Medical Care

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

Surgical Care

Gingivectomy with carbon dioxide, YAG,^[37]or diode laser^[38]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. They can be effective for the removal of hyperplastic gingival tissue and result in fast healing with only mild discomfort. Low-level laser therapy (LLLT),^[39]photobiomodulation diode laser, and dual-wavelength (904/650-nm) laser treatments have been reportedly used as adjuvants in the management of drug-induced gingival hyperplasia. 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.^{[11, 24]}

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.

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.

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.^[40]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.

Long-Term Monitoring

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.

Medication

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Media Gallery

Swelling of the gingival mucosa around the right lower canine and multiple areas of erythema, erosions, and bleeding throughout the upper gingival mucosa.
Enlarged upper and lower gingival mucosa in a partially edentulous patient. Notice how the overgrown tissue tends to engulf the teeth. Poor oral hygiene and poor dentition are the most likely contributing factors in this patient receiving immunosuppressive therapy.
A palatal view of enlarged upper and lower gingival mucosa in a partially edentulous patient. Notice the severity of the gingival enlargement. If left untreated, patients develop severe periodontal disease and lose teeth.

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Author

Lina M Mejia, DDS, MPH Assistant Professor, Oral Medicine and Diagnostic Sciences, Nova Southeastern University College of Dental Medicine

Lina M Mejia, DDS, MPH is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association, 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.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Professor Emeritus, Department of Dermatology, Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Piamkamon Vacharotayangul, DDS, PhD, to the development and writing of this article.