UNDERSTANDING DRUG-INDUCED GINGIVAL OVERGROWTH: MECHANISMS, MANAGEMENT, AND IMPLICATIONS

Drug induced gingival enlargement is the one of the most undesirable and adverse effects of systemic medication on the periodontal tissues affecting a patients mastication, aesthetics, maintenance of oral hygiene, and the overall well-being of the patient. It is attributed mainly to three classes of drugs which comprise of anticonvulsants, calcium channel blockers and immunosuppressants. The pathophysiologic mechanisms responsible for drug induced gingival overgrowth (DIGO) can be divided into biochemical and inflammatory pathways that alter the cation influx inhibiting folate absorption accompanied by the alteration in the production of inflammatory cytokines and interaction of chemotactic factors. Ultrastructural studies demonstrate that the increase in gingival tissue volume is primarily due to a connective tissue response rather than the epithelial cell layer involvement, wherein the main cell that is targeted is the gingival fibroblast, that is responsible for elevated levels of collagen synthesis and the decrease in its turnover rate. Comprehensive management of gingival enlargement is multi-disciplinary in nature and the dentist along with the physician, should emphasize on treatment that provides superlative functional and aesthetic outcome for the patient.