In two patients, it was possible to control this side effect adequately by optimising oral hygiene and dental plaque control. This report describes four patients with cluster headache who developed gingival enlargement after initiating treatment with verapamil. Feb 04, 2019 the gingiva, which covers the alveolar bone, is classified as a masticatory portion of oral mucosa. Influence of mast cells in druginduced gingival overgrowth. Calcium channel blocker induced gingival enlargement following implant placement in a fibula free flap reconstruction of the mandible. Six weeks before presentation, the patient developed bilateral lowerextremity arthralgias.
It may be caused by gum inflammation and periodontal disease. Gingival fibromatosis is classified as two types according to its form. In normal physiology the growth in size of muscles e. If mild, it involves only the interdental papillae gum between the teeth, but usually, it affects the marginal gum gum over the teeth also. A hypertrophic frenum, or one with an aberrant attachment near the free gingival margin, may be associated with gingival recession. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Gingival enlargement due to calcium channel blockers is a common complaint reported by patients. Thus the effective management of gingival enlargement needs a thorough diagnosis and then its disparate management. The rftnthcfm treatment of plaqueinduced gingivitis, chronic. An enlargement of the gingiva due to an increase in the number of cells gingival hypertrophy. Ijerph free fulltext druginduced gingival overgrowth.
Gingival hyperplasia associated with the administration of amlodipine to dogs with degenerative valvular disease 20042008. There are several causes of gingival enlargement and they can be grouped into four categories. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. May 03, 2018 gingival enlargment and its treatment 1. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Gingival enlargement, chronic myeloid leukemia, zimmermannlaband syndrome. Further, indepth studies are needed to establish the link between drugs and gingival enlargement for prevention and improved treatment. Individualized treatment plan for gingival enlargement. Antibiotics free fulltext periodontal microbiological status. Aug 03, 2018 gingival enlargement or overgrowth is a common disease of gingiva. Hereditary gingival fibromatosis presents as a localised or generalised overgrowth of the attached keratinised gums of variable severity. Gingival enlargement or gingival overgrowth go is the preferred term for all medicationrelated gingival lesions previously termed gingival hyperplasia or gingival hypertrophy. Phenytoin induced gingival overgrowth, a side effect with multifactorial aetiology, is characterized by an. Oral cavity examination showed diffuse grade iii gingival hypertrophy gingiva covering more than twothirds of visible crown, bleeding, and.
Department of oral and maxillofacial sciences, sapienza university of. Diagnosis and treatment plan for gingival diseases and. This graphic shows the relationship of the gingivae to the tooth and the alveolar bone. The terms gingival hyperplasia and gingival hypertrophy have been used to describe this topic in the past.
Drugs that cause gingival hyperplasia are classified by the american academy of periodontology as a dental plaqueinduced gingival disease, as evidence suggests that existing gingival inflammation may be necessary for its development and that proper plaque control and effective oral hygiene can lessen its severity or potentially prevent its. Gingival hyperplasia or gingival overgrowth is a common occurrence in patients taking phenytoin, cyclosporine, or calcium channel blockers. In more severe cases, your gums can completely cover your teeth, making it difficult to maintain effective oral hygiene. Epulis is a nonspecific term that designates a growth of the gingiva.
Conditions that may cause this include benign bony tori or more sinister disease processes such table 1 classification of gingival enlargement local factors local factors inflammatory acute abscesses gingival periodontal. Pdf on jul 26, 2019, shruti bhatnagar published treatment of gingival enlargement find, read and cite all the research you. Buy this article and get unlimited access and a printable pdf. Gingival overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs. Gingival overgrowth, hypertrophic gingivitis, gingival. Gingival hyperplasia is most common in brachycephalic dog breeds and is present in 30% of boxer dogs older than 5 years. Gingival hypertrophy and anemiadiagnosis hematology jama. Jul 09, 2019 gingival enlargement increase in the size of the gingiva clinical descriptive term avoid pathological terms used in the past, such as hypertrophic gingivitis and gingival hyperplasia. Cyclosporineinduced gingival hypertrophy clinical pharmacy and. Gingival hyperplasia is a simple overgrowth of gum tissue, principally the fibrous submucosa. Oct 02, 2019 the prevalence of gingival and periodontal disease is manifold and has not been highlighted much due to its asymptomatic and milder symptoms. Gingiva hypertrophy an overview sciencedirect topics. Grossly, gingival hyperplasia can be indistinguishable from an epulis fig. Drugs that cause gingival hyperplasia pdf free pdf epub.
The length of the free gingiva was taken as the dis tance from the. The woman was not currently taking any medications, and the family history was unremarkable. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Lawrence kotlow, in principles and practice of laser dentistry second edition, 2016. One week later, he fell and subsequently refused to ambulate. The present case report describes a case of long standing gingival enlargement. The causative factors may range from inflammation due to local factors to conditioned enlargement and neoplastic enlargements. Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva.
The median timetoonset of gingival hyperplasia values for immunosuppressants, calcium channel blockers, and anticonvulsants use were 71. Gingival enlargement is the proliferation and intensification of the gingiva which is a prevailing character of the diseased gingival tissues. The free gingival margin is the interface between the sulcular epithelium and the epithelium of the oral cavity. Gingiva hyperplasia an overview sciencedirect topics. Acute form o f gingival enlargement includes abscesse s of the. Prevalence and severity of amlodipine induced gingival overgrowth. Gingival hyperplasia around dental implants in jaws reconstructed with free vascularized flaps. This overgrowth of gingiva may be exaggerated in patients with genetic or drugrelated systemic factors e.
A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Gingival hypertrophy and anemiadiagnosis hematology. Pdf gingival enlargement is an increase in the size or inflammation of the gingiva. Agrandamientos gingivales inducidos por medicamentos. Accepted current terminology for this condition is gingival enlargement or gingival. An overgrowth or increase in size of the gingiva gingival hyperplasia. These are not precise descriptions of gingival enlargement because these terms are strictly histologic diagnoses, and such diagnoses require microscopic analysis of a tissue sample. Top causes of gingival enlargement and treatment options. Gingival tissue enlargement is a common side effect of.
An update on the mechanisms of phenytoin induced gingival. Gingival hyperplasia for a problem that is so common, there is really not very much in the veterinary literature on this odd condition, so it seems time for me to tell you a bit about my understanding of gingival hyperplasia, what brings it about, why it is a concern and how we manage it. They commonly present as bulbous interdental gingival, diffuse swelling of gingival. Localized gingival enlargements e321 introduction localized gingival enlargements lges are common in clinical practice 1,2 and are usually of reactive origin 1,2 developing as a response to chronic local irrita tion or trauma 3. Unusual clinical presentation of generalised gingival enlargement. Such growth accompanies an increase in the functioning of the tissue.
Many forms of gingival hyperplasia are of unknown etiology and termed as idiopathic gingival fibromatosis. Now customize the name of a clipboard to store your clips. Gingival enlargement can occur by taking certain medications, leading to problems in speech, eating, teething functions and aesthetics. Druginduced gingival enlargement is the term now used to describe medicationrelated gingival hypertrophy or hyperplasia, a condition commonly induced by three main classes of drugs. Gingival retraction or gingival recession is when there is lateral movement of the gingival margin away from the tooth surface. Inflammatory gingival enlargement, also synonymous with the terms gingival hyperplasia or gingival hypertrophy, can be defined as an abnormal growth of gingival tissues. The hyperplasia can become severe enough to bury incisor teeth fig. Most published studies focus on reac tive lges 36 i. First, the marginal gingiva, which is the free end of gingiva with a smooth surface, enclosing the neck of the teeth as a collar shape to define the gingival sulcus. Gingival overgrowth is a serious side effect that accompanies the use of amlodipine.
The starting point of periodontal disease is usually. Article english pdf article in xml format how to cite this article scielo analytics curriculum scienti automatic translation. Such increased volume of gingiva may compromise normal oral functions, aesthetics in addition. Chronic inflammatory gingival enlargement associated with. The expression and the severity of this tissuespecific condition are influenced by a variety of factors, mainly drug and periodontal variables. It is classified as true hfh thfh with unilateral enlargement of the viscerocranium, and partial hfh phfh in which not all structures are enlarged. Hyperplasia refers to an increased number of cells, and hypertrophy refers to an increase.
Gingival hyperplasia around dental implants in jaws. Gum enlargement usually begins after the second permanent incisor teeth erupt, usually by the age of 10 years. What are the clinical features of hereditary gingival fibromatosis. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. The prevalence and severity of cyclosporin and nifedipineinduced gingival overgrowth. Brunet l, miranda j, farre m, berini l, mendieta c 1996 gingival enlargement.
Due to the unaesthetic appearance of the overgrown gingiva, treatment becomes inevitable. Gingival enlargement due to chronic inflammation has also been seen in mouth breathers and patients with incompetent lips figs 3a and b. Verapamil induced gingival enlargement in cluster headache. Verapamil is an effective prophylactic treatment for cluster headaches and, therefore, is widely used. A pilot study on the effect of diphenylhydantoin and gabapentin on human gingival. Medically induced gingival hyperplasia mayo clinic proceedings. Treatment options consist of periodontal plastic surgery, such as a free gingival graft with. Nifedipine induced gingival enlargement in an edentulous patient. Calcium channel blocker induced gingival enlargement. Cyclosporin ainduced gingival overgrowth is not associated with. The following grades were scored in 6 points around each tooth. Gingival enlargement, amlodipine, cyclosporine, phenytoin. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement.
Gelberg, in pathologic basis of veterinary disease sixth edition, 2017 hyperplastic diseases. Druginduced gingival overgrowth digo is previously termed as gingival hypertrophy or gingival hyperplasia by finding an increased number of fibroblasts in gingival connective tissues 1. The present case report describes a case of long standing gingival enlargement in a systemically. Gingival enlargement is an increase in the size of the gingiva gums.
Pdf treatment of gingival enlargement researchgate. Acute form of gingival enlargement includes abscesses of the periodontium. When the final result of orthodontic repositioning of the front teeth results in gingival hypertrophy, or orthodontic therapy itself causes gingival hypertrophy from poor oral hygiene, the laser can be a useful tool to increase crown length, to give the patient a more esthetic. False gingival enlargement there may be an increase in the size of the gingival tissues due to the underlying hard tissues. Widespread hemorrhagic hyperplasia involving the free gingiva and almost all teeth both in the vestibular and lingual sides were observed on the intraoral.
Drugs that cause gingival hyperplasia introduction. New clinical index for druginduced gingivai overgrowth. It is usually given its due importance when the gingival disease progresses to advanced periodontal disease, displays symptoms of dull pain and tooth mobility, and is associated with pus discharge. Surgical therapy was carried out to provide a good. Gingival hypertrophy article about gingival hypertrophy by. Periodontal management of cyclosporin ainduced gingival. Gingival tissue enlargement is a common side effect of antiepileptic medications e. Several conflicting theories have been proposed to. A developmentally normal 5yearold boy presents to the emergency department with epistaxis, arthralgias, refusal to ambulate, and gingival hyperplasia. Clipping is a handy way to collect important slides you want to go back to later.
The gingiva intimately associated with the bone is referred to as the attached gingiva, while the gingiva that forms a cuff around the tooth is designated as the free gingiva. Department of oral and maxillofacial sciences, sapienza university of rome, rome, italy. The space, or potential space, that is created from the tip of the free gingiva to the attachment of the gingiva. Gingival enlargement chronic gingival inflammation may result in gingival enlargement. An enlargement of the gingiva due to an increase in the size of cells according to the glossary of periodontal terms, 4th edition, 2001. Gingival enlargement is one of the frequent features of gingival diseases. Gingival hypertrophy definition of gingival hypertrophy by. Unusual clinical presentation of generalised gingival. Feb 26, 2018 gingival hyperplasia is an oral condition that causes your gums to overgrow.
This interface exists at the most coronal point of the gingiva, otherwise known as the crest of the marginal gingiva because the short part of gingiva existing above the height of the underlying alveolar process of maxilla, known as the free gingiva, is not bound down to the. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Gingival hypertrophy article about gingival hypertrophy. Anatomically, there are three demarcated parts of gingiva. Druginduced gingival overgrowth digo is the most commonly encountered side effect resulting from administration of calcineurin inhibitors such as. The rftnthcfm treatment of plaqueinduced gingivitis. It is a frequent side effect associated with three major drug groups.
Gingival enlargement has been classified based on etiologic factors and pathological changes, they are inflammatory enlargement a. Thus, increase in size of the gingiva is a common feature of gingival disease. It is usually termed gingival retraction as an intentional procedure, and in such cases it is performed by mechanical, chemical, or electrical means in order to perform certain dental surgery procedures. Gingival hypertrophy definition of gingival hypertrophy. Rarely it starts with the first primary deciduous milk teeth or very rarely earlier.
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