gingival overgrowth

• 歯肉増殖、歯肉肥厚、歯肉異常増殖

関

gingival hyperplasia、gingival hypertrophy

WordNet

1. grow too large
2. grow beyond or across; "The ivy overgrew the patio" (同)grow over
3. become overgrown; "The patio overgrew with ivy"
4. a profusion of growth on or over something else
5. the tissue (covered by mucous membrane) of the jaws that surrounds the bases of the teeth (同)gum
6. of or relating to the gums

PrepTutorEJDIC

1. 《受動態で》〈草などが〉…‘に'一面に生える,はびこる / …‘より'大きくなる / はびこる / 大きくなり過ぎる
2. 〈C〉一面におい茂ったもの / 〈U〉繁茂;育ち過ぎ

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/05 05:12:15」(JST)

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Gingival enlargement
Gingivitis, a common cause of inflammatory gingival enlargement.
Classification and external resources
Specialty	gastroenterology
ICD-10	K06.1 (ILDS K06.100)

Gingival enlargement, (also termed gingival overgrowth, hypertrophic gingivitis, gingival hyperplasia, or gingival hypertrophy, and sometimes abbreviated to GO), is an increase in the size of the gingiva (gums). It is a common feature of gingival disease. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. The treatment is based on the cause. A closely related term is epulis, denoting a localized tumor (i.e. lump) on the gingiva.

Classification

The terms gingival hyperplasia and gingival hypertrophy have been used to describe this topic in the past. These are not precise descriptions of gingival enlargement because these terms are strictly histologic diagnoses, and such diagnoses require microscopic analysis of a tissue sample. Hyperplasia refers to an increased number of cells, and hypertrophy refers to an increase in the size of individual cells. As these identifications obviously cannot be performed with a clinical examination and evaluation of the tissue, the term gingival enlargement is more properly applied. Gingival enlargement has been classified according to etiology into 5 general groups:

• Inflammatory enlargement
• Drug induced enlargement
• Enlargement associated with systemic diseases or conditions
• Neoplastic enlargement
• False enlargement.

Causes

Inflammatory enlargement

Gingival enlargement may be caused by a multitude of causes. The most common is chronic inflammatory gingival enlargement, when the gingivae are soft and discolored. This is caused by tissue edema and infective cellular infiltration caused by prolonged exposure to bacterial plaque, and is treated with conventional periodontal treatment, such as scaling and root planing.

Gingivitis and gingival enlargement are often seen in mouth breathers, as a result of irritation brought on by surface dehydration, but the manner in which it is caused has not been demonstrated.

The accumulation and retention of plaque is the chief cause of inflammatory gingival enlargement. Risk factors include poor oral hygiene, as well as physical irritation of the gingiva by improper restorative and orthodontic appliances.

Drug-induced enlargement

This type of gingival enlargement is sometimes termed "drug induced gingival enlargement", "drug influenced gingival enlargement", "drug induce gingival overgrowth" abbreviated to "DIGO". Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response: Gingival overgrowth is a common side effect of phenytoin, termed "Phenytoin-induced gingival overgrowth" (PIGO).

• anticonvulsants (such as phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate and primidone NOT common for valproate)
• calcium channel blockers (antihypertensives such as nifedipine, amlodipine, and verapamil). The dihydropyridine derivative isradipidine can replace nifedipine and does not induce gingival overgrowth.
• cyclosporine, an immunosuppresant.

Of all cases of DIGO, about 50% are attributed to phenytoin, 30% to cyclosporins and the remaining 10-20% to calcium channel blockers.

Drug-induced enlargement has been associated with a patient's genetic predisposition, and its association with inflammation is debated. Some investigators assert that underlying inflammation is necessary for the development of drug-induced enlargement, while others purport that the existing enlargement induced by the drug effect compounds plaque retention, thus furthering the tissue response. Careful attention to oral hygiene may reduce the severity of gingival hyperplasia. In most cases, discontinuing the culprit drug resolves the hyperplasia.

Enlargement associated with systemic factors

Many systemic diseases can develop oral manifestations that may include gingival enlargement, some that are related to conditions and others that are related to disease:

• Conditioned enlargement
  • pregnancy
  • puberty
  • vitamin C deficiency
  • nonspecific, such as a pyogenic granuloma
• Systemic disease causing enlargement
  • leukemia
  • granulolomatous diseases, such as granulomatosis with polyangiitis, sarcoidosis, or orofacial granulomatosis.
  • neoplasm
    • benign neoplasms, such as fibromas, papillomas and giant cell granulomas
    • malignant neoplasms, such as a carcinoma or malignant melanoma
  • false gingival enlargements, such as when there is an underlying bony or dental tissue lesion

Management

The first line management of gingival overgrowth is improved oral hygiene, ensuring that the irritative plaque is removed from around the necks of the teeth and gums. Situations in which the chronic inflammatory gingival enlargement include significant fibrotic components that do not respond to and undergo shrinkage when exposed to scaling and root planing are treated with surgical removal of the excess tissue, most often with a procedure known as gingivectomy.

In DIGO, improved oral hygiene and plaque control is still important to help reduce any inflammatory component that may be contributing to the overgrowth. Reversing and preventing gingival enlargement caused by drugs is as easy as ceasing drug therapy or substituting to another drug. However, this is not always an option; in such a situation, alternative drug therapy may be employed, if possible, to avoid this deleterious side effect. In the case of immunosuppression, tacrolimus is an available alternative which results in much less severe gingival overgrowth than ciclosporin, but is similarly as nephrotoxic. The dihydropyridine derivative isradipidine can replace nifedipine for some uses of calcium channel blocking and does not induce gingival overgrowth.

Epidemiology

Gingival enlargement is common.

Other animals

Gingival hyperplasia

It is commonly seen in Boxer dogs and other brachycephalic breeds, and in the English Springer Spaniel. It usually starts around middle age and progresses. Some areas of the gingiva can become quite large but have only a small attachment to the rest of the gingiva, and it may completely cover the teeth. Infection and inflammation of the gingiva is common with this condition. Under anesthesia, the enlarged areas of gingiva can be cut back with a scalpel blade, but it usually recurs. Gingival enlargement is also a potential sequela of gingivitis. As in humans, it may be seen as a side effect to the use of ciclosporin.

References

UpToDate Contents

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• 1. 成人における歯肉炎および歯周炎：分類と歯科治療 gingivitis and periodontitis in adults classification and dental treatment
• 2. 小児における口腔軟部組織病変 soft tissue lesions of the oral cavity in children
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• 5. Sweet症候群（急性熱性好中球皮膚症）：病因、臨床症状、および診断 sweet syndrome acute febrile neutrophilic dermatosis pathogenesis clinical manifestations and diagnosis

English Journal

• Lack of pathogenic mutations in SOS1 gene in phenytoin-induced gingival overgrowth patients.

• Margiotti K1, Pascolini G2, Consoli F3, Guida V4, Di Bonaventura C5, Giallonardo AT6, Pizzuti A7, De Luca A8.
• Archives of oral biology.Arch Oral Biol.2017 Aug;80:160-163. doi: 10.1016/j.archoralbio.2017.04.002. Epub 2017 Apr 5.
• PMID 28433619

• Oral health of pediatric liver transplant recipients.

• Sandoval MJ1, Zekeridou A1, Spyropoulou V2, Courvoisier D3, Mombelli A1, McLin V2, Giannopoulou C1.
• Pediatric transplantation.Pediatr Transplant.2017 Jul 3. doi: 10.1111/petr.13019. [Epub ahead of print]
• PMID 28670817

• TRPA1 Channels Mediate Human Gingival Fibroblast Response to Phenytoin.

• López-González MJ1, Luis E1, Fajardo O1, Meseguer V1, Gers-Barlag K1, Niñerola S1, Viana F1.
• Journal of dental research.J Dent Res.2017 Jul;96(7):832-839. doi: 10.1177/0022034517695518. Epub 2017 Mar 6.
• PMID 28571526

Japanese Journal

• Management of gingival hyperplasia associated with sore mucositis in an acute leukemia patient

• Acta medica Nagasakiensia 60(3), 129-133, 2016-04
• NAID 120005758040

• ニフェジピンによる薬物性歯肉増殖症を伴った広汎型中等度 ~ 重度慢性歯周炎18年の経過 : 症例報告

• 日本臨床歯周病学会会誌 33(2), 55-59, 2015
• NAID 40020895077

• The Effect of Phenytoin on the Matrix Metalloprotease-3 Production in HGFs

• Journal of Oral Tissue Engineering 13(2), 57-66, 2015
• NAID 130005150540

Related Links

• Gingival Overgrowth

In children taking certain medications can cause changes in the appearance of the tissues of the mouth or induce the development of gingival overgrowth. Frequently blamed drugs: epileptics lowering the body’s resistance calcium ...

• Gingival Overgrowth - MEDICAL DIAGNOSIS AND ...

Gingival Overgrowth. On-line free medical diagnosis assistant. Ranked list of possible diseases from either several symptoms or a full patient history. A similarity measure between symptoms and diseases is provided.

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★リンクテーブル★

リンク元	「歯肉増殖症」「歯肉肥厚」「gingival hypertrophy」「歯肉異常増殖」
拡張検索	「phenytoin-induced gingival overgrowth」
関連記事	「overgrowth」「gingival」

「歯肉増殖症」

　　[★]

英

gingival hyperplasia

同

歯肉肥大症 gingival hypertrophy、歯肉増殖

関

歯肉、歯肉肥厚、歯肉肥大症 gingival hypertrophy、歯肉異常増殖、gingival overgrowth

原因

• 遺伝
• 内分泌異常
• 薬剤性

• 抗てんかん薬：フェニトイン
• 降圧薬：ニフェジピン
• 免疫抑制薬：
• ピル：

「歯肉肥厚」

　　[★]

英

gingival overgrowth、gingival hyperplasia、gingival hypertrophy

関

歯肉増殖症、歯肉肥大症、歯肉増殖、歯肉異常増殖

「gingival hypertrophy」

　　[★]

• 歯肉肥厚、歯肉増殖、歯肉増殖症、歯肉肥大症

関

gingival hyperplasia、gingival overgrowth

「歯肉異常増殖」

　　[★]

英

gingival overgrowth

関

歯肉肥厚、歯肉増殖

「phenytoin-induced gingival overgrowth」

　　[★] フェニトイン誘発性歯肉増殖症

「overgrowth」

　　[★]

• 過成長、異常増殖

関

neoplasia

　 　

「gingival」

　　[★]

• adj.

• 歯肉の

関

gingiva、gum