Drug induced gingival hyperplasia refers to the abnormal overgrowth of gingival tissues caused as a side effect of certain systemic medications.
Etiology:
The primary drug classes associated with gingival hyperplasia include:
1. Anticonvulsants – e.g. Phenytoin
2. Calcium Channel Blockers – e.g. Nifedipine, Amlodipine, Verapamil
3. Immunosuppressants – e.g. Cyclosporine A
Pathophysiology:
Although the exact mechanism is unclear, gingival overgrowth is believed to be caused by:
• Stimulation of fibroblast proliferation
• Increase in collagen production
• Reduced breakdown of extracellular matrix
• Genetic predisposition and poor oral hygiene act as contributory factors
Clinical Features:
• Begins in interdental papillae especially in anterior regions
• Tissue appears firm, pale pink and lobulated
• Can progress to cover crown portions interfering with mastication and aesthetics
• May cause pseudopockets and increased risk of periodontitis
• Inflammation and bleeding may occur if superimposed plaque is present
Diagnosis:
• Based on clinical history (drug intake)
• Examination of gingival overgrowth pattern
• Correlation with plaque status and oral hygiene
Management:
1. Initial Phase:
• Emphasize meticulous oral hygiene
• Scaling and root planing to reduce local irritants
• Chlorhexidine rinses
2. Medical Management:
• Consultation with the physician for possible drug substitution
3. Surgical Management (if overgrowth persists):
• Gingivectomy
• Periodontal flap surgery (for deeper involvement)
Prognosis:
• Recurrence is possible if drug use continues and oral hygiene is poor
• Regular follow-up and maintenance are essential