This report describes four patients with cluster headache who developed gingival enlargement after initiating treatment with verapamil. Currently, calcium channel blockers are being used increasingly for the treatment of hypertension in the elderly. Individualized treatment plan for gingival enlargement. 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. Gingival hyperplasia symptoms, causes, and treatment. Three years following reconstructive surgery, the patient received restorative dental treatment in the form of mandibular dental implants to support. To remove gingival hyperplasia, we used either a traditional cold scalpel or an electric cautery or laser. Depending on the severity of gingival enlargement, your dentist may recommend one or more of the following treatments. Pdf management of cyclosporine and nifedipine induced. Tjiptoningsih evaluasi dan penatalaksanaan pasien medicallycompromised di tempat praktek gigi evaluation and management of medically compromised patient in dental practice. Terms such as gum hypertrophy or gum hyperplasia go hand in hand but. Due to the unaesthetic appearance of the overgrown gingiva, treatment becomes inevitable. Gingival hyperplasia around dental implants in jaws.
As the free gingiva becomes inflamed reaction to dental plaque on the crown of the tooth, it starts to become edematous and collagenase starts to break down the stiff collagen fibers in the free gingiva. The physiologic design of the free gingival margin by surgical means, gingivoplasty, must. Surgical therapy was carried out to provide a good. There are several causes of gingival enlargement and they can be grouped into four categories. The use of free gingival grafts in the treatment of periimplant soft tissue complications.
The increased use of drugs systemically induce several alterations in micro and macroscopic tissues and may create. In 27 patients gingival hyperplasia remained absent 6 months later, 3 patients required a second course of treatment, and another required gingival surgery. Inflammatory gingival enlargement, also synonymous with the terms gingival hyperplasia or gingival hypertrophy, can be defined as an abnormal growth of gingival tissues. Feb 26, 2018 gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Fixed appliances that bonded to the teeth surface can cause difficulty in controlling the plaque especially in the marginal region that can cause the inflamation and gingival enlargement. We observed marked gingival hyperplasia, similar clinically and histologically to the hyperplasia caused by 5.
The management hyperplasia in patient received 10 mg per day of consists of oral hygiene. Healthy and inflammationfree periodontal tissues provide an ideal anterior. Unusual clinical presentation of generalised gingival. It can cover teeth in various degrees, and can lead to aesthetic disfigurement. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally. Treatment involves recreating normal anatomy surgically. Individualized treatment plan for gingival enlargement longdom. Gingivoplasty is the remodeling of the gum to achieve a more physiological contour and eliminate gingival defects 7. Treatment of this condition has varied from surgical excision to no treatment followed by spontaneous remission.
At present, around 20 or more drugs are linked to gingival enlargement 4. There are a number of causes for this condition, but its often a symptom of poor oral hygiene or a side effect of using certain medications. However, families with autosomal recessive inheritance and apparent maternal inheritance have also been reported. Gingival hyperplasia or gingival overgrowth is a common occurrence in patients taking phenytoin, cyclosporine, or calcium channel blockers. The onset of this phenomenon was not influenced by either the kind of implant and free flaps used or by the local conditions of the patients such as radiotherapy. Pdf drug induced gingival overgrowth balasubramanian. Due to the unaesthetic appearance of the overgrown gingiva, treatment. Gingival hyperplasia is a term used to describe the abnormal growth of excessive gum tissue. Hgf is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva.
Gingival hyperplasia may be described as an increase in the size of the gingiva. The incidence of cyclosporin induced gingival overgrowth varies between 2550% depending upon drug dosage, plasma concentration, duration of therapy, method of assessing gingival enlargement, underlying periodontal status, age of the patient, medical status and genetic predisposition to be responders or non responders. Several case reports in the dental literature suggest that patients treated with the calcium channel blockers manifest gingival hyperplasia similar to that seen in. Gingival hyperplasia in acute leukemia stanford medicine 25. The most common clin wegener granulomatosis, but the patient demographics ical diagnosis was pyogenic granuloma. This may look like a gingival mass in one area, or it can be generalized and look like knobby gingival growths around each tooth. Hereditary gingival fibromatosis hgf, also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. Gingival hyperplasia is most commonly observed in boxer dogs. Pdf treatment of gingival enlargement researchgate. The definitive diagnosis, based on biopsy and histopathologic examination, led to hormonal therapy, without periodontal treatment. Pdf effects of azithromycin on cyclosporineinduced. Brunet l, miranda j, farre m, berini l, mendieta c 1996 gingival enlargement induced by drugs. Most published studies focus on reac tive lges 36 i.
Gingival enlargements and localized gingival overgrowths. Azithromycin treatment of gingival hyperplasia in kidney transplant recipients is effective and safe. Calcium channel blocker induced gingival enlargement. There are a few different treatment options available for gingival overgrowth. Idiopathic gingival hyperplasia manifests as a dense, diffuse, smooth or nodular overgrowth of one or both arches, usually appearing about the time of eruption of the permanent. Gingiva hyperplasia an overview sciencedirect topics. Gingivectomy and gingivoplasty gingivectomy and gingivoplasty are surgical procedures designed to remove excess gingiva and to restore its physiological contours. Multiple case reports have demonstrated similar positive. 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. The physiologic design of the free gingival margin by surgical means, gingivoplasty, must be taken under consideration. It does not include return to the actual nature of the structure. Among the long term adverse effects of anticonvulsants, gum hyperplasia is cosmetically disturbing and can give rise to complications such as bleeding and gingivitis. In chronic or severe cases, inflammation and its secondary effects mineral or calcium deposition may be observed.
Treating patients with druginduced gingival overgrowth. It can result in systemic diseases or oral traumatic lesion. Nov 06, 2020 pdf on jul 26, 2019, shruti bhatnagar published treatment of gingival enlargement find, read and cite all the research you need on researchgate. Department of oral and maxillofacial sciences, sapienza university of rome, rome, italy. Effects of azithromycin on cyclosporineinduced gingival. Gingival hyperplasia can manifest from mild to severe depending on modifying factors including the patients ability to remove plaque biofilm and the length of time the patient is on amlodipine. Gingival abscess due to an unusual nailbiting habit. Hypertrophic gingival margins are often seen in orthodontic treatment secondary to marginal gingival inflammation. Drugs that cause gingival hyperplasia pdf free pdf epub. Pdf on jun 17, 2015, biju thomas published treatment of. The rounded free gingival margin starts to fall out of.
The hyperplasia can become severe enough to bury incisor teeth fig. Gingival hyperplasia is a proliferation of the attached gingiva, often due to a chronic inflammatory response to the bacteria in plaque, food impaction, dental malposition and dental resorptive lesions. An in vitro study using amlodipine and human gingival fibroblasts. This is a case report of a patient with idiopathic gingival hyperplasia and an undiagnosed genetic disorder that demonstrated static encephalopathy, mental retardation, developmental delay, seizures, hypotonia, and severe gingival hypertrophy. Hgf, previously known as elephantiasis gingivae, hereditary gingival hyperplasia, and hypertrophic gingiva, is a genetic disorder characterized by a progressive enlargement of the gingiva.
Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Mar 26, 2019 druginduced gingival overgrowth, also known as gingival hyperplasia secondary to drugs, was first reported in the dental literature in the early 1960s in institutionalized epileptic children who were receiving therapy with phenytoin dilantin for the treatment of seizures 2, 3, 4 this gingival overgrowth has also been reported in the adult. Clocheret k, dekeyser c, carels c, willems g 2003 idiopathic gingival hyperplasia and orthodontic treatment. Gingival hyperplasia is a simple overgrowth of gum tissue, principally the fibrous submucosa. In such cases, overgrown gums may need to be surgically removed.
Gingival hyperplasia is caused by an increase in the number of cells within the gums. Signs and symptoms related to gingival enlargement are seen within 24 mo. Gingival hyperplasia archives long meadow veterinary clinic. Conservative treatment of localized juvenile spongiotic. Because gingival hyperplasia denotes a specific histologic diagnosis, clinicians must rule out other. Gingival overgrowth describes a generalised or localised enlargement of the gingival tissues. Druginduced gingival overgrowth digo, also referred to as druginduced gingival enlargement, and previously known as druginduced gingival hyperplasia, is a noted sideeffect of certain drugs given for nondental uses where the gingival tissue is not the intended target organ. They commonly present as bulbous interdental gingival, diffuse swelling of gingival. Treatment of gingival enlargement by dr harshavardhan patwal.
The causative factors may range from inflammation due to local factors to conditioned. Pdf azithromycin treatment of gingival hyperplasia in. The most common form of enlargement is due to plaque induced inflammation of the adjacent gingival tissues inflammatory hyperplasia and this tends to be associated most. The maintenance therapy recall program has been effective because the patient is currently under follow up for 4 years of followup fig. Covering of exposed roots and implants with free grafts. Gingival hyperplasia is most common in brachycephalic dog breeds and is present in 30% of boxer dogs older than 5 years. Other areas such as appliance trauma, ectopically positioned. Dentists try for regeneration in the tissues of the periodontal ligament, but it is not possible to.
Top causes of gingival enlargement and treatment options. Calcium channel blocker induced gingival enlargement following. This condition frequently begins at the interdental papillae and is found at the labial surfaces of both anterior and posterior teeth figure 72. In this study it is used free soft tissue grafts, because this procedure increase the width of.
Gingiva overgrowth an overview sciencedirect topics. Treatment of cyclosporininduced gingival hyperplasia with. Differential diagnosis, gingival hyperplasia, gingival. During treatment sometimes there is problem toward periodontal tissue. Pdf on jul 26, 2019, shruti bhatnagar published treatment of gingival enlargement find, read and cite all the research you need on. These epulides grow from under the free gingival margin and not as a result of a primary inflammatory gingival enlargement.
Lauritano d, martinelli m, baj a, beltramini g, candotto v, ruggiero f, palmieri a int j immunopathol pharmacol 2019 jandec. Gingival hyperplasia in a patient with hypertension. The clinical and histological appearances of lesions caused by these drugs are. If the gum tissue impedes proper chewing or cleaning or is otherwise concerning, your dental or medical professional may recommend removing your gum tissue also known as gingivectomy. Suzuki, in contemporary esthetic dentistry, 2012 tissue regeneration. Left maxillary and mandibular views of an eightyearold boxer dog with typical presentation of generalized gingival hyperplasia. Verapamil is an effective prophylactic treatment for cluster headaches and, therefore, is widely used. Gingival enlargement is related to multiple factors like inflammatory, systemic, hormonal, genetic, on the usage of drugs and other idiopathic factors. Pdf on jul 26, 2019, shruti bhatnagar published treatment of gingival enlargement find, read and cite all the research you need on researchgate. Occasion ally palatal and lingual surfaces are also involved. How to treat gingival hyperplasia veterinary practice news. Gingival hyperplasia induced by nifedipine, an arterial. Gingival hyperplasia is an overgrowth of gum tissue around the teeth.
Oral hygeine may be impaired by developmental disability or poor manual dexterity as a result of stroke, osteoarthritis of the hands, or alzheimers disease or other dementia. This video is based on gingival hyperplasia or gingival enlargement. The patient was counseled on the likelihood that her gingival hyperplasia gh was an uncommon adverse effect of calcium channel blocker ccb therapy, and nisoldipine was therefore stopped. Laser is a good option for the removal of gingival hyperplasia, and affords multiple intraand postoperative advantages. The most common form of enlargement is due to plaqueinduced in.
The simplest form of medical treatment is to stop any medications that are known to cause the disease. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Gingivectomy is the removal of gingival tissue for the purpose of removing or reducing the periodontal pocket. Root debridement was carried out with manual and ultrasonic. This case report demonstrates successful management of the lesion using a conservative treatment approach. Treatment of gingival hyperplasia induced by cyclosporine. In two patients, it was possible to control this side effect adequately by optimising oral hygiene and dental plaque control. Clinical report systemic and clinical treatment of. Once the condition begins, it creates a cycle of difficulty performing good oral hygiene, leading to higher risk and possibly more severe symptoms of overgrowth. There are two ways of treating gingival hyperplasia, medical and surgical. Hereditary gingival fibromatosis is most commonly inherited in an autosomal dominant manner, meaning that each child of an affected parent has a 50% chance of developing the condition.
Recently the orthodontic treatment needs had increased with the increased of community incomes. Surgical treatment of gingival overgrowth with 10 years of followup. Patients can experience gingival hyperplasia because of leukemic infiltration into the gums. Management of druginduced gingival enlargement australian. The gingival tissue is one of the few places in the body where complete regeneration is possible. Amlodipineinduced gingival hyperplasia a case report. Gingival enlargement in dogs vetlexicon canis from. Gingival enlargement, also called gingival hyperplasia, is thickening or overgrowth of the gum tissues that surround the tooth.
The differential diagnosis of gingival hyperplasia includes poor oral hygiene, medications like cyclosporine and phenytoin, systemic illnesses like sarcoidosis or crohns disease, hematological disorders like aml, and genetic conditions. The management of gingival hyperplasia on patient with. Periodontitis can be treated using conventional clinical care, but the gingival enlargement may require changes to the medication regimen, periodontal surgery to remove excess tissue, or a combination of the two. The causative factors may range from inflammation due to local factors to conditioned enlargement and neoplastic enlargements. Gingival hyperplasia improved in all patients p hyperplasia was lower. Treatment planning becomes more complex where there is periodontitis plus gingival enlargement that is a cosmetic or functional problem. We read with interest the case report of tajani and nesbitt 1 regarding severe gingival hyperplasia gh in a hypertensive patient who had received multiple calcium channel blockers ccbs. The use of lasers causes less discomfort and is wellaccepted by young patients and their parents. The problem of gh with ccbs, although well established in the literature, 2 has not been studied in depth in hypertensive patients, possibly due to the multiple options for alternative. Gingival hyperplasia is a histological not clinical term, referring to an abnormal increase in the number of normal cells in a normal arrangement. This report describes a case of gingival abscess in a child due to a fingernailbiting habit.
Fibrous enlargement is most common in areas of maxillary and. Gingival o vergro wth is caused by three categories of drugs. Gingival enlargement is a common finding in clinical practice and the appropriate treatment depends on correctly diagnosing the cause of the enlargement. Aim nailbiting is one of the most frequent deleterious oral habits in children. Grossly, gingival hyperplasia can be indistinguishable from an epulis fig. Repair does not mean the same thing as regeneration. Gingival enlargement also referred to as gingival overgrowth, and previously known as gingival hyperplasia is a swelling of the attached gingivae that obliterates the gingival contours. Healthy and inflammation free periodontal tissues provide an ideal anterior.
In those for whom this is not possible, good oral hygiene and referral for surgical gingivectomy remain the only treatment. Gingival enlargement or overgrowth is a common disease of gingiva. A patient had gingival bleeding and gingival hyperplasia in association with markers of hypothyroidism. It may develop rapidly at 1 to 2 weeks after initiation of cyclosporine and may lead to alveolar bone loss and consequent tooth loss, particularly in patients with uncontrolled hyperplastic. Nifedipineinduced gingival enlargement a systematic. Sep 21, 2020 gingival hyperplasia is a condition of the mouth involving overgrowth of the gingiva the gum tissue surrounding the teeth. The treatment protocol of gingival enlargement is changeable and. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions.
Gingival hyperplasia definition of gingival hyperplasia by. Treatment consists of surgical excision of the hyperplastic tissue to restore. Phenobarbitone induced gingival hyperplasia journal of. Epulis is a nonspecific term that designates a growth of the gingiva. Pdf idiopathic gingival fibromatosis a case report. This term has replaced gingival hyper plasia increase in cell number and gingival hypertrophy increase in cell size as these are histological diagnoses and do not accurately describe the varied pathological processes seen within the tissues. In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a. A final planning step established that if necessary, a gingival regrowth surgery would be. Gingival hyperplasia can be associated with poor oral hygiene, underlying systemic disease, or as a medication side effect. The use of free gingival grafts in the treatment of peri. Chronic inflammatory gingival enlargement associated with. Gingival hyperplasia modified by medications are commonly seen in dental practice. Several causes of gingival hyperplasia are known, and the most recognized is druginduced gingival enlargement. These include, but are not limited to, periodontal flap surgery, a gingivectomy, and laser gum treatment.
Gingival hyperplasia treatment and care the proper treatment for the overgrowth of your gums will vary depending on its severity and the underlying cause. The present case report describes a case of long standing gingival enlargement in a systemically. Medically induced gingival hyperplasia mayo clinic proceedings. Pdf localized juvenile spongiotic gingival hyperplasia. Localized juvenile spongiotic gingival hyperplasia ljsgh is a recently described uncommon and distinctive form of inflammatory hyperplasia. Verapamil induced gingival enlargement in cluster headache. The histological diagnosis was compatible with druginduced gingival hyperplasia fig. Hyperplasia is a histologic term which should be distinguished from hypertrophy. Gingival overgrowth was first described in dental literature of 1960. Indication for performance of the gingivectomy is the complete elimination of the periodontal pocket gingival overgrowthe. A definitive diagnosis of gingival hyperplasia can be made only by biopsy and a microscopic examination. This increase in the extracellular volume is caused by hyperplasia involving fibroblasts.
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