THE PATHOGENESIS OF DRUG-INDUCED GINGIVAL OVERGROWTH

Gingival overgrowth is a well-documented unwanted effect, associated w ith phenytoin, cyclosporin, and the calcium channel blockers. The path ogenesis of drug-induced gingival overgrowth is uncertain, and there a ppears 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-induce d inflammatory and immunological changes and activation of growth fact ors. Of these, genetic factors which give rise to fibroblast heterogen eity, gingival inflammation, and pharmacokinetic variables appear to b e significant in the expression of gingival overgrowth. A more thoroug h understanding of the pathogenesis of this unwanted effect will hopef ully elucidate appropriate mechanisms for its control. (C) Munksgaard, 1996.