Drug Influenced Gingival Enlargement
Drug influenced gingival enlargement is an overgrowth of the gums caused by medications. The American Academy of Periodontology (AAP) classifies it as type IA, plaque induced gingival disease. The enlargement of the tissue is first seen in the spaces between the teeth, the papillae, and continues on to the marginal gingiva. This erratic overgrowth is often in the anterior portions of the mouth although it can be experienced in the posterior portions as well. Gingival enlargement is most common in children but can be experienced by any patient 3 months after taking medications such as anticonvulsants, immunosuppressants or calcium channel blockers. If severe, gingival enlargement can completely cover the teeth. (see picture)
Anticonvulsants are used to treat patients who experience epileptic seizures. Recently, anticonvulsants have also been used in the treatment of bipolar disorder. In the journal article “Prevalence and Risk of Gingival Enlargement in Patients Treated with Anticonvulsant Drugs” by L.Brunet, J. Miranda, P. Rose, L. Berini, M. Farre and C. Mendieta, of the 157 patients that were studied, 73% that were treated for seizures with phenytion experienced gingival enlargement. Those treated with other anticonvulsants, such as sodium valproate and viabatrin, showed signs of gingival enlargement by only 31.8% (L.Brunet, J. Miranda, P. Rose, L. Berini, M. Farre and C. Mendieta, 2001).
Other patients that can encounter gingival enlargement are those who take immunosuppressant drugs, like cyclosporine, to help suppress their natural immune system. This is necessary after an organ transplant or if the individual has an autoimmune disease. According to The American Academy of Oral Medicine, these patients have a 27% possibility of experiencing gingival overgrowth (C. Hong and the AAOM Web Writing Group, 2007).
Additional drugs that can cause gingival enlargement are calcium channel blockers like amlodipine, nifedipine and verapamil. Patients who experience chest pain or high blood pressure usually receive these drugs. These individuals have 10-20% prevalence for gingival enlargement (C. Hong and the AAOM Web Writing Group, 2007).
Patients that show signs of gingival enlargement should be meticulous about their oral homecare. Although this will not eliminate the overgrowth, it will drastically decrease it. If proper homecare is not sufficient enough, surgical procedures can be performed to remove the extra tissue. However, this will not prevent overgrowth and it can reoccur.
References:
Brunet, L., Miranda, J., Roset, P., Berini, L., Farré, M., & Mendieta, C. (2001). Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs. European Journal Of Clinical Investigation, 31(9), 781-788.
C. Hong and the AAOM Web Writing Group. (December 31, 2007). The American Academy of Oral Medicine, Gingival Enlargement. Retrieved from http://www.aaom.com/patients/gingival-enlargement/
Additional resources from:
Neild-Gehrig, Jill S., & Willmann, Donald E. (2011) Foundations of Periodontics for the Dental Hygienist (3rd ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
*Pictures from Google Images
Anticonvulsants are used to treat patients who experience epileptic seizures. Recently, anticonvulsants have also been used in the treatment of bipolar disorder. In the journal article “Prevalence and Risk of Gingival Enlargement in Patients Treated with Anticonvulsant Drugs” by L.Brunet, J. Miranda, P. Rose, L. Berini, M. Farre and C. Mendieta, of the 157 patients that were studied, 73% that were treated for seizures with phenytion experienced gingival enlargement. Those treated with other anticonvulsants, such as sodium valproate and viabatrin, showed signs of gingival enlargement by only 31.8% (L.Brunet, J. Miranda, P. Rose, L. Berini, M. Farre and C. Mendieta, 2001).
Other patients that can encounter gingival enlargement are those who take immunosuppressant drugs, like cyclosporine, to help suppress their natural immune system. This is necessary after an organ transplant or if the individual has an autoimmune disease. According to The American Academy of Oral Medicine, these patients have a 27% possibility of experiencing gingival overgrowth (C. Hong and the AAOM Web Writing Group, 2007).
Additional drugs that can cause gingival enlargement are calcium channel blockers like amlodipine, nifedipine and verapamil. Patients who experience chest pain or high blood pressure usually receive these drugs. These individuals have 10-20% prevalence for gingival enlargement (C. Hong and the AAOM Web Writing Group, 2007).
Patients that show signs of gingival enlargement should be meticulous about their oral homecare. Although this will not eliminate the overgrowth, it will drastically decrease it. If proper homecare is not sufficient enough, surgical procedures can be performed to remove the extra tissue. However, this will not prevent overgrowth and it can reoccur.
References:
Brunet, L., Miranda, J., Roset, P., Berini, L., Farré, M., & Mendieta, C. (2001). Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs. European Journal Of Clinical Investigation, 31(9), 781-788.
C. Hong and the AAOM Web Writing Group. (December 31, 2007). The American Academy of Oral Medicine, Gingival Enlargement. Retrieved from http://www.aaom.com/patients/gingival-enlargement/
Additional resources from:
Neild-Gehrig, Jill S., & Willmann, Donald E. (2011) Foundations of Periodontics for the Dental Hygienist (3rd ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
*Pictures from Google Images