Drug-related gingival hyperplasia

Drug-related gingival hyperplasia is a condition characterized by the overgrowth of the gum tissue (gingiva) around the teeth, a side effect associated with certain medications. This condition is also known as drug-induced gingival enlargement or drug-induced gingival overgrowth. It is a significant dental health issue that can affect both the appearance and functionality of the gums, leading to discomfort and, in severe cases, affecting the alignment of the teeth and oral hygiene.

Causes

Drug-related gingival hyperplasia is primarily caused by three types of medications:

• Anticonvulsants: Medications used to manage seizures, with Phenytoin being the most commonly implicated.
• Calcium channel blockers: Used in the treatment of hypertension, certain heart conditions, and migraine headaches. Nifedipine, Amlodipine, and Verapamil are examples of calcium channel blockers that can cause gum overgrowth.
• Immunosuppressants: Drugs that suppress the immune system, such as Cyclosporine, used in organ transplant patients to prevent organ rejection.

Pathophysiology

The exact mechanism by which these drugs cause gingival hyperplasia is not fully understood. However, it is believed that these medications may stimulate the production of certain types of collagen or other extracellular matrix components, leading to an accumulation of connective tissue. Additionally, they may also interfere with the normal cell death process (apoptosis), resulting in an accumulation of gingival fibroblasts, which contribute to the increased bulk of the gum tissue.

Symptoms

Symptoms of drug-related gingival hyperplasia include:

• Swollen, overgrown gums
• Gums that bleed easily
• Discoloration of the gums
• Difficulty with oral hygiene due to the enlargement of the gums
• In severe cases, the overgrown gums can cover the teeth completely and may interfere with eating and speaking.

Diagnosis

Diagnosis of drug-related ginginal hyperplasia is primarily based on the medical history of the patient, particularly the use of medications known to cause gum overgrowth, and a clinical examination of the oral cavity. Dental X-rays may be used to assess the severity of the condition and to rule out other causes of gum enlargement.

Treatment

Treatment options for drug-related gingival hyperplasia include:

• Good oral hygiene practices, including regular brushing and flossing, to minimize plaque accumulation that can exacerbate the condition.
• Professional dental cleanings and possibly more extensive periodontal treatments to manage the overgrowth.
• In some cases, surgical removal of the excess gum tissue (gingivectomy) may be necessary.
• Consultation with the prescribing physician to discuss the possibility of switching to an alternative medication that does not cause gingival hyperplasia, if feasible.

Prevention

Preventive measures focus on maintaining excellent oral hygiene and regular dental check-ups, especially for individuals taking medications known to cause gingival overgrowth. Early detection and management of the condition can prevent or minimize its severity.

See also

• Gingivitis
• Periodontitis
• Dental plaque
• Oral hygiene