Surgical Management of Drug-Induced Gingival Overgrowth (DIGO) Using A Periodontal Resective Flap Procedure: A Case Report

Gingival hyperplasia or Drug-induced Gingival Overgrowth (DIGO) may be caused by a variety of conditions or prescribed medications and/or therapies, for example, immuno-suppressive therapy (cyclosporin), anticonvulsants (phenytoin) and calcium channel blockers (nifedipine, amlodipine or diltiazem). According to Ellis [1] the prevalence of Gingival Overgrowth or DIGO is approximately 20% to 83% of the patients taking the medication. Of the medication prescribed 50% of DIGO is attributed to phenytoin, 30% to cyclosporin, and 10% to 20% to calcium channel blockers. Nifedipine appears to be the more prominent calcium channel blocker causing DIGO [2]. Hyperplasia of this nature is usually the result of a combination of the above-mentioned medications and a local irritant such as plaque biofilms. Plaque may be associated with dental calculus or a poorly adapted margin of a dental restoration, which may allow biofilm accumulation and maturation and therefore may impede its disruption and removal. If left untreated, this oral condition can affect the alignment of the teeth and increase the risk of developing gum disease. Gingival hyperplasia can be resolved by improving oral hygiene habits. In more severe cases, surgical treatment is necessary. It has been proposed that medication affects the normal inflammatory response with a resultant increase in gingival fibroblast proliferation and collagen production [3].