Drug-Induced Gingival Hyperplasia

Abstract

ImageA 37-year-old Spanish-speaking man presented with a complaint of tender, bleeding, and swollen gums. He had had an orthotopic heart transplant in 1997. His current mediations include Cyclosporine 125 mg bid and amlodipine 5 mg qd as well as CellCept, aspirin, and allopurinol for gout. Gingival overgrowth, also known as gingival hyperplasia, has been well described in the literature. The most recognized cause is drug-induced gingival enlargement from phenytoin (Dilantin), which is commonly used to treat patients with epileptic seizures. Less known drugs that contribute to this phenomenon are Cyclosporine, a potent immunosuppressant used in organ transplant recipients, and calcium channel blocker agents. The interaction of these medications with epithelial keratinocytes, fibroblasts, and collagen can lead to an overgrowth of gingival tissue, particularly in patients with poor oral hygiene, periodontal disease, and malpositioned teeth. Treatment for gingival hyperplasia includes discontinuing the drug or reducing its dose. In those for whom this is not possible, good oral hygiene and referral for surgical gingivectomy remain the only treatment. Gingival hyperplasia should be considered when treating organ transplant recipients on immunosuppressant therapy. Dr. McGregor is an assistant professor of emergency medicine at the Warren Alpert Medical School of Brown University and an attending at Rhode Island Hospital and the Miriam Hospital. Dr. Hsu-Hung is a resident in emergency medicine at the Warren Alpert Medical School of Brown University.