OVERVIEW

What is drug-induced gingival hyperplasia?

Gingival hyperplasia refers to the excessive growth of gum tissue and is a common feature of gum disease. Gum swelling can be caused by various factors, including inflammation and side effects of certain medications. Gingival hyperplasia induced by drugs is referred to as "drug-induced gingival hyperplasia."
Medications such as anticonvulsants, cyclosporine, and calcium channel blockers may cause this condition. Typically, the gums can naturally recede after discontinuing systemic medication or switching drugs, with a favorable prognosis. However, for cases that do not resolve, surgical removal of the overgrown gum tissue may be necessary.

Is drug-induced gingival hyperplasia common?

Drug-induced gingival hyperplasia is clinically rare and occurs only in specific medication-using populations. There is limited research on its incidence among the general population.

SYMPTOMS

What are the manifestations of drug-induced gingival hyperplasia?

After taking certain medications, patients may experience symptoms such as gum swelling, pain, and bleeding. During oral examinations, it can be observed that the hyperplastic gums appear spherical, covering part of the tooth surface and forming "pockets," known as periodontal pockets. These pockets accumulate debris, promote bacterial growth, compromise oral hygiene, and increase the risk of various oral health issues.

CAUSES

Which drugs commonly cause drug-induced gingival hyperplasia?

There are three main types of drugs that cause gingival hyperplasia: anticonvulsants (such as phenytoin sodium, phenobarbital, etc.), calcium channel blockers (antihypertensive drugs, such as nifedipine, amlodipine, etc.), and cyclosporine (an immunosuppressant).
Among all cases of drug-induced gingival hyperplasia, approximately 50% are attributed to phenytoin sodium, 30% to cyclosporine, and the remaining 10% to calcium channel blockers.

How does drug-induced gingival hyperplasia occur?

Drug-induced gingival enlargement is related to a patient's genetic predisposition and may also be associated with inflammation caused by local plaque. Some researchers claim that underlying inflammation is necessary for the development of drug-induced gingival hyperplasia, and existing gingival hyperplasia caused by drug effects can hinder proper plaque removal, further promoting tissue inflammatory responses.

DIAGNOSIS

How to Identify Drug-Induced Gingival Hyperplasia?

The diagnosis of drug-induced gingival hyperplasia is relatively straightforward. It is usually concluded by directly examining the general gingival morphology, combined with medical history and medication history.

What Diseases Should Drug-Induced Gingival Hyperplasia Be Distinguished From?

Many systemic diseases or conditions may present with oral manifestations similar to gingival hyperplasia, which should be differentiated from drug-induced gingival hyperplasia.
For example, pregnancy, adolescence, vitamin C deficiency, leukemia, granulomatous diseases, benign or malignant tumors, and pseudo-gingival hyperplasia (such as lesions in the bone or dental tissues beneath the gums), etc. Since these conditions are often accompanied by other characteristic medical histories or manifestations, differentiation is relatively simple.

TREATMENT

Which department should I visit for drug-induced gingival hyperplasia?

Generally, you should visit the Department of Stomatology.

How to prevent and treat drug-induced gingival hyperplasia?

When gingival hyperplasia occurs, regardless of the cause, the first step is to improve oral hygiene. From the doctor's perspective, basic periodontal treatment is necessary to remove irritants such as dental calculus and plaque around the teeth, especially near the gumline.
From the patient's perspective, thorough oral hygiene is essential—brush teeth thoroughly and properly for at least 2 minutes twice a day, preferably using the modified Bass brushing technique, ensuring to clean the gum-tooth junction during brushing.
Additionally, use dental floss at least once daily for interdental cleaning, and mouthwash can also be used as a supplementary measure.
Secondly, since drug-induced gingival hyperplasia is primarily caused by certain medications, and most of these drugs have alternatives, switching to alternative medications may help resolve (or at least alleviate) the issue.
However, because chronic gingival hyperplasia involves significant fibrous tissue, even with thorough scaling and root planing, the gums may not fully return to their original state. Therefore, if hyperplasia affects oral function, aesthetics, speech, or hygiene, surgical removal of excess gum tissue (gingivectomy) may be required.

DIET & LIFESTYLE

What should patients with drug-induced gingival hyperplasia pay attention to in daily life?

• If drug-induced gingival hyperplasia occurs, the related medication should be discontinued immediately, and its use should be avoided as much as possible in the future.

• In terms of diet, maintain a healthy diet and avoid consuming excessively hot or cold foods to prevent gum irritation and pain.

• Maintain oral hygiene, schedule regular dental check-ups or cleanings, and practice proper brushing techniques.

PREVENTION

Can Drug-Induced Gingival Hyperplasia Be Prevented?

Although certain medications that may cause gingival hyperplasia cannot be completely avoided due to treatment needs, the condition can still be prevented (or detected and intervened early). For example, choosing drugs with similar efficacy but less reported risk of gingival hyperplasia, adjusting dosage and administration methods, etc. For unavoidable cases, close monitoring of gum changes is essential during medication use. If abnormalities occur, temporarily discontinue the drug and explore the possibility of switching to alternative medications.