Drug-Induced Gingival Enlargement: A Review of Diagnosis and Current Treatment Strategies.

Drug-induced gingival enlargement (DIGE) is a biofilm-mediated gingival inflammatory condition associated with pharmacological agents. Specifically, calcium channel blockers, immunosuppressants, and anticonvulsants are among the primary medications associated with DIGE. Modifiable risk factors for DIGE include drug dose and dental biofilm, and the use of concomitant inducing medications. Although the clinical presentation of DIGE depends on these and patient-specific variables, its classical appearance is described as fibrotic, pink, bulbous, or mulberry-shaped overgrowths of the attached gingiva and dental papillae, with no bleeding on probing. The clinical manifestations of DIGE may worsen as the disease increases in severity. Likewise, the treatment strategies become more complex. The dental management of DIGE includes nonsurgical, surgical if necessary, and maintenance therapies. Drug substitutions, which may only be considered in consultation with the patient's family physician or primary healthcare provider, are a form of nonsurgical therapy. DIGE can be extremely debilitating, especially in its advanced stages, and make oral hygiene cumbersome, which translates to poorer oral and periodontal health outcomes. Therefore, DIGE must be properly identified and treated accordingly to re-establish a healthy and maintainable periodontium.

Management of medication-induced gingival hyperplasia: a systematic review.

OBJECTIVE: Medication-induced gingival hyperplasia (MIGH) has been linked to several medications, with a reported prevalence ranging between 0.5% and 85%. The aim of this study was to systematically review the management approaches for MIGH and estimate recurrence rate and time to relapse. STUDY DESIGN: An electronic literature search was conducted using PICO questions (P = patients with medication-induced gingival hyperplasia; I = surgical and/or nonsurgical treatment options; C = no control is required; and O = partial or complete resolution and recurrence) and medical subject heading terms in the PubMed and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol up to December 2019. All English-language articles on MIGH surgical and nonsurgical management options were included. Eligible articles were systematically reviewed and assessed for bias using preset criteria and multiple levels of elimination. Data were extracted from eligible studies and analyzed. RESULTS: Twenty-two eligible articles were included in this study. Management approaches included discontinuation or change of the offending medication if medically feasible in addition to surgical and nonsurgical interventions. Nonsurgical approach included scaling and root planing, oral hygiene instructions, and antimicrobial mouthrinses. Persistent or relapsed cases had complete resolution with excision of hyperplastic gingiva. Laser-assisted surgeries combined with intensive plaque control measures demonstrated less risk of recurrence. CONCLUSIONS: Several treatment options for MIGH have been reported with variable outcomes. Duration and size of hyperplastic gingival tissue may have an effect on overall recurrence rate.

Hiperplasia gingival fibrosa asociada a incisivo central superior retenido / Fibrous gingival hiperplasia associated with upper central incisor retained / Hiperplasia gengival fibrosa associada a incisivo central superior retido

RESUMEN Se describió el caso clínico de un adolescente de 12 años de edad, atendido en el Departamento de Ortodoncia de la Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba, al cual se le diagnosticó retención del incisivo central superior derecho hace más de dos años y para la cual recibió tratamiento con aparatología fija previo entorche del diente y seguimiento clínico-radiográfico. Durante el proceder ortodóncico, es remitido al Departamento de Periodoncia por presentar en la zona de dicho diente un aumento de volumen de color rosa coral, de consistencia dura y aspecto fibroso, que imposibilitó la incorporación definitiva del diente en su arco y plano de oclusión. Se realizaron los exámenes complementarios correspondientes, se diagnosticó hiperplasia gingival fibrosa localizada y se realizó tratamiento quirúrgico (gingivectomía), lo que permitió llevar a feliz término el tratamiento ortodóncico sin ninguna implicación psicológica y social para el paciente. La poca frecuencia de aparición de este tipo de lesión asociada a la retención de incisivos centrales superiores motivó el presente informe de caso.

ABSTRACT It was described a clinical case of a 12-year-old adolescent, treated at the Orthodontic Department of the Provincial Stomatological Clinic "Mártires del Moncada" in Santiago de Cuba, who was diagnosed with retention of the upper right central incisor more than two years ago and for which he received treatment with fixed appliances prior to tooth straightening and clinical-radiographic follow-up. During the orthodontic procedure, he was referred to the Department of Periodontics because he had a coral pink increase in volume in the area of that tooth, with a hard consistency and fibrous appearance, which made it impossible to definitively incorporate the tooth into its arch and occlusion plane. The corresponding complementary examinations were carried out, localized fibrous gingival hyperplasia was diagnosed and surgical treatment (gingivectomy) was performed, which allowed the successful completion of orthodontic treatment without any psychological or social implications for the patient. The rare occurrence of this type of injury associated with retention of upper central incisors motivated this case report.

RESUMO O caso clínico de um adolescente de 12 anos de idade, atendido no Departamento de Ortodontia da Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba, diagnosticado com retenção do incisivo central superior direito, foi descrito mais de dois anos e para os quais ele recebeu tratamento com aparelhos fixos antes do bloqueio dentário e monitoramento clínico-radiográfico. Durante o procedimento ortodôntico, é encaminhado ao Departamento de Periodontia por apresentar na área do referido dente um aumento no volume rosa coral, de consistência dura e aparência fibrosa, o que impossibilitou a incorporação definitiva do dente em seu arco e plano de oclusão. Foram realizados os exames complementares correspondentes, diagnosticada hiperplasia gengival fibrosa localizada e realizado tratamento cirúrgico (gengivectomia), o que permitiu o tratamento ortodôntico sem envolvimento psicológico e social do paciente. A baixa frequência de ocorrência desse tipo de lesão associada à retenção dos incisivos centrais superiores motivou este relato de caso.

Aumento gengival associado à terapia de reposição hormonal / Gingival overgrowth associated to hormone replacement therapy ­ case report

Os aumentos gengivais são lesões proliferativas de evolução lenta e indolor que acometem os tecidos gengivais e envolvem várias possibilidades diagnósticas. O presente trabalho teve como objetivo relatar um caso clínico de aumento gengival em uma paciente jovem sob tratamento de reposição hormonal, ressaltando os aspectos clínicos e histopatológicos desta inter-relação.

Gingival overgrowth are proliferative lesions of painless and slow evolutive character, wich envolve the gingival tissues. This paper shows a case report of this lesion in a young female patient under hormone replacement therapy, highlightening the clinical and histopathologic aspects of this relationship.

Hiperplasia gingival inducida por amlodipino en paciente con periodontitis crónica. Presentación de un caso / Gingival hyperplasia induced by amlodipine in a patient with chronic periodontitis. Case presentation

Introducción: numerosos informes basados en estudios epidemiológicos demuestran la existencia de una relación entre las infecciones periodontales y las enfermedades sistémicas, a la par que se reportan incrementos de los casos de hiperplasia gingival relacionados con el uso de medicamentos bloqueadores de los canales del calcio. Objetivo: presentar un caso de hiperplasia gingival inducida por amlodipino, que resulta de interés para los profesionales de la salud por ser ésta una entidad poco frecuente en la práctica estomatológica y ser además el efecto adverso menos estudiado de este medicamento. Presentación del caso: paciente femenina de 40 años de edad y color de la piel blanco, que acudió a la Consulta de Periodoncia por presentar sangrado e inflamación grave de las encías, con molestias al hablar y durante la masticación. La paciente es hipertensa y se encontraba descompensada, por lo que tenía tratamiento con amlodipino en dosis de 10 mg diarios desde hacía cuatro meses. En los exámenes físico y radiográfico se constató una hiperplasia gingival medicamentosa asociada a periodontitis crónica del adulto, profunda y generalizada, por lo que se le indicó tratamiento antimicrobiano combinado con enjuagatorios de clorhexidina acuosa, tartrectomía (manual y ultrasónica) y la sustitución del amlodipino por atenolol. A los dos meses de tratamiento el cuadro remitió.Conclusiones: en pacientes con periodontitis crónica no es recomendable emplear amlodipino para compensar la hipertensión arterial, porque la hiperplasia gingival inducida farmacológicamente forma un ciclo vicioso con la enfermedad de base y la agrava, lo que puede ocasionar una enfermedad aterosclerótica cardiovascular(AU)

Introduction: numerous reports based on epidemiological studies have demonstrated the existence of a relationship between periodontal infections and systemic diseases, while increases in gingival hyperplasia associated with the use of calcium channel blockers are reported.Objective: to present a case of gingival hyperplasia induced by amlodipine, which is of interest to health professionals because it is a rare entity in the stomatological practice and also is the least studied adverse effect of this drug. Case presentation: female patient of 40 years of age and white skin color, who attended the Periodontal Consultation due to bleeding and severe inflammation of the gums, with discomfort when speaking and during chewing. The patient suffers high blood pressure and she was decompensated, so she had been treated with amlodipine at doses of 10 mg daily for four months. Physical and radiographic exams revealed a gingival hyperplasia associated with chronic, deep and generalized adult periodontitis, for which antimicrobial treatment was combined with aqueous chlorhexidine rinses, tartrectomy (manual and ultrasonic) and amlodipine replacement with atenolol. At two months of treatment, the symptoms went forward.Conclusions: in patients with chronic periodontitis it is not recommended to use amlodipine to compensate the arterial hypertension, because induced gingival hyperplasia forms a vicious cycle with the underlying disease and aggravates it, which can lead to cardiovascular atherosclerotic disease(AU)

Fibroma ossificante periférico ­ Relato longitudinal de dois casos clínicos / Long-term follow-up of peripheral ossifying fibroma ­ report of two cases

O fibroma ossificante periférico é uma lesão não neoplásica proliferativa, não patognomônico, de evolução lenta e indolor, que acomete os tecidos gengivais. O presente trabalho teve como objetivo relatar dois casos clínicos desta lesão em um acompanhamento em longo prazo, ressaltando os aspectos clínicos e histopatológicos, bem como seu tratamento e prognóstico.

The peripheral ossifying fibroma is a non-neoplasic, proliferative lesion of painless and slow evolutive character, which involves the gingival tissues. This paper reports on two clinical cases in a long-term follow-up highlightening their clinical and histopathologic aspects, treatment, and outcomes.

Agrandamiento gingival por ciclosporina: reporte de un caso / Gingival enlargement due to cyclosporine: a case report

El agrandamiento gingival (AG) es el aumento de volumen anormal de la encía que genera cambios estéticos y síntomas clínicos como sangrado gingival espontáneo o inducido, trastornos periodontales y migración patológica dentaria, entre otros. Este proceso patológico puede ser un efecto secundario a ciertos fármacos como anticonvulsivantes, bloqueadores de canales de calcio e inmunosupresores. Se presenta el caso de un paciente sexo masculino de 74 años de edad con antecedentes de trasplante renal, en tratamiento con ciclosporina, que acude por aumento del volumen intraoral, clínicamente compatible con agrandamiento gingival. Se realiza tratamiento basado en exodoncias, biopsia y control de placa. A los 2 meses se pudo observar una regresión de la lesión, y se confirma el diagnóstico con el estudio histopatológico. El manejo actual del tratamiento de esta enfermedad se basa en el control de la placa. Se sugiere dar un enfoque multidisciplinario y crear protocolos para derivar oportunamente antes de la expresión más agresiva de la enfermedad.

Gingival enlargement is an abnormal increased volume of the gum that induces cosmetic changes and clinical symptoms, such as gingival bleeding, periodontal disorders, pathological tooth migration, among others. This condition can be a side effect of certain drugs such as anticonvulsants, calcium channel blockers, and immunosuppressants. A 74 year-old male patient with a medical record of kidney transplant secondary to chronic renal failure receiving cyclosporine for the past 14 years is referred to our Hospital with the chief complaint of gingival enlargement. The treatment is based on tooth extractions, biopsy and periodontal treatment. A complete regression of the lesion was observed after two months. The current approach to treat this disease is focused on plaque control. A multidisciplinary approach should be used and clinical protocols prepared that allow early treatment and avoidance of more aggressive disease expression.

Sturge Weber Syndrome: An Unusual Case with Multisystem Manifestations.

BACKGROUND: Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder. It is characterized by the presence of facial port wine stains, neurological abnormalities like seizures and mental retardation, ocular disorders, oral involvement and leptomeningeal angiomas. CASE REPORT: A 13-year-old boy presented with the chief complaint of swollen, bleeding gums and deposits on the teeth. Detailed medical and dental history, clinical examination and investigations confirmed the diagnosis of Sturge-Weber syndrome. The treatment comprised of a thorough plaque control regimen to reduce the gingival enlargement, and it included oral hygiene instructions, thorough scaling, root planing at regular intervals and plaque index scoring which motivated the patient at each visit. CONCLUSION: This case illustrates that early intervention in a patient with Sturge-Weber syndrome is quintessential because of its associated gingival vascular features and their complicating manifestations. Furthermore, the need for periodic oral examinations and maintenance of good oral hygiene to prevent any complications from the oral vascular lesions has been highlighted.

Nonsurgical Management of Phenytoin-induced Gingival Hyperplasia.

INTRODUCTION: The aim of this report is to present a severe case of phenytoin (PHT)-induced gingival hyperplasia in a Saudi patient. MATERIALS AND METHODS: A 12-year-old male epileptic patient, undergoing PHT therapy, was diagnosed clinically with severe gingival hyperplasia. His treatment consisted meticulous oral care and weekly professional prophylaxis. The patient was advised oral folic acid supplementation (0.5 mg/day) and was also recommended 0.2% chlorhexidine gluconate mouthwash twice daily. RESULTS: There was significant reduction in the hyperplastic tissue within 4 weeks of treatment. CONCLUSION: It is possible to treat PHT-induced gingival hyperplasia non-surgically with intensive dental care, correct oral hygiene and oral folic acid supplements.

Periodontitis associated with plasminogen deficiency: a case report.

BACKGROUND: Plasminogen deficiency is a rare autosomal recessive disease, which is associated with aggressive periodontitis and gingival enlargement. Previously described treatments of plasminogen deficiency associated periodontitis have shown limited success. This is the first case report indicating a successful therapy approach consisting of a non-surgical supra- and subgingival debridement in combination with an adjunctive systemic antibiotic therapy and a strict supportive periodontal regimen over an observation period of 4 years. CASE PRESENTATION: The intraoral examination of a 17-year-old Turkish female with severe plasminogen deficiency revealed generalized increased pocket probing depths ranging from 6 to 9 mm, bleeding on probing over 30%, generalized tooth mobility, and gingival hyperplasia. Alveolar bone loss ranged from 30% to 50%. Clinical attachment loss corresponded to pocket probing depths. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens have been detected by realtime polymerase chain reaction. Periodontal treatment consisted of full mouth disinfection and adjunctive systemic administration of amoxicillin (500 mg tid) and metronidazole (400 mg tid). A strict supportive periodontal therapy regimen every three month in terms of supra- and subgingival debridement was rendered. The reported therapy has significantly improved periodontal health and arrested disease progression. Intraoral examination at the end of the observation period 3.5 years after non-surgical periodontal therapy showed generalized decreased pocket probing depths ranging from 1 to 6 mm, bleeding on probing lower 30%, and tooth mobility class I and II. Furthermore, microbiological analysis shows the absence of Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola after therapy. CONCLUSION: Adjunctive antibiotic treatment may alter the oral microbiome and thus, the inflammatory response of periodontal disease associated to plasminogen deficiency and diminishes the risk of pseudomembrane formation and progressive attachment loss. This case report indicates that patients with plasminogen deficiency may benefit from non-surgical periodontal treatment in combination with an adjunctive antibiotic therapy and a strict supportive periodontal therapy regimen.

Comparison of Electric Toothbrush, Persica and Chlorhexidine Mouthwashes on Reduction of Gingival Enlargement in Orthodontic Patients: A Randomised Clinical Trial.

PURPOSE: To compare the efficacy of chlorhexidine, Persica mouthwash and electric toothbrushes in improving gingival enlargement in patients with fixed orthodontic appliances. MATERIALS AND METHODS: Seventy-two orthodontic patients with at least two sites of gingival enlargement were randomly allocated into four equal groups: 1) manual toothbrush; 2) electric toothbrush; 3) manual toothbrush+Persica mouthwash; 4) manual toothbrush+chlorhexidine mouthwash. All participants were instructed to brush their teeth at least twice a day. The subjects in groups 3 and 4 were instructed to use Persica or chlorhexidine according to the respective manufacturer's instructions. Bleeding on probing (BOP) index, gingival index (GI), O'Leary's plaque index (PI) and constructed hyperplastic index (HI) of all the subjects were measured in a blind manner at the start of the study and 2 weeks later. Changes of indices in the entire oral cavity and individual affected teeth were analysed with SPSS 16 using chi-square, ANOVA, ANCOVA, LSD and the paired t-test. RESULTS: In the entire oral cavity, there was a statistically significant improvement in indices in all the groups except for HI, which significantly improved only in group 4 (p=0.001). Data of individual teeth with hyperplastic gingiva showed significant reduction of all the variables except for HI in group 1 (p=0.08). No significant differences were found between groups 1 and 2 or between groups 3 and 4. CONCLUSION: The efficacy of Persica was similar to that of chlorhexidine in improving gingival conditions. None of the treatment modalities could reduce gingival enlargement to the clinically acceptable level of health.

The clinical features and their impact on the prosthodontic management in a case of Gardner's syndrome.

Gardner's syndrome is a variant of Familial Adenomatous Polyposis (FAP), a condition that manifests as hundreds of colorectal polyps likely to undergo malignant change by the fourth decade. Early diagnosis of this condition has the potential to be life saving for individuals and due to its inherited nature other family members can often also be affected. Additional features of Gardner's Syndrome include multiple jaw osteomas with missing teeth that can make prosthodontic treatment a challenge. This case report highlights the presenting features and the prosthodontic problems faced when treating a patient with Gardner's syndrome.

Manifestações bucais associadas à imunossupressão em pacientes submetidos a transplante de coração / Oral manifestations associated with immunosupression in patients undergoing heart transplant

A condição de imunossupressão de pacientes transplantadoscardíacos possibilita o surgimento de manifestações bucaisimportantes que representam risco para o sucesso dotransplante cardíaco. A avaliação e o acompanhamentoodontológico desses pacientes são fundamentais na prevençãodessas manifestações bucais e infecções sistêmicas. Por meiodo relato dos casos clínicos de três pacientes transplantadoscardíacos, apresentamos e discutimos as condições clínicas eas opções terapêuticas das manifestações bucais mais comunsneste grupo de pacientes...

The condition of immunosuppression in heart transplant patientsenables emergence of oral manifestations that represent significantrisk to the success of heart transplantation. The oral and dentalevaluation and the follow up of these patients are critical in preventingthese oral manifestations and systemic infections. Through thereports files of three patients who underwent cardiac transplantation,we present and discuss the clinical and therapeutic options of themost common oral manifestations in this group of patients...

Global developmental delay with sodium valproate-induced gingival hyperplasia.

Global developmental delay (GDD) refers to a disturbance in an individual child across one or more developmental domains, which include motor, cognition, daily activities, speech and language. The present case discusses a 5-year-old child with GDD associated with infantile spasms treated with sodium valproate. Delay in the widespread acquisition of skills, epilepsy and poor oral hygiene with gingival enlargement was the main concern to seek medical aid. This case is special as the child was suffering from GDD associated with sodium valproate-induced gingival enlargement.

Eficácia do laser cirúrgico de diodo no tratamento da hiperplasia fibrosa inflamatória / Efficacy of diode laser surgery in the treatment of inflammatory fibrous hyperplasia

O objetivo deste trabalho foi avaliar a eficácia do laser cirúrgico de diodo no tratamento da hiperplasia fibrosa inflamatória comparada com a técnica convencional utilizando o bisturi em um ensaio clínico randomizado. Trinta e oito pacientes com hiperplasia fibrosa inflamatória foram avaliados. No grupo controle os pacientes foram submetidos ao tratamento com bisturi, e no grupo de estudo ao tratamento com laser cirúrgico de diodo. Os pacientes do grupo de estudo foram tratados utilizando um laser de diodo em um comprimento de onda de 808nm em modo contínuo, com uma média de potência de 2.96W...

Localized juvenile spongiotic gingival hyperplasia: a report of 3 cases.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a recently described benign condition that affects the gingiva of children and young adults. Clinically distinctive, LJSGH presents as a localized area of erythema on the attached gingiva, with a subtly papillary surface architecture. The lesions are generally biopsied because of the lack of resolution with conservative oral hygiene therapeutic measures and esthetic concerns. The histopathology has a characteristic appearance of subtle papillary epithelial hyperplasia, acute inflammation, and numerous engorged capillary vascular spaces in the lamina propria, although clinical correlation is necessary to make the diagnosis. The purposes of this paper were to: introduce localized juvenile spongiotic gingival hyperplasia to the pediatric dental community; document its clinical and histologic features and treatment and the follow-up of three cases; and discuss the most common clinical differential diagnoses.

Periodontal considerations for children.

This article reviews periodontal disease and gingival disease and also explores issues relating to mucogingival defects such as gingival hyperplasia, gingival recession, and exposure of impacted canines.

Integrated approach to outpatient dental treatment of a patient with cerebral palsy: a case report.

The large number of oral manifestations associated with motor disorders in patients with cerebral palsy (CP) makes the dentist an indispensable member of the multidisciplinary team caring for this population. This case report presents an 11-year-old girl with spastic CP who had severe motor impairment, and a description of her care illustrates the importance of integrated care for patients with CP who are receiving outpatient dental treatment. It was determined that the use of adaptations based on knowledge of CP supported the outpatient dental treatment. The integrated approach used during dental treatment enabled the application of knowledge from the fields of dentistry, physical therapy, and speech therapy to provide for a better quality of life for the patient and, consequently, the caregiver through the improvement in the patient's oral and general health.