eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Drug-Induced Gingival Hyperplasia: Treatment & Medication

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

Treatment

Medical Care

For dental care, refer patients to a general dentist and/or oral medicine specialist for evaluation.

Surgical Care

Gingivectomy with carbon dioxide or YAG laser is recommended for patients who have moderate-to-severe gingival enlargement that does not resolve when the dose is reduced, proper oral hygiene is maintained, or after a short course of antibiotics. In the majority of patients for whom drug discontinuation or substitution is not possible and for whom prophylactic measures have failed, surgical excision of gingival tissue remains the only treatment option.

Consultations

  • For evaluation and treatment planning, refer patients to a dental practitioner and/or an oral medicine specialist familiar with the oral care of medically complex patients.
  • An oral medicine specialist and a periodontist should monitor patients with gingival overgrowth for as long as they receive therapy with cyclosporine, phenytoin, or calcium channel blockers to evaluate and treat oral complications from medical therapy.

Diet

No diet restrictions are recommended for patients with gingival overgrowth other than minimizing the consumption of sweets, starch, soft drinks, and simple carbohydrates.

Activity

No activity restrictions are reported.

Medication

Recent observations suggests that roxithromycin, a macrolide antibiotic, may have a therapeutic role in reducing cyclosporine-induced gingival overgrowth, owing to its inhibitory effect on transforming growth factor-beta production.15 Azithromycin has been used successfully.16,17,18

In addition, tacrolimus, a commonly used immunosuppressive agent, can become an alternative to cyclosporine-A use.19 However, tacrolimus can also induce gingival overgrowth, but this effect appears to be time related.20

Clinical studies comparing oral hygiene programs versus azithromycin indicate that azithromycin plus oral hygiene significantly reduces cyclosporine-induced gingival hyperplasia, while oral hygiene alone reduces oral symptoms but does not affect cyclosporine-induced gingival hyperplasia.21

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Azithromycin (Zithromax)

Used to treat mild-to-moderate oral microbial infections. Clinical studies comparing oral hygiene programs vs azithromycin indicate that azithromycin plus oral hygiene significantly reduces cyclosporine-induced gingival hyperplasia, while oral hygiene alone reduces oral symptoms but does not affect cyclosporine- induced gingival hyperplasia.
Azithromycin is a macrolide antibiotic that acts by suppressing protein synthesis of gram-positive and gram-negative aerobes. Take 1-2 h pc.

Adult

Day 1: 500 mg PO
Days 2-5: 250 mg PO qd

Pediatric

>6 months
Day 1: 10 mg/kg PO once; not to exceed 500 mg/d
Days 2-5: 5 mg/kg PO qd; not to exceed 250 mg/d

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with administration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when administered with cyclosporine

Documented hypersensitivity; hepatic impairment; do not administer with pimozide

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in patients who are hospitalized, geriatric, or debilitated

Mouthwash antiseptics

Antiseptic agent for oral bacterial and fungal infections.


Chlorhexidine gluconate (Peridex)

Effective, safe, and reliable mouthwash antiseptic. Polybiguanide with bactericidal activity; usually is supplied as a gluconate salt. At physiologic pH, the salt dissociates to a cation that binds to bacterial cell walls.

Adult

15 mL rinse and expectorate/spit bid after thoroughly brushing teeth to prevent staining

Pediatric

5-10 mL rinse and expectorate/spit bid after thoroughly brushing teeth to prevent staining

Documented hypersensitivity; avoid in the presence of any oral ulcers or if patient presents with mucositis secondary to radiation or chemotherapy, if alcohol is present in chlorhexidine

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Irritation if open ulcers are seen in the mouth; dental deposits, staining of teeth, taste changes, and parotitis have been reported


Lysozyme, lactoferrin, glucose oxidase, lactoperoxidase (Biotene)

Alcohol-free mouthwash antiseptic.

Adult

Rinse mouth BID/TID

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

None reported

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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  35. Thomason JM, Seymour RA, Rawlins MD. Incidence and severity of phenytoin-induced gingival overgrowth in epileptic patients in general medical practice. Community Dent Oral Epidemiol. Oct 1992;20(5):288-91. [Medline].

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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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