14/16/2010 Risk factors for drug-induced gingival overgrowth

Resident: J. Hencler
Date: 14/16/2010
Article title: Risk factors for drug-induced gingival overgrowth
Author(s): Seymour, Ellis, Thomason
Journal: J Clin Periodontol 2000; 27: 217-223

Major topic: drug-induced gingival overgrowth (DIGO)

Type of Article: Review

Main Purpose:
review various risk factors that have been associated with DIGO. Identifiable factors can be considered under the following headings: age and other demographic factors; drug variables; concomitant medication; periodontal variables; and genetic factors.

Discussion:

Age: has been considered an important risk factor for drug-induced gingival overgrowth especially for phenytoin and cyclosporine. Early studies on the prevalence of phenytoin-IGO identified in teenagers were particularly at risk from this unwanted effect. Combo of younger age and poor OH seemed to predispose to severest level of gingival involvement. Age has been reported as a risk factor for cyclosporine-IGO. Nearly all the patients from these studies showed some form of gingival changes and the number of children w/ clinically significant GO was higher (52%) when compared to adults. In relation to DIGO, associations include phenytoin and the young, Ca channel blockers and the middle aged, and cyclosporine and a broad range of ages.

Gender And Race: Gender and race were not important risk factors in phenytoin IGO. Cyclosporin studies showed that males were at greater risk and greater severity than females. Males were also showed to be 3Xs more likely than females to develop DIGO when taking Ca channel blockers.

Drug Variables: Drug dosages tend to be a poor predictor of gingival changes. It would be more appropriate to relate dosage to body weight to obtain a significant interpretation of dosage and it’s relationship to DIGO.
Concomitant Medication: Polypharmacy has been suggested to increase the prevalence of DIGO but not the severity.

Periodontal Variable: Plaque scores and gingival inflammation appear to exacerbate the expression of DIGO, irrespective of the initiating drug. When ortho appliances impede cleaning then the prevalence of DIGO is high.

Genetic Factor: Fibroblast heterogeneity remains one of the key factors used to explain the variable response of the gingival tissues to the various DIGO. While cytochrome p450 variation may be a risk factor for DIGO it is totally impractical to assess this on a clinical basis

Summary of conclusions:
Risk factors for any condition are only meaningful if they exhibit both reliability and sensitivity. While it is possible to identify the severity of these effects relative to each other within a study, it is not possible to rank these or provide additional weighting for observations from different studies.

Assessment of article:
Not so much, article is 10 yrs old. This review presented much information about the 6 risk factors some pertinent to us, some not.