eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Drug-Induced Gingival Hyperplasia: Follow-up

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

Follow-up

Further Outpatient Care

  • To monitor for gingival overgrowth–associated oral complications (eg, bleeding gums, poor oral hygiene, gingivitis, oral candidiasis), oral medicine specialists should provide follow-up care twice a year for patients taking drugs known to induce gingival overgrowth.
  • Dental hygiene is recommended every 3 months to control dental plaque.
  • Patients should practice thorough oral hygiene twice a day (ie, before breakfast, before going to bed) and rinse mouth with plain water after each meal.

Inpatient & Outpatient Medications

  • Chlorhexidine 12% once before going to bed or Biotene mouthwash after meals is recommended for those patients known to be at risk for gingivitis.

Deterrence/Prevention

  • Ensure healthy periodontal tissue prior to any organ transplantation or the use of phenytoin or calcium channel blocker.
  • Consider alternative drugs (ie, mycophenolate [CellCept], or tacrolimus [Prograf] in organ transplant recipients, verapamil in place of calcium channel blockers) for patients at high risk.22 One study showed that in a case of pediatric renal transplantation, gingival overgrowth was improved after switching from cyclosporine A to tacrolimus.
  • Use lower doses of cyclosporine.
  • Educate patients about the importance of good oral hygiene and routine dental care, not only to minimize gingival overgrowth but also to reduce risk of systemic complications, including organ rejection.

Complications

  • Severe gingival overgrowth in patients with poor oral health can lead to early tooth loss.
  • Chlorhexidine 12% mouthwash might cause teeth staining; however, brushing teeth prior to rinsing out with chlorhexidine can prevent it. The stain can be removed by routine oral prophylaxis.

Prognosis

  • The prognosis is better if patients maintain regular oral hygiene and plaque control.

Patient Education

  • Inform patients of the risk of developing gingival enlargement secondary to therapy and the role of oral health in minimizing complications from therapy.
  • Advise patients to see a pedodontist, a periodontist, and an oral medicine dentist for a baseline evaluation; full mouth x-ray films; tooth extractions, if needed; and dental hygiene before transplant or the use of any drug known to induce gingival overgrowth.
  • For excellent patient education resources, visit eMedicine's Teeth and Mouth Center. Also, see eMedicine's patient education articles Gingivitis and When to Visit the Dentist.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform appropriate diagnostic procedures (ie, periodontal evaluation, full mouth x-ray film, routine histology)
  • Failure to appropriately identify and monitor patients at risk for the development of gingival overgrowth secondary to systemic therapy known to induce gingival overgrowth (ie, regular oral hygiene, frequent visits to dental professional)

Special Concerns

  • Emphasize the importance of good oral hygiene and routine dental care.
  • In a patient who is pregnant, rule out pregnancy tumor/pyogenic granuloma.
  • Refer all patients, regardless of sex and age, to their dentists prior to therapy with medications known to induce gingival overgrowth.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Piamkamon Vacharotayangul, DDS, PhD, and previous Chief Editor, William D. James, MD, to the development and writing of this article.



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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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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