drug-induced gingival hyperplasia
Introduction
Introduction to drug-induced gingival hyperplasia Drug-inducedgingivalhyperplasia refers to the proliferation and volume of gingival fibrosis caused by taking certain drugs. Drug-induced gingival hyperplasia is one of the less common side effects of drugs. The drugs that can cause gingival hyperplasia are phenytoin, phenobarbital, aminohexenoic acid, epilepsy, nifedipine, felodipine, verapamil, cyclosporin and the like. Most of the patients are adolescents and children, while the elderly are less common and the incidence rate is not equal. The main clinical manifestations are the gingival margin and the gingival papilla hyperplasia, which gradually merge and enlarge from the initial globular shape until covering part of the tooth surface. basic knowledge The proportion of illness: 0.007%-0.009% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling
Cause
The cause of drug-induced gingival hyperplasia
Phenytoin (30%):
Long-term use of anti-epileptic drug phenytoin (Dalendin) can cause fibrous hyperplasia of gingival gingiva, but the true mechanism of gingival hyperplasia caused by drugs is not very clear. It is generally believed that the degree of hyperplasia and oral hygiene status and The original degree of inflammation has a significant relationship. Human and animal experiments have shown that drug-induced gingival hyperplasia can be greatly reduced or avoided if there is no obvious irritant and gingival inflammation, but hyperplasia can also occur in gums without local irritants.
Cyclosporin (30%):
In recent years, there have been many reports that other drugs such as cyclosporine and nifedipine (nifedipine) can also cause drug-induced gingival hyperplasia. Cyclosporin is an immunosuppressant and is often used for organ transplantation or some Some autoimmune patients, it is reported that about 30% to 50% of patients taking this drug have gingival fibrosis, nifedipine is a calcium channel blocker, for patients with hypertension, coronary heart disease has dilated peripheral blood vessels and coronary artery effect.
Local stimuli (20%):
Although the local stimulating factor is not the primary factor of drug-induced gingival hyperplasia, gingivitis caused by plaque, tartar, food impaction, etc. can accelerate the development of the disease.
Prevention
Drug-induced gingival proliferative prevention
1. Pay attention to oral hygiene and develop a good habit of brushing your teeth in the morning and evening and gargle after a meal.
2. Regular oral professional examination, especially emphasis on pre-pregnancy examination, follow the doctor's advice, early detection, early diagnosis, early treatment, timely treatment of oral diseases.
3. Pre-pregnancy orthodontic treatment, pre-pregnancy and early pregnancy should promptly treat the original chronic gingivitis, strict control of plaque, can greatly reduce the occurrence of puberty gingivitis and gingivitis during pregnancy.
4. For those who need long-term use of phenytoin, cyclosporine and calcium channel blockers, oral examination should be performed before starting the drug to eliminate all possible stimulating factors of gingivitis, and teach patients to control plaque to maintain oral cavity. Hygienic methods. Active treatment of the original gingivitis can reduce the occurrence of drug-induced gingival hyperplasia.
Complication
Drug gingival hyperplasia complications Complications swelling
The proliferating nipples continue to grow closer to each other or to each other, covering part of the tooth surface, and in severe cases, the attachment of the gums, causing a significant change in the appearance of the gums.
Symptom
Symptoms of drug-induced gingival hyperplasia Common symptoms Gum swollen toothache Inflamed teeth chewing wear
The gingival hyperplasia caused by phenytoin usually begins at 1 to 6 months after taking the drug. The hyperplasia starts at the buccal side of the lip or the gingival papilla and marginal ridge of the tongue, which is a small globular protrusion on the surface of the gingival, followed by a proliferating nipple. Continue to increase and close to each other or connect, cover part of the tooth surface, and when it is serious, it will affect the appearance of the gums. The hyperplasia of the gum tissue is tough, slightly elastic, pale pink, and generally not easy to bleed. Local no symptoms, no pain, hyperplasia of the gums often squeeze the teeth, more common in the upper anterior region.
Drug-induced gingival hyperplasia often occurs in full-mouth gums, but the upper and lower anterior teeth regions are heavier. It only occurs in the edentulous area. After tooth extraction, the proliferating gingival tissue can resolve itself.
Examine
Examination of drug-induced gingival hyperplasia
1, physical examination, visual inspection.
2, long-term lesions need to do pathological examination to rule out malignant transformation.
3. The presence of plaque and calculus.
4, the shape of the gums changes: the gums are bright red or dark red, the gingival margin becomes thicker, the nipples are round and blunt, sometimes spheroidal hyperplasia. A small number of patients with severe inflammation may have sputum erosion or granulation. The gums sometimes have a soft and fragile surface.
5, at the time of probing, sulcus bleeding, the sulcus bottom should be located at the enamel bone boundary, no clinical attachment loss.
6. Imaging performance of the alveolar bone without the alveolar crest.
Diagnosis
Diagnosis and differentiation of drug-induced gingival hyperplasia
Differential diagnosis
Hereditary gingival fibromatosis
The disease has no long-term medication history but may have a family history, and the gingival hyperplasia is extensive and severe.
Proliferative gingivitis
Generally, the inflammation is more obvious, and it occurs in the labial side of the anterior teeth. The degree of hyperplasia is lighter, and the coverage of the crown is generally less than 1/3. There are obvious local stimulating factors and no long-term medication history.
