Gingival overgrowth and associated factors in a population of Nigerian hypertensives

Background: Gingival overgrowth may be idiopathic or secondary. Drug Induced Gingival Overgrowth (DIGO) occurs within 3 months of treatment and is more prevalent in younger age group with predilection for the anterior gingival tissue and usually not associated with attachment loss or tooth mobility unless there is an existing periodontal disease. Methodology: 170 hypertensive patients were recruited for the study; 85 calcium channel blocker (CCB) and 85 non-CCB users. Interviewer-administered questionnaires was used to obtain socio-demographic information as well as medical and drug history. GO was assessed using New Clinical Index for DIGO and data was analyzed with SPSS version 21 (Armonk, NY: IBM Corp). Continuous and nominal variables were described with means, standard deviations and frequencies. Statistical significance was set at P < 0.05. Results: Amlodipine was the most commonly used CCB. The prevalence of DIGO in CCB and non-CCB was the same (49.5%). Gingival enlargement was found equally among both sexes in the CCB and non-CCB groups. A third of the participants with GO were 70 years and above while those without were majorly in the fifth and sixth decade of life. Two-third of those with DIGO had fair oral hygiene status, two-fifth had gingival bleeding and three-fifth had mild gingival inflammation. Those without DIGO in both groups had a slight female predominance and majorly good oral hygiene. Associated factors with DIGO were female sex, 60-69 age group, 10mg drug dosage, been on medication less than 10 years, mild gingival inflammation and generalized gingivitis. Conclusion: There was no difference in the prevalence of DIGO between BBC and non-BBC users. However, there was mild gingival inflammation in all participants with DIGO and amlodipine users were three times more at risk of developing DIGO than nifedipine users. Thus, it is imperative to advise the hypertensives on the importance of maintaining adequate oral hygiene measures and incorporate periodontal care in their management so as to ameliorate the side effects of their medication.

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Oral Contraceptives Induced Gingival Overgrowth – A Clinical Case Report

POJ Dental and Oral Care ◽

10.32648/2578-8817/1/1/001 ◽

2017 ◽

Vol 1 (1) ◽

pp. 1-5

Author(s):

Anushi Mahajan ◽

Ritesh Sood

Keyword(s):

Oral Contraceptives ◽

Oral Hygiene ◽

Periodontal Therapy ◽

Response To Therapy ◽

Drug Induced ◽

Gingival Overgrowth ◽

Periodontal Tissues ◽

Hygiene Measures ◽

Nonsurgical Periodontal Therapy ◽

Gingival Enlargement

Aim: The purpose of this article is to report a case of drug induced gingival enlargement due to oral contraceptives, managed by nonsurgical periodontal therapy. Background: Drug-induced gingival overgrowth remains the most widespread unwanted effect of systemic medication on the periodontal tissues. Hormones are specific regulatory molecules that modulate a host of body functions. Oral contraceptives that contain estrogen and/or progesterone are associated with gingival enlargement. Report: A 32-year-old female presented with a complaint of swelling of the gingiva with spontaneous bleeding in the mandibular anterior region for a period of two years. The health history documented the use of contraceptives for two years, and a clinical examination revealed the existence of poor oral hygiene and enlarged painful gingival tissues that bled when touched. Summary: Females on oral contraceptives can be considered as a “risk group” for periodontal diseases. Not all females on oral contraceptives respond in similar way. Plaque control is the most important procedure in periodontal therapy. Although the initial picture presented the possibility of surgical intervention, the clinical problems were resolved with non-surgical treatment. Another factor contributing to response to therapy is patient compliance. The patient followed home care instructions well and was effective in personal oral hygiene measures. Keywords: Gingival enlargement, Sex hormones, Oral contraceptives.

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Nonsurgical Management of Nifedipine Induced Gingival Overgrowth

Case Reports in Dentistry ◽

10.1155/2014/741402 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

George Sam ◽

Staly Chakkalakkal Sebastian

Keyword(s):

Case Report ◽

Oral Hygiene ◽

Medical Community ◽

Unwanted Effect ◽

Gingival Inflammation ◽

Drug Induced ◽

Gingival Overgrowth ◽

Nonsurgical Management ◽

Gingival Enlargement ◽

Oral Hygiene Practice

Drug-induced gingival overgrowth is frequently associated with three particular drugs: phenytoin, cyclosporin, and nifedipine. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and cyclosporin. The frequency of gingival enlargement associated with chronic nifedipine therapy remains controversial. Within the group of patients that develop this unwanted effect, there appears to be variability in the extent and severity of the gingival changes. Although gingival inflammation is considered a primary requisite in their development, few cases with minimal or no plaque induced gingival inflammation have also been reported. A case report of gingival overgrowth induced by nifedipine in a patient with good oral hygiene and its nonsurgical management with drug substitution is discussed in this case report.

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On the Cellular and Molecular Mechanisms of Drug-Induced Gingival Overgrowth

The Open Dentistry Journal ◽

10.2174/1874210601711010420 ◽

2017 ◽

Vol 11 (1) ◽

pp. 420-435 ◽

Cited By ~ 9

Author(s):

Albert Ramírez-Rámiz ◽

Lluís Brunet-LLobet ◽

Eduard Lahor-Soler ◽

Jaume Miranda-Rius

Keyword(s):

Extracellular Matrix ◽

Molecular Mechanisms ◽

Phenotypic Variability ◽

Membrane Receptors ◽

Gingival Tissue ◽

Inflammatory Factor ◽

Drug Induced ◽

Gingival Overgrowth ◽

Pubmed Database ◽

Gingival Enlargement

Introduction: Gingival overgrowth has been linked to multiple factors such as adverse drug effects, inflammation, neoplastic processes, and hereditary gingival fibromatosis. Drug-induced gingival overgrowth is a well-established adverse event. In early stages, this gingival enlargement is usually located in the area of the interdental papilla. Histologically, there is an increase in the different components of the extracellular matrix. Objective: The aim of this manuscript is to describe and analyze the different cellular and molecular agents involved in the pathogenesis of Drug-induced gingival overgrowth. Method: A literature search of the MEDLINE/PubMed database was conducted to identify the mechanisms involved in the process of drug-induced gingival overgrowth, with the assistance of a research librarian. We present several causal hypotheses and discuss the advances in the understanding of the mechanisms that trigger this gingival alteration. Results: In vitro studies have revealed phenotypic cellular changes in keratinocytes and fibroblasts and an increase of the extracellular matrix with collagen and glycosaminoglycans. Drug-induced gingival overgrowth confirms the key role of collagenase and integrins, membrane receptors present in the fibroblasts, due to their involvement in the catabolism of collagen. The three drug categories implicated: calcineuron inhibitors (immunosuppressant drugs), calcium channel blocking agents and anticonvulsant drugs appear to present a multifactorial pathogenesis with a common molecular action: the blockage of the cell membrane in the Ca2+/Na+ ion flow. The alteration of the uptake of cellular folic acid, which depends on the regulated channels of active cationic transport and on passive diffusion, results in a dysfunctional degradation of the connective tissue. Certain intermediate molecules such as cytokines and prostaglandins play a role in this pathological mechanism. The concomitant inflammatory factor encourages the appearance of fibroblasts, which leads to gingival fibrosis. Susceptibility to gingival overgrowth in some fibroblast subpopulations is due to phenotypic variability and genetic polymorphism, as shown by the increase in the synthesis of molecules related to the response of the gingival tissue to inducing drugs. The authors present a diagram depicting various mechanisms involved in the pathogenesis of drug-induced gingival overgrowth. Conclusion: Individual predisposition, tissue inflammation, and molecular changes in response to the inducing drug favor the clinical manifestation of gingival overgrowth.

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Agrandamiento gingival inducido por medicamentos. Reporte de un caso clínico / Drug-Induced Gingival Overgrowth. A Clinical Case Report

Universitas Odontologica ◽

10.11144/javeriana.uo36-77.agim ◽

2018 ◽

Vol 36 (77) ◽

Author(s):

Laura Vanessa Cañas Díaz ◽

María Isabel Pardo Silva ◽

Silie Soad Arboleda Salaimán

Keyword(s):

Oral Hygiene ◽

Treatment Plan ◽

Treatment Protocol ◽

Plaque Index ◽

Channel Blockers ◽

San Jose ◽

Drug Induced ◽

Support Design ◽

Gingival Overgrowth ◽

Gingival Enlargement

RESUMEN. Antecedentes: el agrandamiento gingival inducido por medicamentos es una condición clínica frecuente en pacientes que ingieren anticonvulsivantes, inmunosupresores y bloqueadores de los canales de calcio. La prevalencia de agrandamiento gingival inducido por medicamentos es de 3 - 20 % en comparación con otras condiciones gingivales inflamatorias. Todos estos medicamentos producen lesiones clínicas y características histológicas indistinguibles unas de otras, que llegan a comprometer la función y la estética de los pacientes afectados. Propósito: Describir el manejo terapéutico integral y el seguimiento a 12 meses de una paciente con agrandamiento gingival inducido por tacrolimus y amlodipino. Descripción del caso: Paciente de 22 años con discapacidad mental limítrofe, receptora de trasplante renal fue remitida al servicio de Odontología del Hospital Infantil Universitario de San José (Bogotá, Colombia) por presentar agrandamiento gingival. El examen clínico mostró un índice de placa de O’Leary del 84,3 %, inflamación generalizada y bolsas gingivales de 4 a 6 mm. El protocolo de tratamiento periodontal fue revisado por el equipo de trasplante renal e incluyó: trabajo con la familia para red de apoyo, diseño de un programa personalizado de higiene oral, gingivectomía y mantenimientos periodontales periódicos. Esta estrategia terapéutica permitió reducir el índice de placa y lograr un resultado clínico favorable. Conclusión: La condición sistémica y psicológica de la paciente determinó desarrollar un plan de tratamiento ajustado a sus necesidades. Pacientes susceptibles deben ser instruidos sobre la importancia de tener unas prácticas adecuadas de higiene oral y ameritan ser incluidos en un programa de mantenimiento periodontal.ABSTRACT. Background: drug-influenced gingival enlargement, is a frequent clinical condition in patients who ingest anticonvulsant, immunosuppressant and calcium channel blockers. The prevalence of gingival overgrowth due to prescribed medications ranges from 3% to 20% in comparison to other gingival inflammatory conditions. These drugs produce clinical lesions and histological characteristics that are indistinguishable from one another, which compromise the function and aesthetics of the affected patients. Purpose: To describe the total therapeutic management and the clinical follow up at 12-months from a patient with gingival enlargement induced by tacrolimus and amlodipine. Case description: A 22-year-old patient with borderline mental disability who received a kidney transplant was referred to San Jose Hospital - Medical Dental Unit (Bogotá, Colombia) presenting gingival enlargement. The clinical examination revealed an O'Leary plaque index of 84.3%, generalized inflammation, and gingival pockets of 4 to 6 mm. The periodontal treatment protocol was reviewed by the transplant team and included: family engagement to create a network for support, design of a personalized program for oral hygiene, gingivectomy and periodic periodontal maintenance. This therapeutic strategy allowed to reduce the plaque index and achieve favorable clinical result. Conclusion: The systemic and psychological condition of the patient established the development of a treatment plan adjusted to her needs. Susceptible patients need to be instructed about the importance of adequate oral hygiene practices and should be included in a maintenance periodontal program.

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Gingival Enlargement Induced by Felodipine Resolves with a Conventional Periodontal Treatment and Drug Modification

Case Reports in Dentistry ◽

10.1155/2016/1095927 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Nabil Khzam ◽

David Bailey ◽

Helen S. Yie ◽

Mahmoud M. Bakr

Keyword(s):

Oral Hygiene ◽

Medical Condition ◽

Systemic Effect ◽

Periodontal Treatment ◽

Inflammatory Cell Infiltrate ◽

Drug Induced ◽

Chronic Inflammatory Cell ◽

Anterior Teeth ◽

Hygiene Measures ◽

Gingival Enlargement

We present a case of a 47-year-old male who suffered from GE around his lower anterior teeth as soon as he started treatment with Felodipine 400 mg. We show that oral hygiene measures, antibiotics, and conventional periodontal treatment (scaling and root planing SRP) were all not sufficient to resolve the drug induced GE, which will persist and/or recur provided that systemic effect of the offending medication is still present. The condition immediately resolved after switching to a different medication. The mechanism of GE is complex and not fully understood yet. It is mainly due to overexpression of a number of growth factors due to high concentrations of calcium ions (Ca2+). This affects fibroblasts proliferation and DNA synthesis and leads to a heavy chronic inflammatory cell infiltrate. Our case was managed according to the suggested protocols in previous case studies. The unique features in our case were the immediate onset of the adverse effect after starting the medication and the absence of any underlying medical condition apart from high blood pressure. Improving the oral hygiene together with SRP and cessation of the medication resolves drug induced GE.

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Connective Tissue Metabolism and Gingival Overgrowth

Critical Reviews in Oral Biology & Medicine ◽

10.1177/154411130401500305 ◽

2004 ◽

Vol 15 (3) ◽

pp. 165-175 ◽

Cited By ~ 91

Author(s):

P. C. Trackman ◽

A. Kantarci

Keyword(s):

Extracellular Matrix ◽

Connective Tissue ◽

Oral Hygiene ◽

Tissue Specificity ◽

Gingival Fibroblast ◽

Drug Induced ◽

Gingival Overgrowth ◽

Connective Tissue Metabolism ◽

Matrix Metabolism ◽

Systemic Health

Gingival overgrowth occurs mainly as a result of certain anti-seizure, immunosuppressive, or antihypertensive drug therapies. Excess gingival tissues impede oral function and are disfiguring. Effective oral hygiene is compromised in the presence of gingival overgrowth, and it is now recognized that this may have negative implications for the systemic health of affected patients. Recent studies indicate that cytokine balances are abnormal in drug-induced forms of gingival overgrowth. Data supporting molecular and cellular characteristics that distinguish different forms of gingival overgrowth are summarized, and aspects of gingival fibroblast extracellular matrix metabolism that are unique to gingival tissues and cells are reviewed. Abnormal cytokine balances derived principally from lymphocytes and macrophages, and unique aspects of gingival extracellular matrix metabolism, are elements of a working model presented to facilitate our gaining a better understanding of mechanisms and of the tissue specificity of gingival overgrowth.

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Laporan Kasus: Manifestasi Oral Penderita Hipertensi berupa Ginggival Enlargement

STOMATOGNATIC - Jurnal Kedokteran Gigi ◽

10.19184/stoma.v17i2.25219 ◽

2020 ◽

Vol 17 (2) ◽

pp. 54

Author(s):

Anindita L. ◽

Aris Aji K. ◽

Arcadia Sulistijo J.

Keyword(s):

Case Reports ◽

Gingival Tissue ◽

High Dose ◽

Gingival Inflammation ◽

Gingival Enlargement ◽

History Of ◽

Root Planning ◽

Pro Inflammatory Cytokines

Hypertension presents an increase in blood pressure following the oral manifestations, such as gingival enlargement. A 42-year-old woman came to the General Sudirman University Dental and Oral Hospital complaining of enlarged front gums seven years ago. The patient had a history of hypertension and regularly consumed drugs, amlodipine 5 mg. Extraoral examination revealed no lymphadenopathy and no swelling of the head and neck area. Intraoral examination revealed a gingival enlargement involving the papilla to the gingival margin present on the entire upper and lower labial gingival surface. The patient's diagnosis was gingival enlargement caused by gingival enlargement due to the use of amlodipine. Gingival enlargement has been noted with long-term or high-dose amlodipine use. The mechanism of amlodipine in causing gingival enlargement is through the role of fibroblasts with abnormal susceptibility to the drug, resulting in increased levels of protein synthesis, especially collagen. The role of pro-inflammatory cytokines occurs through an increase in interleukin-1β (IL-1β) and IL-6 in the inflamed gingival tissue due to the gingival fibrogenic response to drugs. Therapies were DHE and scaling and root planning as phase I in periodontal treatment. Plaque elimination is vital to reduce gingival inflammation that may occur. Substitution of the drug amlodipine may be needed if there is no improvement. Based on case reports, hypertension patients who took amlodipine could have gingival enlargement. The therapy given was plaque elimination in the form of DHE and Scaling and regular check-ups with the dentist.

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Recurrent Idiopathic Gingival Hyperplasia

Journal of Nepalese Society of Periodontology and Oral Implantology ◽

10.3126/jnspoi.v3i1.24827 ◽

2019 ◽

Vol 3 (1) ◽

pp. 35-37

Author(s):

Junima Rajkarnikar ◽

Bikash Veer Shrestha ◽

Santhosh Kumar

Keyword(s):

Patient Compliance ◽

Successful Treatment ◽

Oral Hygiene ◽

Chronic Periodontitis ◽

Common Type ◽

Gingival Hyperplasia ◽

Gingival Inflammation ◽

Orthodontic Therapy ◽

Gingival Enlargement

Increase in size of the gingiva is termed as gingival enlargement. Most common type of gingival enlargement is inflammatory, which his caused due to plaque accumulation and improper oral hygiene maintenance. Orthodontic therapy can often lead to failure to improve oral hygiene. This case describes a recurrent, progressive gingival enlargement of a 19 year old female orthodontic patient in which gingivectomy was performed and repeated, which subsequently failed. Hence modified Widman’s flap was performed with medical supplements. Periodic periodontal check up is required in orthodontic cases to control the gingival inflammation. Patient compliance is also very important in such cases. There should be proper co-operation between the Orthodontist and Periodontist for successful treatment of gingival hyperplasia. Patients with such conditions should be carefully monitored and checked to avoid the recurrence and avoid further progression into chronic periodontitis.

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An Update on the Mechanisms of Phenytoin Induced Gingival Overgrowth

The Open Dentistry Journal ◽

10.2174/1874210601913010430 ◽

2019 ◽

Vol 13 (1) ◽

pp. 430-435 ◽

Cited By ~ 2

Author(s):

Fathima Fazrina Farook ◽

Mohamed Nuzaim M. Nizam ◽

Abdulsalam Alshammari

Keyword(s):

Web Of Science ◽

Molecular Level ◽

Gingival Hyperplasia ◽

Pathophysiological Mechanism ◽

Drug Induced ◽

Gingival Overgrowth ◽

Gingival Enlargement ◽

High Prevalence ◽

Central Database ◽

Inflammatory Changes

Background: Phenytoin induced gingival overgrowth, a side effect with multifactorial aetiology, is characterized by an increase in the volume of extracellular tissues, particularly collagenous components, with varying degrees of inflammation. Objective: The aim of this paper is to review the available literature regarding the pathophysiological mechanisms of phenytoin induced gingival overgrowth. Methods: A thorough literature search of the PubMed/ Embase/ Web of science/ Cochrane central database was conducted to identify the mechanisms involved in the process of phenytoin-induced gingival overgrowth using the following keywords: Phenytoin; Anticonvulsant; Gingival Overgrowth; Gingival Enlargement, Gingival Hyperplasia; Drug Induced Gingival Enlargement; Drug Induced Gingival Overgrowth Results: According to the available evidence, several mechanisms have been proposed addressing the pathophysiological mechanism of phenytoin induced gingival overgrowth both at a cellular and molecular level. Evidence suggests that the inflammatory changes in the gingival tissues orchestrate the interaction between phenytoin and fibroblasts particularly resulting in an increase in the extracellular matrix content. Conclusion: However, the mechanism of production of inflammatory mediators is not fully understood. This, together with the high prevalence of Phenytoin induced gingival overgrowth, warrants further research in this area in order to develop treatment and preventive strategies for the management of this condition.

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Biology of Drug-Induced Gingival Hyperplasia: In Vitro Study of the Effect of Nifedipine on Human Fibroblasts

Applied Sciences ◽

10.3390/app11073287 ◽

2021 ◽

Vol 11 (7) ◽

pp. 3287

Author(s):

Dorina Lauritano ◽

Giulia Moreo ◽

Fedora Della Vella ◽

Annalisa Palmieri ◽

Francesco Carinci ◽

...

Keyword(s):

Extracellular Matrix ◽

Real Time ◽

Human Fibroblasts ◽

Control Group ◽

Gingival Hyperplasia ◽

Drug Induced ◽

Gingival Overgrowth ◽

Drug Concentrations ◽

Gingival Enlargement ◽

E Cadherin

Background: It has been proven that the antihypertensive agent nifedipine can cause gingival overgrowth as a side effect. The aim of this study was to analyze the effects of pharmacological treatment with nifedipine on human gingival fibroblasts activity, investigating the possible pathogenetic mechanisms that lead to the onset of gingival enlargement. Methods: The expression profile of 57 genes belonging to the “Extracellular Matrix and Adhesion Molecules” pathway, fibroblasts’ viability at different drug concentrations, and E-cadherin levels in treated fibroblasts were assessed using real-time Polymerase Chain Reaction, PrestoBlue™ cell viability test, and an enzyme-linked immunoassay (ELISA), respectively. Results: Metalloproteinase 24 and 8 (MMP24, MMP8) showed significant upregulation in treated cells with respect to the control group, and cell adhesion gene CDH1 (E-cadherin) levels were recorded as increased in treated fibroblasts using both real-time PCR and ELISA. Downregulation was observed for transmembrane receptors ITGA6 and ITGB4, the basement membrane constituent LAMA1 and LAMB1, and the extracellular matrix protease MMP11, MMP16, and MMP26. Conclusions: The obtained data suggested that the pathogenesis of nifedipine-induced gingival overgrowth is characterized by an excessive accumulation of collagen due to the inhibition of collagen intracellular and extracellular degradation pathways.

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