Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Abstract

Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.

Effect of calcium channel blockers on gingival tissues in hypertensive patients in Lagos, Nigeria: A pilot study

“…[ 1 6 7 ] Furthermore, Samudrala et al . [ 11 ] in a 2017 review suggested certain features to be generally more frequent in DIGOs. These include the initiation of GO within 3 months of drug use, frequent occurrence in the anterior gingiva in younger age groups, and a lack of association with attachment loss.…”

“…Several reports have implicated nifedipine and amlodipine as the frequent causes of GO,[ 2 4 11 15 16 17 18 19 20 ] though this unwanted effect has also been reported in patients taking verapamil. [ 21 ] The recent case reports’ review by Samudrala et al .…”

“…[ 21 ] The recent case reports’ review by Samudrala et al . [ 11 ] summarized the management of CCB-associated GO as follows; changing the drug, thorough scaling and root planing, and conscientious plaque control measures, followed by surgical intervention in the face of persistent DIGO. In their review, only one of the case reports of the CCB-induced DIGO needed surgical intervention despite changing the drug and performing nonsurgical professional therapy.…”

“…The importance of histopathological examination of gingival tissues in the diagnosis and management of DIGO was also buttressed in their analysis. [ 11 ] This aims to clarify disparities that may sometimes occur between clinical and histopathological diagnoses such as that observed in the report by Vishnudas et al .,[ 11 22 ] in which a histopathological diagnosis of plasma cell granuloma was made following the initial amlodipine-associated gingival enlargement.…”

Amlodipine induced Gingival Overgrowth in Patients at a Tertiary Level Hospital of Nepal

“…Histologically, there is presence of sparse to moderate inflammatory cell infiltrate correlated to inflammatory condition. A recent study stated that it is not clear whether plaque is a cause or a result of GO 16. Another reason why some patients have greater cellular proliferation and collagen synthesis may be attributed to the variation in the differential subpopulations of fibroblasts inthe individuals.…”