5. CLASSIFICATION
1. Inflammatory enlargement
a. Chronic
b. Acute
2. Drug induced enlargement
3. Enlargement associated with systemic diseases or conditions
a. Pregnancy
b. Puberty
c. Vitamin c deficiency
d. Plasma cell gingivitis
e. Non specific conditioned enlargement (pyogenic
6. 4. specific diseases causing gingival enlargement
a. Leukemia
b. Granulomatous diseases
5. neoplastic enlargement
a. Benign tumors
b. Malignant tumors
6. false enlargment
7. Drug-induced enlargement
• Drug-induced gingival overgrowth occurs as a
side effect of some systemic medications.
(such as
phenytoin, phenobarbital, lamotrigine, valproate,
vigabatrin, ethosuximide, topiramate and
primidone)
, such as nifedipine
and verapamil.the dihydropyridine derivative
isradipidine can replace nifedipine and does not
induce gingival overgrowth.
, cyclosporine
8. Age
Dose
Duration Demograph
Drug
Saliva conc. ic variables
Serum conc.
HLA Antigen
Genetic
Chronic
predisposit
irritation
ion
Genetic markers
Oral
Hormones
hygiene
Molecular Pharmaco
&cellular kinetic
changes variables
9. Diagnosis
The diagnosis of drug-induced gingival
overgrowth is mainly based on :
Clinical appearance
Medical history
Histopathological features
10. • Discomfort
• Interfere with speech or chewing
• Halitosis (bad odour to the breath)
• Look unsightly
13. Continue…
• Mulberry shaped, firm, pale pink, resilient,
lobulated surface, no tendancy to bleed.
• When complicated by inflammation,:
red/bluish red color,obliterate the surface
demarcation, tendency to bleed
• Onset within 3 months
• Predilection for anterior gingiva
14. , a drug used for the
management of epilepsy,
50 to 100% of treated patients can occur
Male patients are at high risk
16. Continue…
• Enlargement is Independent of local
inflammation
• Also Precipitate megaloblastic anemia & folic
acid deficiency
17. , an immunosuppressant
drug used to reduce organ transplant
rejection
15 to 85% of treated patients can occur
Male patients are at high risk
cyclosporin solution experience earlier onset of
gingival changes than using capsules.
18. • Prevent organ transplant rejection
• Reversibly inhibit helper T cell
• Dosage >500 mg/day induce g.enlargement
• More vascularized connective tissue
• Enlargement is a hypersensitivity reaction
20. -a group of
anti-hypertensive drugs
10 to 30% treated patients can occur
nifedipine, verapamil, diltiazem, oxodipine, amlodipine),
21. • Increases gingival fibroblast
• Increase in production of connective tissue
matrix
• Used in the treatment of cvs conditions,
• In kidney transplantation patient along with
cyclosporine
22. Other drugs, such as antibiotics
and
have been also
associated with this
side effect.
23. Histopathology
• Pronounced hyperplasia of connective tissue
& epithelium
• Acanthosis of epithelium
• Elongated rete pegs
• Increased fibroblast, collagen, new blood
vessels
• Abundant amorphous ground substance.
24.
25.
26.
27. Mild gingival enlargement will often diminish
with removal of plaque and calculus deposits.
Mouth washes:
Chlorhexidine
Tooth brushing
Flossing
29. • It may take from 1 to 8 weeks for resolution of
gingival lesions.
• CCB: amlodipine and felodipine, isradipin
• Cyclosporine: tacrolimus
• Phenytoin: valproic acid, carbamazepine, or
phenobarbitone, vigabatrin
30. • Patient taking cyclosporin, the azithromycin
decrease the severity of gingival overgrowth
• Organ transplant patients,dosages of both
prednisolone and azathioprine
31. • Gingivectomy is the treatment preferred when
the
• Gingival overgrowth involves small areas (up
to six teeth), there is no evidence of
attachment loss and
• There is at least 3 mm of keratinized tissue.
32. • The periodontal flap is preferred when the
• gingival overgrowth involves larger areas
(more than six teeth) and there is evidence of
attachment loss combined with osseous
defects
33.
34. • CO2 or argon-laser surgery has been
proposed as surgical treatment of gingival
overgrowth because of decreased surgical
time and rapid post-operative haemostasis.
35. • Good oral hygiene for preventing or retarding
the recurrence of the gingival overgrowth is
important after surgery.
36. RISK FACTORS
• Potential risk factors for drug-induced gingival
overgrowth include the following:
• Poor oral hygiene
• Periodontal disease
• Periodontal pocket depth
• Gingival inflammation
• Degree of dental plaque
• Duration and dose of cyclosporine
37. Prognosis
• Recurrences are frequent, particularly in
patients with less than optimal plaque control
and when the drug regimens cannot be
modified or reduced.
38. Prevention
may help to prevent the
onset and development of gingival
enlargement.
