Drug-induced gingival hyperplasia (Dilantin hyperplasia)
DESCRIPTION: Drug-induced gingival enlargement was first described almost 50 years ago with the use of the anticonvulsant Dilantin (phenytoin). Other drugs especially calcium channel blockers such as Procardia (nifedipine) and cyclosporine have also been implicated. Dilantin causes gingival enlargement in almost 50% of those that regularly take it, while only about 25% of patient talking cyclosporine and calcium channel blockers have enlargement. Poor oral hygiene and especially dental plaque accentuate the enlargement. Superimposed gingivitis also causes boggy and red tissues that mask the true nature of the enlargement.
ETIOLOGY: Drug induced. As stated above, the condition may become aggravated by superimposed gingivitis and periodontitis. There is evidence that associated drugs may impair the secretion of collagenase by gingival fibroblasts permitting the accumulation of excessive gingival collagen.
TREATMENT: The inflammatory component may be reduced by good dental hygiene. The fibrous overgrowth requires surgical removal. Discontinuance of associated drugs may result in gradual regression of the overgrowth within one year.
PROGNOSIS: Good
DIFFERENTIAL DIAGNOSIS: Hereditary gingival fibromatosis, hyperplastic gingivitis from dental neglect, and leukemic infiltrates of the gingiva.
