II. Definitions
- Gingival Hyperplasia
- Non-inflammatory thickening of gum tissue (via increased cell number) overlying the alveolar ridge
- Gingival Hypertrophy
- Abnormal gum enlargement (via swelling of existing cells)
III. Pathophysiology
IV. Risk Factors
- Increased Dental Plaque
- Increased dental Plaque is associated with worse Gingival Hyperplasia
- Male Gender (RR 3)
- Age <40 years old
- Family History (possible genetic predisposition)
V. Causes
- Medication causes
- Anticonvulsants
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin, occurs in 20-57% of patients)
- Calcium Channel Blockers (uncommon)
- Amlodipine (Norvasc, occurs in 2-3% of patients)
- Nifedipine (Procardia, occurs in 6-15% of patients)
- Diltiazem (Cardizem, occurs in 5-20% of patients)
- Verapamil (occurs in 5% of patients)
- Cyclosporine (Sandimmune)
- Erythromycin
- Oral Contraceptives
- Anticonvulsants
- Other causes
VI. Symptoms
- Onset of increased gum tissue starting 1-3 months after causative factors (e.g. medications)
VII. Signs
- Gingiva heaped up and partially cover teeth
VIII. Management
- Decrease or eliminate causative medications
- Discontinuation of causative medications is preferred (consider alternative medications)
- Reduce causative medication doses to the lowest effective dose
-
Dental Hygiene to reduce Plaque formation
- Twice daily brusing with fluoride toothpaste
- Dental flossing
- Increased dental office cleaning frequency
- Chlorhexidine gluconate (peridex) rinses (as directed by Dentistry)
- Risk of Oral Hyperpigmentation
- Refractory cases (>3 months)
- Open flap Debridement of teeth (Gingiva reflected away from teeth for cleaning)
- Excision of excess gum tissue (laser, Electrosurgery, scalpel)
IX. Prognosis
- Gingival size typically decreases within 6-12 months of stopping causative medications