Makindo Medical Notes

Related Subjects: |Macroglossia |Microstomia |Glossitis |Medical Teeth |Gum hypertrophy |Angular Stomatitis - Cheilitis |Oral Aphthous Ulcers |Oral Leukoplakia

🦷 Gum hypertrophy (gingival hyperplasia) may occur with chronic anticonvulsants (esp. phenytoin) and in pregnancy. ⚠️ Always consider haematological malignancy if gum hypertrophy is new, progressive, or associated with systemic features.

📖 About

• Common exam topic linking pharmacology, oral medicine, and haematology.
• Seen with long-term anticonvulsants and immunosuppressants, but also with systemic disease.
• Can impair dental hygiene, speech, and quality of life.

🧪 Aetiology

• 🪥 Poor oral hygiene: Plaque-induced gingivitis can cause gum overgrowth.
• 💊 Medications:
  • Phenytoin (anticonvulsant – classic association).
  • Ciclosporin (immunosuppressant, transplant patients).
  • Nifedipine (calcium channel blocker, hypertension).
• 🤰 Hormonal: Pregnancy and oral contraceptives may cause gum hypertrophy.
• 🍊 Vitamin deficiency: Scurvy (vitamin C deficiency) → bleeding, swollen gums.
• 🩸 Haematological: AML and other leukaemias may present with gingival hypertrophy + bleeding.

🧠 Clinical Presentation

• Swollen, inflamed gums ± bleeding when brushing or eating.
• Discomfort, aesthetic concerns, halitosis.
• Severe cases: difficulty with speech and mastication.

🔍 Investigations

• 🧪 FBC: Look for anaemia, thrombocytopenia, or blast cells if leukaemia suspected.
• 📋 Medication history: Always ask about phenytoin, ciclosporin, nifedipine.
• 🦷 Dental review: Assess plaque burden, denture fit, periodontal status.

💊 Management

• 💊 Medication review: Discuss alternatives with prescriber if drug-induced.
• 🪥 Optimise oral hygiene: Regular brushing, flossing, and dental cleaning (scaling/root planing).
• 🦷 Dental/surgical intervention: Gingivectomy if overgrowth is severe and functionally limiting.
• 🍊 Nutritional support: Vitamin C supplementation if scurvy suspected.
• ⚠️ Red flag: If unexplained gum hypertrophy + systemic symptoms (weight loss, fever, night sweats) → urgent haematology referral.

🌍 Teaching Pearl

• 💡 Phenytoin, Ciclosporin, Nifedipine = the “big three” drug causes. Easy marks in exams.
• 💡 AML → gum hypertrophy + bruising + fatigue = classic OSCE red flag.