Drug and Overgrowth
Calcium channel blockers, used to control high blood pressure, are well known to be related to gingival overgrowth. Old literature used to refer this condition as “gingival hyperplasia caused by drugs.” Many researchers have pointed out that this condition is not a true hyperplasia, but rather an increase in extracellular matrix and also that these drugs do not cause this overgrowth but are some how related to it. The exact mechanism of drug induced gingival overgrowth is not clearly understood, but plaque has been shown to play an important role in the development of this condition. Therefore, plaque control is important just as in any other periodontal diseases.
Causing Drugs
Anti-hypertensive drugs known to induce gingival overgrowth include Norvasc (R), Cardiazem (R), Dilacor (R), Adalat (R), Procardia (R) and others. Other drugs commonly known to induce gingival overgrowth include, Cyclosporin-A (immunosuppressant used in organ transplant patients) and Phenytoin.
Clinical Findings
The overgrowth usually start at the interproximal areas, usually in the anterior area but not always. The overgrowth has not been reported to occur in the edentulous areas. Bulbous papillae will grow and sometimes coalesce with overgrown tissues from adjacent papillae. These overgrown tissue will sometimes grow occlusally and sometimes cover the occlusal surfaces of the teeth. When the overgrowth is small, the tissue is inflamed to some degree. When the tissue is grown so much to cover the occlusal surfaces, it will be severely inflamed, bleed easily and interfere with mastication and cause pain.
- Gingival Overgrowth – starts interproximally
- Gingival Overgrowth, Before Surgery
Treatment
Oral hygiene instruction (OHI) is probably the most important aspect of treatment. Some mild cases will respond favorably to OHI and non-surgical therapy, scaling and root planing. Severe cases on the other hand require surgical interventions such as gingivectomy or flap surgery and removing the overgrown tissue inside the flaps. Some researches have shown that the incidence of recurrence is less with flap surgeries. Either surgical method requires good plaque control on the patient’s part. Some patients on steroid may require IV bolus steroid and require medical consultations with their physicians.
- After Surgery – better plaque control needed
When to Refer?
If the overgrowth is small and limited to a few interproximal areas, good plaque control by the patient may be the only treatment required. Cases with overgrown tissues that bleed easily and have coalesced with adjacent papillae may require a surgical intervention. Switching to a different type of medication (in case of anti-hypertensive drugs) may help reduce or reverse the condition, but the decision is up to the patient’s physician.
