eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Drug-Induced Gingival Hyperplasia: Differential Diagnoses & Workup

Author: Lina M Mejia, DDS, Assistant Professor, Oral Medicine and Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University
Coauthor(s): Francina Lozada-Nur, DDS, MS, MPH, Professor Clinical Oral Medicine (Emerita), University of California at San Francisco School of Dentistry
Contributor Information and Disclosures

Updated: Oct 23, 2009

Differential Diagnoses

Other Problems to Be Considered

Leukemia (bleeding gums) 
Pyogenic granuloma
Pregnancy tumor
Warts (Warts, Nongenital)
Monomorphic B-cell post-transplantation
Lymphoproliferative disease (Posttransplant Lymphoproliferative Disorder)

Workup

Laboratory Studies

  • CBC count is indicated in patients with severe gum bleeding to rule out anemia and leukemia.

Imaging Studies

  • Periapical (full mouth series) or Panorex (panoramic view) radiographs are indicated prior to treatment to evaluate the status of the periodontal tissue or any compromised teeth.

Other Tests

  • Culture is recommended to rule out oral candidiasis.

Procedures

  • Tissue biopsy may be indicated if gingival overgrowth has an unusual clinical presentation or if the patient is not on a medication known to induce gingival overgrowth.
  • Periodontal examination is necessary to evaluate for the presence of periodontal disease.
  • Dental hygiene is required to remove dental plaque.
  • Root planning may be indicated.
  • Dental extraction of periodontically compromised teeth is indicated if those teeth may interfere with subsequent medical treatment. It also may be considered if the patient cannot perform prophylactic dental care (eg, young epileptic patient).

Histologic Findings

Histologic changes are similar in gingival overgrowth that is caused by either phenytoin or cyclosporine. The term gingival hyperplasia is inappropriate because enlargement does not result from an increase in the number of cells but rather an increase in extracellular tissue volume.

A highly vascular connective tissue is observed histologically with focal accumulation of inflammatory cells, primarily plasma cells. The overlying epithelium is of variable thickness, irregular, and multilayered. Acanthosis and parakeratosis with pseudoepitheliomatous proliferation have been reported.

Immunohistologic studies have demonstrated an increase in the number of Langerhans cells within the epithelium and adjacent to inflamed sites.

More on Drug-Induced Gingival Hyperplasia

Overview: Drug-Induced Gingival Hyperplasia
Differential Diagnoses & Workup: Drug-Induced Gingival Hyperplasia
Treatment & Medication: Drug-Induced Gingival Hyperplasia
Follow-up: Drug-Induced Gingival Hyperplasia
Multimedia: Drug-Induced Gingival Hyperplasia
References
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References

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Further Reading

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Keywords

drug-induced gingival hyperplasia, gingival hyperplasia, drug-induced gingival overgrowth, gingival overgrowth, gingival enlargement, gum overgrowth, gum enlargement, gum hyperplasia, cyclosporine, phenytoin, calcium antagonist-induced gingival hyperplasia

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Contributor Information and Disclosures

Author

Lina M Mejia, DDS, Assistant Professor, Oral Medicine and Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University
Lina M Mejia, DDS is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association, and California Dental Association
Disclosure: Nothing to disclose.

Coauthor(s)

Francina Lozada-Nur, DDS, MS, MPH, Professor Clinical Oral Medicine (Emerita), University of California at San Francisco School of Dentistry
Francina Lozada-Nur, DDS, MS, MPH is a member of the following medical societies: American Academy of Oral Medicine
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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