Prevention and treatment considerations in patients with drug-induced gingival enlargement

Drug-induced gingival overgrowth is an iatrogenic disease caused by the use of phenytoin, cyclosporine, nifedipine, and other medications in the susceptible patient. The gingival overgrowth can be due to three causes: noninflammatory, hyperplastic reaction to the medication; chronic inflammatory hyperplasia; or a combined enlargement due to chronic inflammation and drug-induced hyperplasia. Drug-induced gingival enlargement can be minimized, but not prevented, by elimination of local irritants, meticulous oral hygiene, and regular periodontal recall. If gingival enlargement interferes with function, speech, esthetics, or oral hygiene, tissue reduction can be accomplished by gingivectomy or a flap procedure. Gingival enlargement may recur, especially in the patient with poor oral hygiene.