The pathogenesis of drug-induced gingival overgrowth.
Gingival overgrowth is a well-documented unwanted effect, associated with phenytoin, cyclosporin, and the calcium channel blockers. The pathogenesis of drug-induced gingival overgrowth is uncertain, and there appears to be no unifying hypothesis that links together the 3 commonly implicated drugs. In this review, we consider a multifactorial model which expands on the interaction between drug and/or metabolite, with the gingival fibroblasts. Factors which impact upon this model include age, genetic predisposition, pharmacokinetic variables, plaque-induced inflammatory and immunological changes and activation of growth factors. Of these, genetic factors which give rise to fibroblast heterogeneity, gingival inflammation, and pharmacokinetic variables appear to be significant in the expression of gingival overgrowth. A more thorough understanding of the pathogenesis of this unwanted effect will hopefully elucidate appropriate mechanisms for its control.
Seymour
R A
RA
Department of Restorative Dentistry, Dental School, Newcastle-upon-Tyne, UK.
Thomason
J M
JM
Ellis
J S
JS
D000328:Adult; D000367:Age Factors; D000927:Anticonvulsants / Q000009:adverse effects / Q000493:pharmacokinetics; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000493:pharmacokinetics; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects / Q000493:pharmacokinetics; D003773:Dental Plaque / Q000150:complications / Q000276:immunology; D005347:Fibroblasts / Q000187:drug effects / Q000378:metabolism; D005881:Gingiva / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D005885:Gingival Hyperplasia / Q000139:chemically induced* / Q000235:genetics / Q000473:pathology; D005891:Gingivitis / Q000209:etiology / Q000276:immunology / Q000378:metabolism; D006133:Growth Substances / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics; D010672:Phenytoin / Q000009:adverse effects / Q000493:pharmacokinetics
D000927:Anticonvulsants; D002121:Calcium Channel Blockers; D006133:Growth Substances; D007166:Immunosuppressive Agents; D010672:Phenytoin; D016572:Cyclosporine