Oral hygiene maintenance can modify phenytoininduced gingival enlargement, hence it plays a crucial role in control of this lesion. One of the main drugs associated with go is the antiepileptic. Prevalence and clinical aspects of druginduced gingival. This case report describes the management of a patient with phenytoininduced gingival overgrowth by both nonsurgical and surgical approaches. Interactions between simultaneously administered medications affecting gingival enlargement have also been reported. Gingival enlargement an overview sciencedirect topics.
Drug induced gingival overgrowth is a common complication of the continuous use of medications, such as anticonvulsant phenytoin, antihypertensive calcium channel blockers nifedipine, and immunosuppressant cyclosporinea therapy. Learn the shocking truth about uterine fibroids, drugs and surgeries. Phenytoin is an anticonvulsant which is seen to cause gingival enlargement in human patients with a reported incidence of 50%. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Gingival enlargement is one of the frequent features of gingival diseases. Pathogenesis of phenytoininduced gingival overgrowth. Phenytoininduced gingival overgrowth in rats infected with.
Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Jun 20, 2018 there are an assortment of medications that have been reported to affect the size of the gingival tissues. Phenytoin and amlodipineinduced gingival overgrowth. Gingival overgrowth is a common side effect of phenytoin, termed phenytoin induced gingival overgrowth pigo. Phenytoininduced gingival overgrowth pigo is a common complication of the continuous use of medications. Management per case is different due to different etiologic factors. Reports about the possible etiological mechanisms of drug induced gingival overgrowth have been suggested 1, 2, 3 such as an imbalance in collagen. Gingival enlargement, maintenance phase, phenytoin. Case report drug substitution and nonsurgical therapy in. Gingival overgrowth occurs as a side effect of some systemic medications. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. Phenytoininduced severe gingival overgrowth in a child bmj. Introduction an adverse effect caused due to an intake of three types of drugs namely phenytoin, an antiepileptic. Druginduced gingival enlargement manifests as an abnormal growth of the gingiva due to an adverse drug reaction in patients treated with anticonvulsa.
The gingival fibroblasts can also metabolise phenytoin and this may determine the susceptibility of the patient to phenytoin induced gingival enlargement. Antush mittal and shoyab khan, phenytoin induced gingival overgrowth. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Phenytoin pht induced gingival overgrowth pigo due to chronic administration remains an unsolved problem. Gingival enlargement, chronic myeloid leukemia, zimmermannlaband syndrome, nifedipine introduction gingival enlargement ge is defined as an abnormal overgrowth of gingival tissues. Phenytoin is one of the most common drugs associated with gingival overgrowth. Pdf periodontal management of phenytoin induced gingival. Druginduced gingival enlargement was first reported in 1939 by kimball3 with chronic usage of the antiepileptic drug phenytoin pht mainly administered during epilepsy. Phenytoininduced gingival overgrowth management with. Lesion severity was then compared statistically to other clinical and laboratory parameters. Figure 4 illustrates gingival overgrowth on a patient who has been taking phenytoin for several years.
Crossref david m jacobs, joan m duggan and eric g sahloff, gingival hypertrophy associated with amlodipine use in an hivinfected woman, journal of pharmacy technology, 29, 4, 175. An outpatient population of patients on phenytoin treatment and attending the epilepsy clinic at prince mshiyeni memorial hospital pmmh in durban, south africa, was requested to participate. Although the overgrowth does not seem to affect edentulous areas, 19. Several mechanisms are involved in the development of gingival overgrowth. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. 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. Drug induced gingival enlargement drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Gingival enlargement or overgrowth go is a common complication of the anticonvulsant drug phenytoin pht. Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response. Younger age groups experience more lesions than adults and in the handicapped the prevalence appears to be highest.
Request pdf on may 28, 2014, lisa neelathil chacko and others published phenytoininduced gingival enlargement find, read and cite all the research you need on researchgate. Drug induced gingival overgrowth occurs in whole or in part from systemic drug usage. It is now well established that phenytoin is one such. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Clinical and pharmacological variables as a risk factor. Gingival enlargement during puberty has all the clinical features associated with chronic inflammatory gingival disease.
Aspects of drug induced gingival enlargement prevalence the prevalence of gingival overgrowth varies with drugs. A patient with drug induced gingival enlargement is characterized by granular or pebbly surface, with the enlarged papillae extending facially andor lingually, obscuring the adjacent tissue and tooth surfaces. Systemic and clinical treatment of gingival hyperplasia. To get the facts on exactly how to eliminate your uterine fibroids from the root 100% naturally and permanently and achieve lasting freedom from pcos related symptoms without spending your hardearned money on drugs and over the counters. The incidence rate of phenytoininduced gingival overgrowth ranges from 3% to 93%, but 50% of patients on longterm therapy are prone to develop gingival overgrowth. It is the degree of enlargement and the tendency to develop massive recurrence in the presence of relatively scant plaque deposits that distinguish pubertal gingival enlargement from. Three types of drugs are known to induce gingival overgrowth with variable degrees of fibrosis and inflammation. Druginduced gingival enlargement druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Phenytoininduced gingival enlargement bmj case reports. Nov 14, 2019 the first case of phenytoin induced gingival enlargement was reported in 1939 by kimball. Clinical report systemic and clinical treatment of gingival.
Gupta n, goyal l, gupta nd 2017 periodontal management of phenytoin induced gingival enlargement. We analyzed reports of digh from srs databases and calculated the reporting odds ratios rors of. Gingival hyperplasia or gingival overgrowth is a common occurrence in patients taking phenytoin, cyclosporine, or calcium channel blockers. Gingival enlargement associated with multiple factors is leading to gingival dimorphism agrawal, 2015. Experimental design for phenytoin induced gingival overgrowth in rats. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. Author links open overlay panel antush mittal shoyab khan. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Clinical management of phenytoininduced gingival overgrowth. Phenytoininduced severe gingival overgrowth in a child. A case report, journal of pierre fauchard academy india section, 27, 3, 102, 20. Nonsurgical management of nifedipine induced gingival overgrowth. Phenytoin induced gingival overgrowth in institutionalized. Phenytoin induced gingival overgrowth is a well known and frequently reported gingival lesion, which was.
The enlargement can be inflammatory,fibrotic or a combination of both. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Drug induced gingival overgrowth is frequently associated with three particular drugs. Studies of patients taking this anticonvulsant drug suggest that bacterial plaque is an important determinant of the severity of phenytoin induced gingival overgrowth and stress the importance of instituting. Periodontal management of phenytoin induced gingival. As an anticonvulsant, phenytoin has long been used to treat epilepsy, whereas valproic acid is a new antiepileptic. Pht wako pure chemical industry ltd, osaka, japan was added to the diet only of groups a and c at a concentration of 1 mgg. Gingival enlargement is a well known consequence of the administration of certain anticonvulsants.
In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Drug induced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Acute myelomonocytic leukemia presenting with gingival enlargement as the only clinical manifestation. The pathogenesis of drug induced gingival enlargement is uncertain and there appears to be no unifying hypothesis that links together the three commonly implicated drugs. Dental plaqueinduced gingival conditions murakami 2018. The prevalence rate of drug induced gingival enlargement was reported to vary. Management of phenytoininduced gingival enlargement. Pht induced gingival overgrowth pgo is more common in children than in adults and affects both males and females equally. 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. Unusual clinical presentation of generalised gingival. The most effective treatment of drugrelated gingival enlargement is withdrawal or substitution of medication. Pdf gingival enlargement is known side effect of certain medications like anticonvulsants, calcium channel blockers and immunosuppressant.
Oral hygiene modifies pigo and it is suggested that minimal plaque drug levels. It is now well established that phenytoin is one such agent. It is the degree of enlargement and the tendency to develop massive recurrence in the presence of relatively scant plaque deposits that distinguish pubertal gingival enlargement from uncomplicated. Go is evident in almost half of the patients receiving pht therapy. The drug replacement and scaling and root planing produced drastic reduction in the enlargement, requiring no surgical intervention. Druginduced gingival enlargement was first reported in 1939 by kimball 3 with chronic usage of the antiepileptic drug phenytoin pht mainly administered during epilepsy. To ascertain the prevalence and severity of phenytoin. Positive correlations were detected between overgrowth severity and. Management of druginduced gingival enlargement australian. Individualized treatment plan for gingival enlargement. The gingival fibroblasts can also metabolise phenytoin and this may determine the susceptibility of the patient to phenytoininduced gingival enlargement. Hipertrofia gengival e o termo usado na atualidade.
This case report consists of phenytoin usage, duration and poor oral hygiene. Periodontal management of phenytoin induced gingival enlargement. There are an assortment of medications that have been reported to affect the size of the gingival tissues. There are several causes of gingival enlargement and they can be grouped into four categories. It occurs as a side effect following the administration of drugs used mainly for nondental treatments and thus, the overgrowth can not be explained as a variation of the intended pharmacological action of the drug. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Gingival enlargement or gingival overgrowth are the current terms for all medicationrelated gingival lesions, previously known as gingival hyperplasia or gingival hypertrophy. Treating patients with druginduced gingival overgrowth.
Digo is a common clinical problem that often requires intervention. This case report describes a case of pht induced gingival enlargement in which surgical intervention was done to correct the gingival enlargement, and in spite of patient not discontinuing the drug pht, no recurrence of enlargement was seen even after 1 year. Prevention of phenytoininduced gingival overgrowth by. Gingival enlargement, gingival hyperplasia, gingival overgrowth, amlodipine, phenytoin, drug induced gingival enlargement.
Medically induced gingival hyperplasia mayo clinic proceedings. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Gingival enlargement is a ordinary finding in clinical practice and the appropriate treatment depends on correctly diagnosing the cause of the enlargement. The prevalence of pigo in the general population is around 40% of those taking the drug. The druginduced gingival enlargement could be detected clinically as early as months following the initial dose of ccb. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque induced gingival inflammation and reduce. Studies of patients taking this anticonvulsant drug suggest that bacterial plaque is an important determinant of the severity of phenytoin induced gingival overgrowth and. May 28, 2014 phenytoin and its metabolites have a direct action on the highactivity fibroblast population present in the gingiva leading to a subsequent increase in collagen production. Background gingival enlargement is a common clinical feature of gingival and periodontal diseases.
Calcium channel blockerinduced gingival enlargement. The incidence rate of phenytoin induced gingival overgrowth ranges from 3% to 93%, but 50% of patients on longterm therapy are prone to. The present case report describes a successful management of phenytoin induced gingival enlargement in year old female by combined surgical and nonsurgical approach. Phenytoin induced gingival overgrowth pigo is a common complication of the continuous use of medications. Gingival enlargement is known side effect of certain medications like anticonvulsants, calcium channel blockers and immunosuppressant. Miranda, brunet, roset, berini, farre, mendieta 10 performed a cross sectional study and compared the nifedipineinduced gingival growth to controls who had never received the drug. The patient was treated with complete oral prophylaxis and substitution of phenytoin with gabapentin. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Pgo may vary from mild to severe and does not seem to be dose dependant. Request pdf on may 28, 2014, lisa neelathil chacko and others published phenytoin induced gingival enlargement find, read and cite all the research you need on researchgate. Drug induced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. This druginduced overgrowth is noticed initially in the papillary region and during the course of the process involves the margins and the gingival attachment.
Interactions between simultaneously administered medications affecting. Journal of pierre fauchard academy india section volume 27, issue 3, september 20, pages 102105. Phenytoin and its metabolites have a direct action on the highactivity fibroblast population present in the gingiva leading to a subsequent increase in collagen production. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and.
754 962 670 516 1238 549 329 1576 280 436 466 457 1490 1201 701 1465 213 1476 42 300 246 1518 38 591 627 157 721 1123 442 237 752 273 12 753 1046 1041 1004 1490 612 294 178 99 643 1275 1103 1135 679