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    Gingival Enlargement Induced Drugs: Lluis Brunet, L Jaume Miranda, L Magi Farre, 2 Leonardo Berini Carles Mendieta L

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    Gingival Enlargement Induced Drugs: Lluis Brunet, L Jaume Miranda, L Magi Farre, 2 Leonardo Berini Carles Mendieta L

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    Gingival Enlargement Induced Drugs: Lluis Brunet, L Jaume Miranda, L Magi Farre, 2 Leonardo Berini Carles Mendieta L

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    of 2

    Drug Safety 1996 Sep ; 15 (3): 219-231

    PHARMACOEPIDEMIOLOGY 0114-59 16/96/CXXJ9-D21 9/S06.00/0

    © Adis International Limited. All rights reserved.

    Gingival Enlargement
    Induced by Drugs
    Lluis Brunet,l Jaume Miranda,l Magi Farre,2 Leonardo Berini3 and Carles Mendieta l
    1 Unit of Periodontics, Facultat d'Odontologia, Universitat de Barcelona, Barcelona, Spain
    2 Department of Pharmacology, Institut Municipal d'Investigaci6 Medica (IMIM),
    Universitat Autonoma de Barcelona, Barcelona, Spain
    3 Unit of Oral Surgery, Facultat d'Odontologia, Universitat de Barcelona, Barcelona, Spain

    Contents
    Summary . . . . . . . 219
    1. Periodontal Anatomy 220
    2. Aetiology of Gingival Enlargement 221
    3. Pathogenesis: Drugs That Cause Gingival Enlargement 221
    3.1 Anticonvulsants. 222
    3.2 Cyclosporin .. . . . . 223
    3.3 Calcium Antagonists . 225
    3.4 Oral Contraceptives 226
    4. Management. 226
    5. Conclusion . . . . . . . . 227

    Summary Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly


    associated with dental plaque-related inflammation and drug therapy. Its true
    incidence in the general population is unknown. Gingival enlargement produces
    aesthetic changes, pain, gingival bleeding and periodontal disorders .
    Although gingival overgrowth has been traditionally recognised as an adverse
    effect of phenytoin therapy, it has recently been reported in association with the
    use of cyclosporin and calcium antagonists. These 3 classes of drugs produce
    important changes in fibroblast function, which induce an increase in the extra-
    cellular matrix of the gingival connective tissue.
    In the majority of those patients for whom dosage reduction, or drug discon-
    tinuation or substitution is not possible, and for whom prophylactic measures
    have failed, surgical excision of gingival tissue remains the only treatment of
    choice.

    Gingival enlargement is defined as an abnormal more appropriate to use 'gingival enlargement' or


    growth of the periodontal tissue. The terms 'gingi- 'gingival overgrowth', terms that define the clini-
    val hyperplasia' and 'gingival hypertrophy' have cal picture of this condition.
    been used interchangeably to designate enlarge- Gingival enlargement produces aesthetic changes
    ment of the gum. Since both terms refer to the histo- and clinical symptoms including pain, tenderness,
    pathological characteristics of the process, it seems bleeding, speech disturbances , abnormal tooth
    220 Brunet et al .

    ......- - - - Enamel - - - ---jo

    .........f----Glngival margin - - - - 1Il0l

    ~I----Ginglva l groove

    GINGIVA

    Mucoglngival junction

    ALVEOLAR MUCOSA

    Fig. 1. Periodontal protection tissues. Anatomical relationships of normal gingiva.

    movement, dental occlusion problems, enhancement structure that surrounds the dental root and con-
    of caries development and periodontal disorders.[1,2] nects it to the alveolar bone. This ligament has me-
    Gingival overgrowth usually begins in the inter- chanical (insertion), physiological (remodelling),
    proximal papillae, more commonly in the anterior nutritive (blood supply) and sensorial (propriocep-
    than in the posterior segments of jaw, therefore in- tive sensitivity) functions. The tooth cementum is
    cisors and canine teeth are more often affected than
    premolars and molars. The preferred location is the
    labial (vestibular) surfaces compared with lingual!
    palatal surfaces.l I ,2]
    Gingival margin ----f--t~

    1. Periodontal Anatomy Enamel - - - - / +

    The periodontium comprises the tissues that


    surround and support the teeth, it includes the gum
    and tooth anchorage: the periodontal ligament,
    tooth cementum, and the alveolar bone (figs I and 2).
    The gum is a mucous membrane that covers the
    dental arches, extending between the teeth to which
    Cemenlum - -..... 1
    it is adhered closely. Histologically, the gum con-
    sists of an epithelium (stratified squamous, kera-
    Alveolar bone ---tl-.~
    tinised or parakeratinised), connective tissue with
    fibroblasts and the extracellular matrix (largely Periodonlal - - - - tit>
    ligament
    made up of collagen fibres and ground substance -
    sulfated glycosaminoglycans) (fig. 3).
    The regulating cell of the gingival connective
    tissue is the fibroblast, which synthesises and breaks
    down the collagen fibres and the ground substance. Fig. 2. Periodontal insertion tissues: cementum, alveolar bone
    The periodontal ligament is a connective tissue and periodontal ligament.

    © Adis International Limited. All rights reserved. Drug Safety 1996 Sep; 15 (3)

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