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J Oral Maxillofac Pathol 2020 May-Aug;24(2):403. Epub 2020 Sep 9.

Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Mangaluru, Karnataka, India.

In the modern world, men and women are very much concerned about their esthetic appearance. The gingival perspective of esthetics is more often concerned with the soft tissue envelope surrounding the teeth. Gingival enlargement/overgrowth is numerous in nature and often poses a clinical challenge by altering the function, resulting in poor oral health of an individual. Read More

Transpl Immunol 2021 02 29;64:101355. Epub 2020 Nov 29.

Department of Dermatology, University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 255, 05403-900 São Paulo, SP, Brazil. Electronic address:

Solid organ transplant recipients (SOTRs) are susceptible to various cutaneous side effects as a consequence of long-term immunosuppressive therapy. Skin cancers and infections are well-studied complications that can cause death and/or allograft rejection. Other cutaneous drug reactions, such as inflammatory manifestations, have a high prevalence but are rarely studied. Read More

Int J Environ Res Public Health 2020 11 7;17(21). Epub 2020 Nov 7.

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.

Introduction: The administration of several classes of drugs can lead to the onset of gingival overgrowth: anticonvulsants, immunosuppressants, and calcium channel blockers. Among the anticonvulsants, the main drug associated with gingival overgrowth is diphenylhydantoin.

Materials And Methods: In this study, we compared the effects of diphenylhydantoin and gabapentin on 57 genes belonging to the "Extracellular Matrix and Adhesion Molecule" pathway, present in human fibroblasts of healthy volunteers. Read More

Shanghai Kou Qiang Yi Xue 2020 Aug;29(4):359-364

Department of Stomatology, Zhongshan Hospital, Fudan University. Shanghai 200032, China.

Purpose: The aim of the present study was to investigate the effect of curcumin (Cur) on TGF-β1/Smad3 pathway of rat gingival fibroblast treated with cyclosporine A (CsA) in vitro, and to provide theoretical basis for the mechanism of curcumin inhibiting drug-induced gingival hyperplasia induced by CsA.

Methods: Healthy Sprague-Dawley rat gingival fibroblasts were cultured with different concentrations of Cur (0, 5, 10, 20, 30 μmol/L) and Cur (20 μmol/L)+CsA(200 ng/mL), cell proliferation was assessed with CCK-8 assay. The mRNA levels of TGF-β1, Smad3, α-SMA and collagen type Ⅰ in gingival fibroblasts were detected by real-time PCR under Cur(20 μmol/L)+CsA(200 ng/mL); the protein level of TGF-β1, Smad3, p-Smad3, α-SMA and collagen type Ⅰ were determined through Western blot. Read More

Biomedicines 2020 Jul 17;8(7). Epub 2020 Jul 17.

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.

Drug-induced gingival overgrowth may occur after a chronic administration of three classes of systemic drugs: Anticonvulsants, immunosuppressants, and calcium channel blockers. This study aimed to investigate how cyclosporin A and mycophenolate mophetil (immunosuppressive drugs) could interfere with human gingival fibroblasts functions, leading to gingival enlargement. Human gingival fibroblasts derived from the tissue of a 60-year-old female were cultured in a DMEME medium. Read More

J Neurosci Rural Pract 2020 Apr 2;11(2):349-352. Epub 2020 May 2.

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Drug-induced gingival overgrowth (DIGO) secondary to chronic phenytoin intake for seizure control is a well-recognized phenomenon. Phenytoin-induced gingival overgrowth (PIGO) usually resolves gradually following cessation of phenytoin intake. It is usually seen throughout the dentate regions of the maxillary and mandibular dental arches, but more severely affect their anterior portions exposed to atmosphere. Read More

J Biol Regul Homeost Agents 2019 Dec 10;33(6 Suppl. 1). Epub 2019 Dec 10.

Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.

Gingival overgrowth is a serious side-effect that accompanies the use of cyclosporine. Up to 97% of the patients submitted to immunosuppressant drugs have been reported to suffer from this side-effect. Several conflicting theories have been proposed to explain the fibroblast's function in gingival overgrowth. Read More

Int J Immunopathol Pharmacol 2019 Jan-Dec;33:2058738419827746

Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.

Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast's function in gingival overgrowth. To determine whether amlodipine alters the inflammatory responses, we investigated its effects on gingival fibroblast gene expression as compared with untreated cells. Read More

Antibiotics (Basel) 2019 Aug 21;8(3). Epub 2019 Aug 21.

Department of Dental and Maxillofacial Sciences, "Sapienza" University of Rome, 00100 Rome, Italy.

Immune suppressed renal transplant patients are more prone to developing oral tissue alterations due to medications associated with a pleiotropic set of side effects involving the oral cavity. Drug-induced gingival overgrowth (DIGO) is the most commonly encountered side effect resulting from administration of calcineurin inhibitors such as cyclosporine-A (CsA), the standard first-line treatment for graft rejection prevention in transplant patients. Pathogenesis of gingival overgrowth (GO) is determined by the interrelation between medications and a pre-existing inflammatory periodontal condition, the main modifiable risk factor. Read More

Int J Mol Sci 2019 Apr 25;20(8). Epub 2019 Apr 25.

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.

Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast's function in gingival overgrowth. To determine whether amlodipine alters the fibrotic response, we investigated its effects on treated gingival fibroblast gene expression as compared with untreated cells. Read More

Medicine (Baltimore) 2019 Apr;98(16):e15206

Department of Nephrology.

Rationale: Cyclosporine A (CsA) is a potent immunosuppressive agent originally used to prevent rejection after organ transplantation but now more frequently used for treatment of refractory autoimmune diseases. It can induce adverse effects, such as nephrotoxicity, gastrointestinal reactions, and gingival hyperplasia whist myopathy with subacute muscular atrophy are rare.

Patient Concerns: A 55-year-old male patient with idiopathic membranous nephropathy treated with cyclosporine A at 3 mg/kg/d and prednisone at 0. Read More

Exp Ther Med 2019 May 13;17(5):3399-3402. Epub 2019 Mar 13.

Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.

Gingival overgrowth (GO) includes gingival enlargement and hyperplasia and may be induced by certain drugs, including calcium channel blockers (CCBs), particularly first-generation CCBs. However, to date, only few cases of GO induced by second- or third-generation CCBs have been reported. The present study reports on a case of a 48-year-old diabetic male who was admitted to the First Hospital of Jilin University (Changchun, China) due to poor blood glucose control. Read More

J Evid Based Dent Pract 2018 12 13;18(4):290-297. Epub 2018 Feb 13.

Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA, USA.

Objective: This report proposes a framework to integrate evidence-based dentistry (EBD) in a systematic approach in the clinical management of a patient diagnosed with drug-induced gingival hyperplasia combined with generalized aggressive periodontitis.This report illustrates the case of a 37-year-old female who presented to the Department of Periodontology at Tufts University School of Dental Medicine with enlarged, tender, bleeding gums, and loose teeth combined with a history of uncontrolled hypertension treated with calcium channel blockers.

Methods: Incorporating the EBD process, a new 5-step framework is proposed: ask the clinical question, acquire and appraise the evidence, apply it in the clinical setting, and assess the subjective and objective outcomes. Read More

BMC Oral Health 2018 08 20;18(1):140. Epub 2018 Aug 20.

Department of Periodontics, Taipei Chang Gung Memorial Hospital, Graduate Institute of Dental and Craniofacial Science, Chang Gung University, 6F., No.199, Dunhua N. Rd., Songshan Dist., Taipei City, 105, Taiwan.

Background: Drug-induced gingival enlargement is a common condition which can be observed in patients taking immunosuppressive medications following organ transplant surgery. The disfiguring excessive tissue often hinders proper oral hygiene practices, therefore accompanied by periodontitis, tooth mobility, and even pathological tooth migration in extreme cases. This case report presents a conservative treatment protocol for a patient with the aforementioned conditions involving neither surgical nor orthodontic intervention. Read More

J Periodontol 2018 06;89 Suppl 1:S74-S84

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i. Read More

J Clin Periodontol 2018 06;45 Suppl 20:S68-S77

Division of Periodontology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i. Read More

J Indian Soc Periodontol 2017 Sep-Oct;21(5):409-411

Department of Periodontics, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India.

Gingival enlargement is a very common side effect associated with the administration of several drugs, mainly anticonvulsants, calcium channel blockers (CCBs), and immunosuppressants. Amlodipine (a CCB) is a safe antihypertensive drug with a longer duration of action. Gingival enlargement induced by amlodipine is less prevalent among CCBs. Read More

Ann Anat 2018 May 7;217:7-11. Epub 2018 Feb 7.

Southern Illinois University School of Dental Medicine, Alton, IL 62002, USA. Electronic address:

Gingival overgrowth (GO) is an undesirable result of certain drugs like Cyclosporine A (CsA). Histopathology of GO shows hyperplasia of gingival epithelium, expansion of connective tissue with increased collagen, or a combination. Factors such as age, gender, oral hygiene, duration, and dosage also influence onset and severity of GO. Read More

Contemp Clin Dent 2017 Oct-Dec;8(4):565-570

Department of Medicine, Faculty of Clinical Sciences, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria.

Background: Long-term treatment of common chronic cardiac conditions such as hypertension with calcium channel blockers (CCBs) has long been associated with gingival hyperplasia. This oral side effect may affect esthetics and function, yet often overlooked and therefore underreported among Nigerians.

Aim: This study aimed to determine the association of CCBs with gingival overgrowth (GO) in hypertensive patients. Read More

Indian J Pharmacol 2017 May-Jun;49(3):257-259

Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Gingival overgrowth (GO) is one of the common findings in clinical practice. There could be several causes including drugs associated with the GO. Carbamazepine (CBZ) and amlodipine are the drugs which are infrequently documented as a cause in inducing the gingival hyperplasia. Read More

Atlas Oral Maxillofac Surg Clin North Am 2017 Sep;25(2):127-132

Department of Diagnostics and Biological Sciences, University of Colorado School of Dental Medicine, 13065 East 17th Avenue, Mail Stop F844, Aurora, CO 80045, USA; Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA. Electronic address:

J Pharm Health Care Sci 2017 19;3:19. Epub 2017 Jul 19.

Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan.

Background: Drug-induced gingival hyperplasia (DIGH) causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patient's quality of life (QOL). Thus, the aim of this study was to evaluate the incidence of DIGH using spontaneous reporting system (SRS) databases.

Methods: We analyzed reports of DIGH from SRS databases and calculated the reporting odds ratios (RORs) of suspected drugs (immunosuppressants, calcium channel blockers, and anticonvulsants). Read More

J Clin Diagn Res 2017 Apr 1;11(4):ZD30-ZD32. Epub 2017 Apr 1.

Postgraduate Student, Department of Periodontics, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India.

This case report presents a case of drug induced gingival overgrowth in a 28-year-old female patient with history of Coronary Artery Disease (CAD) and was prescribed digoxin in combination with furosemide and acitrom for the same. On clinical examination, the patient presented with severe gingival overgrowth. The volume of enlargement seen did not correlate solely with the diagnosis of inflammatory Gingival Enlargement (GE), hence an added drug induced component to the Gingival Overgrowth (GO) was suspected. Read More

Hua Xi Kou Qiang Yi Xue Za Zhi 2017 Feb;35(1):99-103

State Key Laboratory of Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.

Drug-induced gingival overgrowth (DIGO) is characterized by fibrous gingival hyperplasia and increased gingival volume. DIGO is histologically associated with proliferation of cells and deposition of extracellular matrices, particularly collagen. Integrin α2β1 is related to collagen phagocytosis and involved in the occurrence and progression of DIGO. Read More

Rom J Morphol Embryol 2017 ;58(4):1371-1376

Department of Pedodontics, Department of Biochemistry, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania;

Several causes of gingival hyperplasia are known, the most widely accepted being the drug-induced gingival augmentation, a side effect associated mainly with three classes of drugs: anticonvulsants (Phenytoin), immunosuppressants (Cyclosporine A), and various calcium channel blockers (Nifedipine, Verapamil, Diltiazem). We studied the effect of Cyclosporine A (CsA) and Nifedipine on gingival fibroblasts extracted from the rat gum. Gingival fibroblasts were isolated from 6-week-old male rats weighing 150-170 g, from gingival explants, and grown in a specific culture medium consisting of Dulbecco's Modified Eagle's Medium (DMEM) supplemented with antibiotic and 10% fetal bovine serum (FBS). Read More

Contemp Clin Dent 2016 Apr-Jun;7(2):265-8

Department of Periodontology, Manipal College of Dental Sciences, Manipal, Karnataka, India.

Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. Read More

J Adv Pharm Technol Res 2016 Apr-Jun;7(2):64-8

Department of Restorative Sciences, Al Farabi Colleges, Riyadh, Saudi Arabia.

Drug reactions are a group of reactionary lesions generally show their manifestations in the oral cavity. The drug reactions may vary from local rashes to well-developed swellings in the oral cavity especially involving the gingiva. Most of the drug reactions are asymptomatic and commonly triggered from the active metabolite of a drug used for a long time. Read More

J Ir Dent Assoc 2015 Oct-Nov;61(5):248-51

Introduction: Many factors can contribute to the development of gingival overgrowth (hyperplasia), including: plaque control; periodontal variables; medications and their relative dose; age; sex; and, genetic factors. Nifedipine is a calcium channel blocker commonly reported to result in drug-induced gingival overgrowth (DIGO). This report outlines a case of gingival overgrowth induced by amlodipine (a calcium channel blocker less frequently reported to cause gingival hyperplasia), exacerbated by the presence of plaque. Read More

West Indian Med J 2015 Jun 14;64(3):279-82. Epub 2015 Apr 14.

Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, NITTE University, Deralakatte, Mangalore, Karnataka, India.

Anticonvulsants, antihypertensive calcium channel blockers and immunosuppressants are the three main classes of drugs known to cause drug-induced gingival hypertrophy or hyperplasia. Among the calcium channel blockers, nifedipine administration has most frequently been associated with medication-related gingival hyperplasia. The incidence with amlodipine, which has a mode of action pharmacodynamically comparable to nifedipine, has rarely been reported. Read More