Drug-Induced Gingival Hyperplasia Workup

Updated: Mar 26, 2019
  • Author: Lina M Mejia, DDS, MPH; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Workup

Laboratory Studies

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

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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.

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Other Tests

Culture is recommended to rule out oral candidiasis.

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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).

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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.

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