Drug-Induced Gingival Hyperplasia is abnormal gum tissue enlargement from prolonged medication use.
Gingival hyperplasia commonly arises from drug-induced enlargement.
Gingival overgrowth occurs in adults with epilepsy on certain medications. Calcium antagonists inhibit calcium ion influx necessary for collagen degradation and synthesis.
Collagen accumulation and extracellular matrix breakdown contribute to gingival hyperplasia development.
Identifying patients at risk of gingival overgrowth from phenytoin, cyclosporine, and calcium antagonists is essential to minimize its onset and severity.
Dental plaque may accumulate phenytoin or cyclosporine, while nickel accumulation causes gingival overgrowth in orthodontic patients.
Oral health status prior to medication significantly contributes to the development of drug-induced gingival hyperplasia.
Epidemiology
Gingival overgrowth is rare, and no population-based studies occurred in the United States.
Phenytoin-induced gingival overgrowth occurs in 15-50% of patients. Gingival hyperplasia occurs in 10-20% of calcium antagonist-treated patients generally.
No global data on gingival overgrowth exists. In India, 57% of epileptic children on phenytoin developed gingival overgrowth within 6 months.
No racial preference affects drug-induced gingival overgrowth. No sexual predilection exists, but males may be three times more likely to develop gingival overgrowth.
Drug-induced gingival overgrowth is more serious in children.
Anatomy
Pathophysiology
Different studies indicate that phenytoin, cyclosporine, and nifedipine can cause gingival tissue overgrowth in susceptible individuals.
Phenytoin induces gingival overgrowth via interaction with sensitive fibroblasts.
Cyclosporine-induced fibroblast overgrowth in adults and children relates to fibroblast proliferation and cytokine network.
Literature indicates a cofactor is essential for gingival overgrowth, with evidence highlights its role in inflammation modulation.
Etiology
Risk factors for drug-induced gingival overgrowth are:
Periodontal disease
Periodontal pocket depth
Poor oral hygiene
Gingival inflammation
Degree of dental plaque
Genetics
Prognostic Factors
No mortality from gingival enlargement. Surgical correction may be needed, but recurrence possible with drug.
Severe morbidity from gingival overgrowth can cause bleeding, pain, teeth displacement, and periodontal disease.
Regular oral hygiene improves patient prognosis significantly. Mild cases improve with better hygiene and adjustments.
Clinical History
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Physical Examination
Extraoral Examination
Intraoral Examination
Systemic Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Sudden increase in swelling over weeks, pain, tenderness, spontaneous bleeding, possible fever and lymphadenopathy
Chronic symptoms are:
Gradual, fibrotic, and painless, minimal bleeding unless inflamed
Differential Diagnoses
Hereditary Gingival Fibromatosis
Leukemic Gingival Enlargement
Scurvy
Hormonal Gingival Enlargement
Neoplastic Gingival Mass
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Refer patients to a dentist or oral medicine specialist. Poor oral health causes severe gingival overgrowth and tooth loss.
Gingivectomy with lasers is advised for moderate-to-severe gingival enlargement unresponsive to reduced dosage treatment.
Refer patients to dental practitioners or oral medicine specialists experienced in complex medical care.
An oral medicine specialist and periodontist should monitor patients on cyclosporine, phenytoin, or calcium channel blockers for gingival overgrowth and oral complications.
Amlodipine is a dihydropyridine calcium antagonist used to treat hypertension and angina to inhibit calcium influx in muscles.
Nifedipine and cyclosporine together enhance effects in transplant hypertension.
Brushing teeth before chlorhexidine mouthwash prevents potential teeth staining.
Low-level laser therapy and dual-wavelength lasers are used to manage drug-induced gingival hyperplasia.
Use soft-bristle toothbrushes to prevent gingival trauma under oral hygiene.
Antiseptic mouthwashes should be used to control plaque and reduce gingival inflammation.
Good bathroom lighting is essential for effective brushing and flossing.
Regularly assess patient medications for early gingival overgrowth.
Use of digital imaging to track changes in gingival size and shape over time.
Take adequate nutrition, including vitamin C and other vitamins to improve gum tissue health.
Proper awareness about Drug-Induced Gingival Hyperplasia should be provided and its related causes with management strategies.
Appointments with dentist and preventing recurrence of disorder is an ongoing life-long effort.
Use of Antibiotics
Azithromycin:
Azithromycin with oral hygiene decreases cyclosporine-induced gingival hyperplasia. It suppresses protein synthesis of gram-positive and gram-negative aerobes.
Use of Mouthwash antiseptics
Chlorhexidine oral:
These are antiseptic agent indicated for oral bacterial and fungal infections. It is an antimicrobial drug that targets bacterial cell walls.
In the initial diagnosis phase, the goal is to identify risk factors and implement initial preventive measures to confirm the diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes the use of antibiotics and mouthwash antiseptics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the dentist are scheduled to check the improvement of patients along with treatment response.
»
Home » CAD » Drug-Induced Gingival Hyperplasia
Drug-Induced Gingival Hyperplasia
Updated :
April 28, 2025
Drug-Induced Gingival Hyperplasia is abnormal gum tissue enlargement from prolonged medication use.
Gingival hyperplasia commonly arises from drug-induced enlargement.
Gingival overgrowth occurs in adults with epilepsy on certain medications. Calcium antagonists inhibit calcium ion influx necessary for collagen degradation and synthesis.
Collagen accumulation and extracellular matrix breakdown contribute to gingival hyperplasia development.
Identifying patients at risk of gingival overgrowth from phenytoin, cyclosporine, and calcium antagonists is essential to minimize its onset and severity.
Dental plaque may accumulate phenytoin or cyclosporine, while nickel accumulation causes gingival overgrowth in orthodontic patients.
Oral health status prior to medication significantly contributes to the development of drug-induced gingival hyperplasia.
Gingival overgrowth is rare, and no population-based studies occurred in the United States.
Phenytoin-induced gingival overgrowth occurs in 15-50% of patients. Gingival hyperplasia occurs in 10-20% of calcium antagonist-treated patients generally.
No global data on gingival overgrowth exists. In India, 57% of epileptic children on phenytoin developed gingival overgrowth within 6 months.
No racial preference affects drug-induced gingival overgrowth. No sexual predilection exists, but males may be three times more likely to develop gingival overgrowth.
Drug-induced gingival overgrowth is more serious in children.
Different studies indicate that phenytoin, cyclosporine, and nifedipine can cause gingival tissue overgrowth in susceptible individuals.
Phenytoin induces gingival overgrowth via interaction with sensitive fibroblasts.
Cyclosporine-induced fibroblast overgrowth in adults and children relates to fibroblast proliferation and cytokine network.
Literature indicates a cofactor is essential for gingival overgrowth, with evidence highlights its role in inflammation modulation.
Risk factors for drug-induced gingival overgrowth are:
Periodontal disease
Periodontal pocket depth
Poor oral hygiene
Gingival inflammation
Degree of dental plaque
No mortality from gingival enlargement. Surgical correction may be needed, but recurrence possible with drug.
Severe morbidity from gingival overgrowth can cause bleeding, pain, teeth displacement, and periodontal disease.
Regular oral hygiene improves patient prognosis significantly. Mild cases improve with better hygiene and adjustments.
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Extraoral Examination
Intraoral Examination
Systemic Examination
Acute symptoms are:
Sudden increase in swelling over weeks, pain, tenderness, spontaneous bleeding, possible fever and lymphadenopathy
Chronic symptoms are:
Gradual, fibrotic, and painless, minimal bleeding unless inflamed
Hereditary Gingival Fibromatosis
Leukemic Gingival Enlargement
Scurvy
Hormonal Gingival Enlargement
Neoplastic Gingival Mass
Refer patients to a dentist or oral medicine specialist. Poor oral health causes severe gingival overgrowth and tooth loss.
Gingivectomy with lasers is advised for moderate-to-severe gingival enlargement unresponsive to reduced dosage treatment.
Refer patients to dental practitioners or oral medicine specialists experienced in complex medical care.
An oral medicine specialist and periodontist should monitor patients on cyclosporine, phenytoin, or calcium channel blockers for gingival overgrowth and oral complications.
Amlodipine is a dihydropyridine calcium antagonist used to treat hypertension and angina to inhibit calcium influx in muscles.
Nifedipine and cyclosporine together enhance effects in transplant hypertension.
Brushing teeth before chlorhexidine mouthwash prevents potential teeth staining.
Low-level laser therapy and dual-wavelength lasers are used to manage drug-induced gingival hyperplasia.
Dermatology, General
Use soft-bristle toothbrushes to prevent gingival trauma under oral hygiene.
Antiseptic mouthwashes should be used to control plaque and reduce gingival inflammation.
Good bathroom lighting is essential for effective brushing and flossing.
Regularly assess patient medications for early gingival overgrowth.
Use of digital imaging to track changes in gingival size and shape over time.
Take adequate nutrition, including vitamin C and other vitamins to improve gum tissue health.
Proper awareness about Drug-Induced Gingival Hyperplasia should be provided and its related causes with management strategies.
Appointments with dentist and preventing recurrence of disorder is an ongoing life-long effort.
Dermatology, General
Azithromycin:
Azithromycin with oral hygiene decreases cyclosporine-induced gingival hyperplasia. It suppresses protein synthesis of gram-positive and gram-negative aerobes.
Dermatology, General
Chlorhexidine oral:
These are antiseptic agent indicated for oral bacterial and fungal infections. It is an antimicrobial drug that targets bacterial cell walls.
Dermatology, General
Surgical procedures for Gingival Overgrowth include gingivectomy with laser and periodontal flap surgery.
Dermatology, General
In the initial diagnosis phase, the goal is to identify risk factors and implement initial preventive measures to confirm the diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes the use of antibiotics and mouthwash antiseptics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the dentist are scheduled to check the improvement of patients along with treatment response.
Drug-Induced Gingival Hyperplasia is abnormal gum tissue enlargement from prolonged medication use.
Gingival hyperplasia commonly arises from drug-induced enlargement.
Gingival overgrowth occurs in adults with epilepsy on certain medications. Calcium antagonists inhibit calcium ion influx necessary for collagen degradation and synthesis.
Collagen accumulation and extracellular matrix breakdown contribute to gingival hyperplasia development.
Identifying patients at risk of gingival overgrowth from phenytoin, cyclosporine, and calcium antagonists is essential to minimize its onset and severity.
Dental plaque may accumulate phenytoin or cyclosporine, while nickel accumulation causes gingival overgrowth in orthodontic patients.
Oral health status prior to medication significantly contributes to the development of drug-induced gingival hyperplasia.
Gingival overgrowth is rare, and no population-based studies occurred in the United States.
Phenytoin-induced gingival overgrowth occurs in 15-50% of patients. Gingival hyperplasia occurs in 10-20% of calcium antagonist-treated patients generally.
No global data on gingival overgrowth exists. In India, 57% of epileptic children on phenytoin developed gingival overgrowth within 6 months.
No racial preference affects drug-induced gingival overgrowth. No sexual predilection exists, but males may be three times more likely to develop gingival overgrowth.
Drug-induced gingival overgrowth is more serious in children.
Different studies indicate that phenytoin, cyclosporine, and nifedipine can cause gingival tissue overgrowth in susceptible individuals.
Phenytoin induces gingival overgrowth via interaction with sensitive fibroblasts.
Cyclosporine-induced fibroblast overgrowth in adults and children relates to fibroblast proliferation and cytokine network.
Literature indicates a cofactor is essential for gingival overgrowth, with evidence highlights its role in inflammation modulation.
Risk factors for drug-induced gingival overgrowth are:
Periodontal disease
Periodontal pocket depth
Poor oral hygiene
Gingival inflammation
Degree of dental plaque
No mortality from gingival enlargement. Surgical correction may be needed, but recurrence possible with drug.
Severe morbidity from gingival overgrowth can cause bleeding, pain, teeth displacement, and periodontal disease.
Regular oral hygiene improves patient prognosis significantly. Mild cases improve with better hygiene and adjustments.
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Extraoral Examination
Intraoral Examination
Systemic Examination
Acute symptoms are:
Sudden increase in swelling over weeks, pain, tenderness, spontaneous bleeding, possible fever and lymphadenopathy
Chronic symptoms are:
Gradual, fibrotic, and painless, minimal bleeding unless inflamed
Hereditary Gingival Fibromatosis
Leukemic Gingival Enlargement
Scurvy
Hormonal Gingival Enlargement
Neoplastic Gingival Mass
Refer patients to a dentist or oral medicine specialist. Poor oral health causes severe gingival overgrowth and tooth loss.
Gingivectomy with lasers is advised for moderate-to-severe gingival enlargement unresponsive to reduced dosage treatment.
Refer patients to dental practitioners or oral medicine specialists experienced in complex medical care.
An oral medicine specialist and periodontist should monitor patients on cyclosporine, phenytoin, or calcium channel blockers for gingival overgrowth and oral complications.
Amlodipine is a dihydropyridine calcium antagonist used to treat hypertension and angina to inhibit calcium influx in muscles.
Nifedipine and cyclosporine together enhance effects in transplant hypertension.
Brushing teeth before chlorhexidine mouthwash prevents potential teeth staining.
Low-level laser therapy and dual-wavelength lasers are used to manage drug-induced gingival hyperplasia.
Dermatology, General
Use soft-bristle toothbrushes to prevent gingival trauma under oral hygiene.
Antiseptic mouthwashes should be used to control plaque and reduce gingival inflammation.
Good bathroom lighting is essential for effective brushing and flossing.
Regularly assess patient medications for early gingival overgrowth.
Use of digital imaging to track changes in gingival size and shape over time.
Take adequate nutrition, including vitamin C and other vitamins to improve gum tissue health.
Proper awareness about Drug-Induced Gingival Hyperplasia should be provided and its related causes with management strategies.
Appointments with dentist and preventing recurrence of disorder is an ongoing life-long effort.
Dermatology, General
Azithromycin:
Azithromycin with oral hygiene decreases cyclosporine-induced gingival hyperplasia. It suppresses protein synthesis of gram-positive and gram-negative aerobes.
Dermatology, General
Chlorhexidine oral:
These are antiseptic agent indicated for oral bacterial and fungal infections. It is an antimicrobial drug that targets bacterial cell walls.
Dermatology, General
Surgical procedures for Gingival Overgrowth include gingivectomy with laser and periodontal flap surgery.
Dermatology, General
In the initial diagnosis phase, the goal is to identify risk factors and implement initial preventive measures to confirm the diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes the use of antibiotics and mouthwash antiseptics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the dentist are scheduled to check the improvement of patients along with treatment response.
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Digital Certificate PDF
On course completion, you will receive a full-sized presentation quality digital certificate.
medtigo Simulation
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
