Concluded Case

DRUG INDUCED GINGIVAL ENLARGEMENT

Sharing today another old case of my PG time. Patient complaints of soft tissue growth over upper left back teeth region along with generalized swelling of gums since 6 months, and also complains of bleeding gums since 1 year and excessive salivation since 5 to 6 months. History dates back to 6 months when patient noticed round reddish soft localized gingival growth present over upper left teeth region which was gradual in onset slowly increase in size to attain present size. H/O associated mild pain over the same region which is dull continuous and non radiating in nature. H/O mild to moderate bleeding from chronically inflamed and enlarged gums since 1 year which was aggravated on brushing, mastication and occasionally on spitting leading to salty taste and bad breadth. H/O unaesthetic appearance associated with the condition along with excessive salivary secretion since 5 to 6 months. All developmental mile stones of the patient were normal. Patient was a diagnosed case of epilepsy (Grand mal type)& has been taking the drug phenytoin sodium(100mg BID)for seizure control approximately for the past 13 years . H/O Seizure when patient stop taking medication in between. Intraoral Examination: ON INSPECTION: Gingiva was reddish pink in color, having blunt contour and loss of stippling. In region 26 ; Solitary well defined, reddish pink lobulated gingival growth with sessile base was present on buccal aspects of marginal gingiva involving attached gingiva .The growth has max dimensions of 2x1.5 cm in size. Provisional diganosis: 1.Drug induced Gingival Enlargement associated with inflammatory changes. 2.Epulis Differential Diagnosis: 1.Pyogenic granuloma 2.Peripheral ossifying fibroma 3.Irritatonal fibroma Histopathological Examination: shows parakeratinised stratified squamous epithelium with elongated deep rete-pegs with deep into connective tissue, which exhibits densely arranged collegen bundles. Severe inflammatory cell infilteration consisting of lymphocytes & plasma cells are noticed in the stroma. Extravasted RBC are present in same area of section. Final Diagnosis: Based on the history ,clinical examination & histopathological examination, a confirmatory diagnosis of Drug Induced Gingival Hyperplasia was made. Looking forward for your valuable opinions. Thank you.

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Case of Drug Induced Gingival Enlargement.
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Nice case Dr well summarized.Phenytoin,nifedipine, amlodipine, cyclosporin are commonly associated with DIGO(Drug Induced gingival overgrowth) .It is associated with a patients genetic predisposition and the presence of existing plaque or gingival inflammation .Management comprises of Drug substitution, oral prophylaxis followed by external bevel gingivectomy or modified widman open flap debridement depending upon residual PPD .
Very well explained @Dr. Kausar Yadwad , thanks for your valuable opinion.
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Yes mam the drug history of patient is suggestive of phenytoin induced gingival enlargement. Phenytoin is notorious for that
Well Said Doc. Thanks for your valuable opinion.
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Gingival hyperplasia secondary to phenytoin Adv Change to safer antiepileptic medication
Valuable opinion
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Well explain mam.. What is the final tx for this type enlargement?
Thanks for the appreciation doc, the final and the most effective treatment of drug-related gingival enlargement is withdrawal or substitution of medication. When this treatment approach is taken, it may take from 1 to 8 weeks for resolution of gingival lesions and yes along with surgical excision and maintenance of proper oral hygiene.
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SUGGESTIVE of ANTI EPILEPTIC INDUCED GINGIVAL HYPERPLASIA
Thank you doctor
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Case of Drug Induced Gingival Enlargement.
Gingival Hyperplasia due to Phenytoin.
I agree
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Gingival Hyperplasia due phenytoin
I agree
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Excellent...
Thank you so much @Dr. Abhishek Dubey Sir.
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Good case @Dr. Saloni Arora
Thank you doctor
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