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Isolation, Characterization and Functional Examination of the Gingival Immune Cell Network
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Risk Factors and Management of Gingival Enlargement: A Systematic Review and Meta-Analysis
Luigi Nibali1, Emily Ming-Chieh Lu1, Helvis E S Paz2
1Periodontology Unit, Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
Journal of Clinical Periodontology
|June 8, 2026
Summary
Gingival enlargement (GE) risk factors include phenytoin, calcium-channel blockers (CCBs), and cyclosporine A (CsA), especially with poor oral hygiene. Effective management involves oral hygiene instructions (OHIs) and plaque removal (PMPR).
Area of Science:
- Periodontology
- Pharmacology
- Oral Health
Background:
- Gingival enlargement (GE) is a multifactorial condition with various known etiologies.
- Drug-influenced gingival enlargement (DIGE) is a significant concern in patients on specific medications.
- Understanding risk factors and effective management strategies is crucial for patient care.
Purpose of the Study:
- To systematically review and identify risk factors and indicators for gingival enlargement (GE).
- To summarize the current evidence regarding the management of gingival enlargement.
- To provide guidance for clinicians on preventing and treating GE.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Literature searches were performed on PubMed (Medline) and Ovid (EMBASE) databases.
- Studies were categorized based on risk factors (PECOTS) and treatment (PICOTS).
Main Results:
- Phenytoin, calcium-channel blockers (CCBs), and cyclosporine A (CsA) were strongly associated with drug-influenced gingival enlargement (DIGE).
- Poor oral hygiene was the most consistent risk factor for GE across various contexts.
- Oral hygiene instructions (OHIs) and professional mechanical plaque removal (PMPR) demonstrated effectiveness in managing GE.
Conclusions:
- Phenytoin, CCBs, CsA, and orthodontic treatment are associated with GE incidence, particularly with poor oral hygiene.
- OHIs and PMPR are essential for patients undergoing therapy with these drugs or orthodontic treatment.
- Adjunctive therapies may be beneficial for severe or recurrent cases of gingival enlargement.
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