Only a relatively small percentage of patients treated with the medications discussed on Monday will develop gingival overgrowth, it may be that these individuals have fibroblasts with an abnormal susceptibility.
Fibroblasts from overgrown gingiva in these patients clearly show elevated levels of protein synthesis, most of which is collagen.
In the susceptible patient, drug-associated gingival enlargement may be improved by meticulous plaque control, and regular periodontal maintenance therapy.
Periodontal maintenance therapy recommended for patients taking drugs associated with gingival enlargement is a three-month repeating cycle.
Included in each recall appointment should be detailed oral hygiene instruction and complete periodontal prophylaxis.
Removal of orthodontic bands and/or appliances should also be given clinical consideration.
The most effective treatment of drug-related gingival enlargement is withdrawal or substitution of medication.
When this treatment approach is followed it may be up to eight weeks for the resolution of gingival lesions.
Not all patients, however, will respond to this mode of treatment, especially those with long standing gingival lesions. Debridement with scaling and root planing has been to shown to offer some relief in gingival overgrowth patients.
Because of the frequent involvement of anterior labial gingiva, surgery is commonly performed for aesthetic reasons before any functional consequences are present. The classical surgical approach has been the external bevel gingivectomy.
A total or partial internal gingivectomy approach has also been suggested as an alternative.
Consultation with the immunosuppressed patient’s physician, regarding antibiotic and steroid coverage, should occur prior to any surgical treatment.
As always, I welcome your questions, comments and suggestions.