Drug Induced Gingival Enlargement

Question 1

What is hereditary gingival fibromatosis?
What is the clinical appearance?

Answer 1

• Inherited condition which is usually caused by an autosomal dominant gene
• Often noticed in secondary dentition or can prevent the eruption of teeth particularly in the upper anterior region
• Can have a localised or generalised appearance
• Occurs due to excessive collagen production due to activated fibroblasts with a high rate of proliferation

Clinical Appearance
- Tissues appear shiny and bulky
- Thick and fibrous
- Large masses of firm, dense, resistant fibrous tissue

Question 2

What problems do patients with hereditary gingival fibromatosis have?

Answer 2

• Hard to maintain plaque control
• Patient may have a true pocket due to periodontitis or a pseudo pocket caused by gingival fibromatosis
• Problems with mastication
• Delayed tooth eruption where the gingiva the crowns partially or completely
• Alter in speech as the sound may not be pronounced
• Aesthetics

Question 3

What is the clinical appearance of general gingival enlargement?

Answer 3

• Papillary swellings
• The swellings are often pedunculate rather than sessile
• Texture of gingiva if often firm and fibrous
• Localised or generalised

Question 4

What are the 3 main medications that can cause gingival enlargement?

Answer 4

1) Calcium channel blockers e.g. amlodipine, nifedipine

2) Phenytoin e.g. epilepsy management

3) Cyclosporin - immunosuppressive

Question 5

What are the general features of drug induced enlargement?

Answer 5

• Growth starts are a painless beadlike enlargement interdentally
• Spreads to buccal and lingual gingival margins
• Can eventually lead to tissue folds that can interfere with occlusion
• The effect is not related to drug dose
• Generally due to an imbalance of collagen degradation and production of connective tissue matrix due to an inactive collagenase production by gingival fibroblasts

Question 6

What is the effect of plaque on drug related gingival enlargement?

Answer 6

Secondary inflammation due to plaque present

Question 7

What are calcium channel blockers?

Answer 7

Used for cardiovascular conditions
- Hypertension
- Angina
- Cardiac arrthmias

They inhibit calcium ion influx across cell membranes of muscles cells. This leads to dilation of the coronary arteries and arterioles. Providing an improved oxygen supply to the heart muscle to reduce hypertension.

Examples: amlodipine, nifedipine

Question 8

What is cyclosporin used for?

Answer 8

Prevents organ transplant rejection. Used for auto-immune disease. It inhibits T helper cells
Over 500mg per day induces the gingival enlargement.

Question 9

What is phenytoin used for?

Answer 9

• Given to treat epilepsy of all types except petit mal
• Gingival enlargement occurs in 50% of patients on this drug
• Occurs due to production of inactive collagenase

Question 10

How is drug induced gingival enlargement managed?

Answer 10

1) Plaque control is important to decrease vascularity of the tissue
2) Surgery (gingivectomy or flap surgery)
3) Changing their medication (need to liaise with gp)