The management of phenytoininduced gingival

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The management of phenytoin‑induced gingival overgrowth is similar to that of other DIGOs. Withdrawal and change of drug, meticulous oral hygiene maintenance, conservative nonsurgical approach followed by surgical intervention if necessary are the sequential steps in the treatment of phenytoin‑associated gingival hyperplasia. Polypharmacy can have an effect on DIGO. Majority of conditions need a combination therapy, particularly organ transplant patients receiving immunosuppressants are frequently administered CCBs to prevent serious life‑threatening complications. However, such concomitant medications have a significant synergistic effect on gingival changes and increase the chances of recurrence. [98] Plaque‑induced inflammatory changes Majority of DIGO cases are reported in patients with poor oral hygiene maintenance. However, whether plaque is a contributing factor to gingival hyperplasia or a consequence of gingival hyperplasia is not yet clearly outlined. Nevertheless, the clinical and histological picture of gingival enlargement [Downloaded free from on Friday, September 15, 2017, IP: 36.79.172.174]
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Samudrala, et al .: DIGO: A review of case reports 4 Journal of Indian Society of Periodontology - Volume XX, Issue XX, Month 2017 and the medical history of the patient led some investigators to diagnose the enlargement as a combination of inflammatory and DIGO. [4] Addition of inflammatory component to the gingival overgrowth, thus complicates the diagnosis and also the management of DIGO. Nonsurgical management of DIGO includes professionally delivered scaling and root planing as well as instructing and reinforcing oral hygiene maintenance measures to the patient. This, in conjunction with drug change, may totally eliminate the overgrowth or might at least partially result in regression of the lesion, allowing for an easy surgical correction. [99] Genetic factors Genotypic variation among individuals was attributed to the observed inter‑individual variability in the expression and presentation of gingival hyperplasia after using systemic medications. Gingival fibroblasts exhibit marked functional heterogeneity in response to various stimuli. [93] This probably could explain why, not all individuals subjected to medications inducing gingival hyperplasia show gingival changes. Babu et al . in 2013 [47] evaluated drug metabolizing enzyme cytochrome P450 2C9 gene polymorphism in an epileptic patient under phenytoin therapy who presented with generalized gingival enlargement. The pharmacogenomic study of the patient revealed that the patient was a homozygous mutant of CYP2C9 which prompted them to substitute the drug. Similarly, Charles et al . in 2012 [13] reported a case of amlodipine‑induced gingival hyperplasia associated with MDR1 3435C/T gene polymorphism. This gene polymorphism was suggested to alter the inflammatory response of the gingival tissues to the drug. Thus, pharmacogenomic studies might be useful in determining the effects of a drug and also help in prompting the physician to choose correct dose of drug or other alternatives.
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