This patient presented for an oral examination less than a year after beginning cyclosporine for atopy. There was significant drug induced gingival hyperplasia present.
What two vital diagnostic steps are necessary to determine a complete treatment plan for this patient?
The importance of full mouth dental radiographs and anesthetized oral examination in these patients is vital. The hyperplastic gingiva is primarily composed of connective tissue and excessive proliferation of normal gingival cells. Sometimes, as with this patient, it is a drug induced side effect. Cyclosporine, calcium-channel blockers and phenytoin are among the more common culprits that stimulate gingival fibroblasts, leading to gingival hyperplasia. Breeds like Boxers and Collies are also genetically predisposed to this condition.
Clinically, hyperplastic gingiva creates pseudopockets that harbor plaque, food and debris and often leads to periodontal disease. Treatment is aimed at reducing those pockets by removing the hyperplastic gingiva with a scalpel blade, electrosurgery or CO2 laser and restoring a normal gingival contour and sulcus depth. The goal after healing is for at least 2mm of attached gingiva to remain. Care must be taken not to overheat or damage the teeth or bone when performing the gingival surgery. Excellent plaque control and discontinuation of the drug associated with the gingival hyperplasia may help to control recurrence.
The patient’s immediate post op photo is below after gingival surgery was complete (but prior to restoration of the right maxillary 4th premolar and mandibular 1st molar due to unrelated uncomplicated fractures).