Drug-Induced Gingival Overgrowth Mechanisms and Management

Drug-induced gingival overgrowth (DIGO) arises as an adverse effect of several widely used medications, notably anticonvulsants, calcium-channel blockers and immunosuppressants. Clinically, it manifests as an excessive enlargement of the gingiva that can impair mastication, phonation and oral hygiene, with consequent risk of periodontal disease and diminished quality of life. Pathogenetically, DIGO is multifactorial, combining disturbed calcium and sodium ion flux with reductions in intracellular folate, altered cytokine profiles and individual genetic susceptibility. At the cellular level, these changes promote hyperplasia of gingival fibroblasts, enhanced deposition of extracellular matrix components such as collagen and glycosaminoglycans, dysregulated collagenase activity and an epithelial–mesenchymal transition that favours fibrogenic phenotypes. Management strategies include meticulous plaque control, modification or substitution of the offending drug where feasible, and use of pharmacological agents targeting profibrotic growth factors. In recalcitrant cases, surgical gingivectomy or minimally invasive laser excision restores gingival contour and function. A coordinated approach involving dental, medical and pharmacological specialists is essential to mitigate the global burden of DIGO and to preserve oral health without compromising systemic therapy.

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Drug-Induced Gingival Overgrowth Mechanisms and Management publication trend

The graph below shows the total number of articles in drug-induced gingival overgrowth mechanisms and management across all publications each year (not limited to Nature Index journals).

Technical terms

Extracellular matrix: A network of structural proteins and polysaccharides that provides mechanical support to cells and mediates intercellular signalling.

Epithelial–mesenchymal transition: A biological process whereby epithelial cells acquire mesenchymal properties, enhancing migratory capacity and fibrogenic activity.

Gingival crevicular fluid: A serum-derived exudate found in the gingival sulcus, used as a biomarker source for periodontal inflammation and tissue remodelling.

Matrix metalloproteinases: A family of zinc-dependent endopeptidases responsible for degradation of extracellular matrix components and regulation of tissue turnover.

References

1. Association between calcium-channel blockers and gingival enlargement: A case-control study. Journal of Dentistry (2024).
2. Drug-Induced Gingival Overgrowth—Molecular Aspects of Drug Actions. International Journal of Molecular Sciences (2023).
3. Refining the Mechanism of Drug-Influenced Gingival Enlargement and Its Management. Cureus (2022).