth and subsequent dentofacial. Pgo may vary from mild to severe and does not seem to be dose dependant. Associated gingival enlargement wiley online library. Treatment of gingival enlargement by dr harshavardhan patwal. In severe cases, gingival hyperplasia can cause marked cosmetic deformity and significant occlusal changes which severely restrict masticatory function. Drug induced gingival enlargement by rajesh hosadurga. Medicationinduced gingival enlargement patients who take certain medications may develop gingival enlargement. 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.
Gingival enlargement can be hereditary or acquired. Anticonvulsant drugs definition anticonvulsant drugs are medicines used to prevent or treat convulsions seizures. An update on the mechanisms of phenytoin induced gingival. If there is no history of being on any of the suspect drugs, and the problem is generalized surrounding many if not all teeth in a fairly symmetrical fashion, then you are likely dealing with idiopathic gingival hyperplasia and surgery will. There are a number of causes for this condition, but its often a symptom of poor oral hygiene or a side effect of using.
Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and. This paper presents a case of pigo hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. Chronic comedication with phenytoin and other anticonvulsant agents does not affect the degree of gingival enlargement in adult epileptic patients. Relationship between amphetamine ingestion and gingival. Patients living with epilepsy suffer from the adverse effects of antiepileptic medication such as gingival enlargement and traumatic injuries of the oral cavity related to the epileptic seizures.
Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Case report gingival enlargement induced by felodipine. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. The chisquare and fisher exact tests were used in statistical analysis. This study was conducted to determine, with the aid of two indices that score vertical and horizontal overgrowth, the prevalence and risk factors for gingival enlargement in patients treated with phenytoin and other anticonvulsant drugs. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and. Treating patients with druginduced gingival overgrowth. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician.
Surgical approach to drug induced gingival enlargement in renal transplant patients case report christina popova, antoaneta mlachkova department of periodontology, faculty of dental medicine, medical university sofia, bulgaria journal of imab annual proceeding scientific papers 2007, vol. Purpose anticonvulsant drugs are used to control seizures in people with epilepsy. Gingival enlargement ge or gingival overgrowth go is a clinical condition that alters the position of the gingival margin and comprises an increase in the size of the gingiva 1 gittaboyina s, mana tk, koduganti rr, reddy pv. Phenytoininduced gingival overgrowth management with.
Hyperplasia specifically means an increase in the number of cells in the gum tissue. Prevalence and risk of gingival enlargement in patients. Although the association between phenytoin and gingival overgrowth is widely recognized, other anticonvulsant agents such as barbiturates, valproic acid. Anticonvulsant drugs definition of anticonvulsant drugs.
Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. Go is evident in almost half of the patients receiving pht therapy. The pathogenesis of druginduced gingival enlargement is uncertain and there appears to be no. Anticonvulsants are drugs that can modify the gingival tissues response to inflammatory processes in the presence of dental plaque, inducing gingival overgrowth. Gingival hyperplasia is an overgrowth of gum tissue around the teeth. The median timetoonset of gingival hyperplasia values for immunosuppressants, calcium channel blockers, and anticonvulsants use were 71. The role of plaque in gingival growth induced by anticonvulsant has been investigated, and the vast majority of studies show that the presence of plaque and gingival inflammation are important intervening factors for the development andor expression of this clinical situation. Systemic and clinical treatment of gingival hyperplasia.
As an anticonvulsant, phenytoin has long been used to treat epilepsy, whereas valproic acid is a new antiepileptic and appears to be as effective as. 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. If the patient is on one of those drugs, get it off. However, few reports discussed the effects of the combination of an anticonvulsant phenytoin and a calciumchannel blocker amlodipine.
As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Anticonvulsant medication, such as phenytoin, is known to potentially contribute to and exacerbate gingival enlargement 16,23. In chronic fibrotic gingival hyperplasia chronic fibrosis which resembles scarring eventually covers the teeth. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Gingival enlargement is one of the frequent features of gingival diseases. Pdf prevalence and risk of gingival enlargement in. This increase in gingival cells has many different causes, but one of the most common is drug. Unusual clinical presentation of generalised gingival.
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