II. Definitions

  1. Gingival Hyperplasia
    1. Non-inflammatory thickening of gum tissue (via increased cell number) overlying the alveolar ridge
  2. Gingival Hypertrophy
    1. Abnormal gum enlargement (via swelling of existing cells)

III. Pathophysiology

  1. Normal pathway of Collagen degradation is disrupted, allowing for increased extracellular Collagen deposition at gums

IV. Risk Factors

  1. Increased Dental Plaque
    1. Increased dental Plaque is associated with worse Gingival Hyperplasia
  2. Male Gender (RR 3)
  3. Age <40 years old
  4. Family History (possible genetic predisposition)

V. Causes

  1. Medication causes
    1. Anticonvulsants
      1. Carbamazepine (Tegretol)
      2. Phenytoin (Dilantin, occurs in 20-57% of patients)
    2. Calcium Channel Blockers (uncommon)
      1. Amlodipine (Norvasc, occurs in 2-3% of patients)
      2. Nifedipine (Procardia, occurs in 6-15% of patients)
      3. Diltiazem (Cardizem, occurs in 5-20% of patients)
      4. Verapamil (occurs in 5% of patients)
    3. Cyclosporine (Sandimmune)
    4. Erythromycin
    5. Oral Contraceptives
  2. Other causes
    1. Puberty
    2. Pregnancy
    3. Leukemia
    4. Blood dyscrasias

VI. Symptoms

  1. Onset of increased gum tissue starting 1-3 months after causative factors (e.g. medications)

VII. Signs

  1. Gingiva heaped up and partially cover teeth

VIII. Management

  1. Decrease or eliminate causative medications
    1. Discontinuation of causative medications is preferred (consider alternative medications)
    2. Reduce causative medication doses to the lowest effective dose
  2. Dental Hygiene to reduce Plaque formation
    1. Twice daily brusing with fluoride toothpaste
    2. Dental flossing
    3. Increased dental office cleaning frequency
    4. Chlorhexidine gluconate (peridex) rinses (as directed by Dentistry)
      1. Risk of Oral Hyperpigmentation
  3. Refractory cases (>3 months)
    1. Open flap Debridement of teeth (Gingiva reflected away from teeth for cleaning)
    2. Excision of excess gum tissue (laser, Electrosurgery, scalpel)

IX. Prognosis

  1. Gingival size typically decreases within 6-12 months of stopping causative medications

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