Drug-influenced Gingival Enlargement: Overview of the Clinical Features and Assessment Methods
DOI:
https://doi.org/10.12974/2311-8695.2019.07.1Keywords:
Gingival enlargement, Drug-induced gingival overgrowth, Calcium channel blocker, Immunosuppressant, Anticonvulsant.Abstract
Drug-influenced gingival enlargement is an unwanted effect of the gingiva affecting patients’ aesthetic as well as oral hygiene procedures. The presentation of the enlargement may range from mild to severe by which the chewing function could also be affected. Patients usually were not aware of this condition until they feel discomfort, thus seek for treatment. This review will discuss the overview of common drugs that influence gingival enlargement, its clinical features, previous and current methods of assessment to determine the severity of the gingival enlargement. The review will serve as a guide for clinician in making diagnosis and treatment plan of such condition.
References
Amit B, Shalu B. Gingival enlargement induced by anticonvulsants, calcium channel blockers and immunosuppressants: a review. IRJP 2012; 3: 116-119.
Andrew W, Evelyn W, Francis M, Mark J, Mark C. Pattern of gingival overgrowth among patients on antihypertensive pharmacotherapy at a Nairobi hospital in Kenya. Open Journal of Stomatology 2014; 4: 169. https://doi.org/10.4236/ojst.2014.44025
Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque–induced gingival conditions. Journal of Clinical Periodontology 2018; 45: S17-S27. https://doi.org/10.1111/jcpe.12937
Gupta N, Goyal L, Gupta N. Periodontal Management of Phenytoin Induced Gingival Enlargement: A Case Report. J Dent Health Oral Disord Ther 2017; 8: 00271.
Preshaw PM. Oral contraceptives and the periodontium. Periodontology 2000 2013; 61: 125-159. https://doi.org/10.1111/j.1600-0757.2011.00399.x
Brown RS, Arany PR. Mechanism of drug-induced gingival overgrowth revisited: a unifying hypothesis. Oral Dis 2015; 21: e51-61. https://doi.org/10.1111/odi.12264
Seymour R, Heasman P. Drugs and the periodontium. Journal of Clinical Periodontology 1988; 15: 1-16. https://doi.org/10.1111/j.1600-051X.1988.tb01549.x
Richens A. Clinical pharmacokinetics of phenytoin. Clinical Pharmacokinetics 1979; 4: 153-169. https://doi.org/10.2165/00003088-197904030-00001
Brunet L, Miranda J, Roset P, Berini L, Farre M, Mendieta C. Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs. European Journal of Clinical Investigation 2001; 31: 781-788. https://doi.org/10.1046/j.1365-2362.2001.00869.x
Angelopoulos A, Goaz P. Incidence of diphenylhydantoin gingival hyperplasia. Oral Surgery, Oral Medicine, Oral Pathology 1972; 34: 898-906. https://doi.org/10.1016/0030-4220(72)90228-9
Modéer T, Dahllöf G, Theorell K. Oral health in non‐institutionalized epileptic children with special reference to phenytoin medication. Community Dentistry and Oral Epidemiology 1986; 14: 165-168. https://doi.org/10.1111/j.1600-0528.1986.tb01524.x
Hassel, Hefti. Drug-induced gingival overgrowth: old problem. Critical reviews in oral biology and medicine: an official publication of the American Association of Oral Biologists. Critical Review in Oral Biology and Oral Medicine 1991; 2: 103-137.
Gopal S, Joseph R, Santhosh VC, Kumar VVH, Joseph S, Shete AR. Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study. Journal of Indian Society of Periodontology 2015; 19: 308. https://doi.org/10.4103/0972-124X.153483
Laurent S. Antihypertensive drugs. Pharmacological Research 2017; 124: 116-125. https://doi.org/10.1016/j.phrs.2017.07.026
Marshall RI, Bartold PM. A clinical review of drug‐induced gingival overgrowths. Australian Dental Journal 1999; 44: 219-232. https://doi.org/10.1111/j.1834-7819.1999.tb00224.x
Lederman D, Lumerman H, Reuben S, Freedman PD. Gingival hyperplasia associated with nifedipine therapy: report of a case. Oral Surgery, Oral Medicine, Oral Pathology 1984; 57: 620-622. https://doi.org/10.1016/0030-4220(84)90283-4
Cucchi G. Gingival hyperplasia caused by verapamil. Ital J Cardiol 1985; 15: 556-557.
Colvard M, Bishop J, Weissman D, Gargiulo A. Cardizem induced gingival hyperplasia: a report of two cases. Periodontal case reports: a publication of the Northeastern Society of Periodontists 1986; 8: 67-68.
Seymour R, Ellis J, Thomason J, Monkman S, Idle J. Amlodipine‐induced gingival overgrowth. Journal of Clinical Periodontology 1994; 21: 281-283. https://doi.org/10.1111/j.1600-051X.1994.tb00318.x
Nishikawa S, Nagata T, Morisaki I, Oka T, Ishida H. Pathogenesis of drug-induced gingival overgrowth. A review of studies in the rat model. Journal of Periodontology 1996; 67: 463-471. https://doi.org/10.1902/jop.1996.67.5.463
Ellis JS, Seymour RA, Steele JG, Robertson P, Butler TJ, Thomason JM. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. Journal of Periodontology 1999; 70: 63-67. https://doi.org/10.1902/jop.1999.70.1.63
Beaumont J, Chesterman J, Kellett M, Durey K. Gingival overgrowth: Part 1: aetiology and clinical diagnosis. Br Dent J 2017; 222: 85-91. https://doi.org/10.1038/sj.bdj.2017.71
Umeizudike KA, Olawuyi AB, Umeizudike TI, Olusegun- Joseph AD, Bello BT. Effect of calcium channel blockers on gingival tissues in hypertensive patients in Lagos, Nigeria: A pilot study. Contemporary Clinical Dentistry 2017; 8: 565. https://doi.org/10.4103/ccd.ccd_536_17
Taib H, Ali TBT, Kamin S. Amlodipine-induced gingival overgrowth: a case report. Archives of Orofacial Sciences 2007; 2: 61-64.
Asari ASM. The Expert Says Current Concept in Gingival Overgrowth. Editorial Advisory Board 2007; 28: 107-111.
Miranda J, Brunet L, Roset P, Berini L, Farré M, Mendieta C. Prevalence and risk of gingival overgrowth in patients treated with diltiazem or verapamil. Journal of Clinical Periodontology 2005; 32: 294-298. https://doi.org/10.1111/j.1600-051X.2005.00662.x
Bowman JM, Levy BA, Grubb RV. Gingival overgrowth induced by diltiazem: a case report. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 1988; 65: 183- 185. https://doi.org/10.1016/0030-4220(88)90163-6
Miller CS, Damm DD. Incidence of Verapamil‐Induced Gingival Hyperplasia in a Dental Population. Journal of Periodontology 1992; 63: 453-456. https://doi.org/10.1902/jop.1992.63.5.453
Rateitschak‐Plüss E, Hefti A, Lörtscher R, Thiel G. Initial observation that cyclosporin‐A induces gingival enlargement in man. Journal of Clinical Periodontology 1983; 10: 237-246. https://doi.org/10.1111/j.1600-051X.1983.tb01272.x
Wysocki GP, Gretzinger HA, Laupacis A, Ulan RA, Stiller CR. Fibrous hyperplasia of the gingiva: a side effect of cyclosporin A therapy. Oral Surgery, Oral Medicine, Oral Pathology 1983; 55: 274-278. https://doi.org/10.1016/0030-4220(83)90327-4
Seymour R, Smith D. The effect of a plaque control programme on the incidence and severity of cyclosporin‐induced gingival changes. Journal of Clinical Periodontology 1991; 18: 107-110. https://doi.org/10.1111/j.1600-051X.1991.tb01698.x
Daley T, Wysocki G, Day C. Clinical and pharmacologic correlations in cyclosporine-induced gingival hyperplasia. Oral Surgery, Oral Medicine, Oral Pathology 1986; 62: 417- 421. https://doi.org/10.1016/0030-4220(86)90291-4
Tyldesley W, Rotter E. Gingival hyperplasia induced by cyclosporin-A. British Dental Journal 1984; 157: 305. https://doi.org/10.1038/sj.bdj.4805474
Seymour R, Smith D, Rogers S. The comparative effects of azathioprine and cyclosporin on some gingival health parameters of renal transplant patients. Journal of Clinical Periodontology 1987; 14: 610-613. https://doi.org/10.1111/j.1600-051X.1987.tb01524.x
Bharti V, Bansal C. Drug-induced gingival overgrowth: the nemesis of gingiva unravelled. Journal of Indian Society of Periodontology 2013; 17: 182. https://doi.org/10.4103/0972-124X.113066
Missouris G, Kalaitzidis R, Cappuccio F, MacGregor G. Gingival hyperplasia caused by calcium channel blockers. Journal of Human Hypertension 2000; 14: 155. https://doi.org/10.1038/sj.jhh.1000954
Smitha Rani Thada VR, Keerthilatha MP. Unusual Clinical Presentation of Generalised Gingival enlargement. International Journal of Collaborative Research on Internal Medicine and Public Health 2012; 4: 240-254
Taylor BA. Management of drug-induced gingival enlargement. Australian Prescriber 2003; 26: 11-13. https://doi.org/10.18773/austprescr.2003.007
Uzel MI, Kantarci A, Hong H-H, Uygur C, Sheff MC, Firatli E, Trackman PC. Connective tissue growth factor in druginduced gingival overgrowth. Journal of Periodontology 2001; 72: 921-931. https://doi.org/10.1902/jop.2001.72.7.921
Hallmon WW, Rossmann JA. The role of drugs in the pathogenesis of gingival overgrowth. A collective review of current concepts. Periodontology 2000 1999; 21: 176-196. https://doi.org/10.1111/j.1600-0757.1999.tb00175.x
Hall P, Levison D, Woods A, Yu CW, Kellock D, Watkins J, Barnes D, Gillett C, Camplejohn R, Dover R. Proliferating cell nuclear antigen (PCNA) immunolocalization in paraffin sections: An index of cell proliferation with evidence of deregulated expression in some, neoplasms. The Journal of Pathology 1990; 162: 285-294. https://doi.org/10.1002/path.1711620403
Dongari-Bagtzoglou A. Research, Science and therapy committee, american academy of periodontology. Drugassociated gingival enlargement. J of Periodontology 2004; 75: 1424-1431. https://doi.org/10.1902/jop.2004.75.10.1424
Schincaglia G, Forniti F, Cavallini R, Piva R, Calura G, Senno L. Cyclosporin‐A increases type I procollagen production and mRNA level in human gingival fibroblasts in vitro. Journal of Oral Pathology & Medicine 1992; 21: 181- 185. https://doi.org/10.1111/j.1600-0714.1992.tb00098.x
Kantarci A, Nseir Z, Kim Y-S, Sume S, Trackman P. Loss of basement membrane integrity in human gingival overgrowth. Journal of Dental Research 2011; 90: 887-893. https://doi.org/10.1177/0022034511404703
Sume SS, Kantarci A, Lee A, Hasturk H, Trackman PC. Epithelial to mesenchymal transition in gingival overgrowth. The American Journal of Pathology 2010; 177: 208-218. https://doi.org/10.2353/ajpath.2010.090952
Seymour R, Smith D, Turnbull D. The effects of phenytoin and sodium valproate on the periodontal health of adult epileptic patients. Journal of Clinical Periodontology 1985; 12: 413-419. https://doi.org/10.1111/j.1600-051X.1985.tb01377.x
Miranda J, Brunet LI, Roset PN, Farré M, Berini L, Mendieta C. Prevalence and risk for gingival enlargement induced by calcium channel blockers (abstract). Int J Dent 1998; 48: 450
Miranda J, Brunet L, Roset P, Berini L, Farré M, Mendieta C. Prevalence and risk of gingival enlargement in patients treated with nifedipine. Journal of Periodontology 2001; 72: 605-611. https://doi.org/10.1902/jop.2001.72.5.605
Ingles E, Rossmann JA, Caffesse RG. New clinical index for drug-induced gingival overgrowth. Quintessence Int 1999; 30: 467-473.
