Pathogenesis of drug-induced gingival overgrowth. A review of studies in the rat model

J Periodontol. 1996 May;67(5):463-71. doi: 10.1902/jop.1996.67.5.463.

Abstract

Drug-induced gingival overgrowth is a side effect associated principally with 3 types of drugs: anticonvulsant (phenytoin), immunosuppressant (cyclosporine A), and various calcium channel blockers (nifedipine, verapamil, diltiazem). In this review, we describe the features of phenytoin-, cyclosporine A- and nifedipine-induced gingival overgrowth in rats and discuss factors influencing the onset and severity of these disorders. There are several features common to the gingival overgrowth induced by these drugs: 1) gingival overgrowth is more conspicuous in the buccal than in the lingual gingiva and less severe in the maxilla than in the mandible; 2) once the blood concentration of the drug reaches a certain level as a result of increasing the dose, the incidence of gingival overgrowth is 100% and its severity is dependent on the blood level, the most severe overgrowth being induced by cyclosporine A; 3) the duration of drug administration for maximal gingival overgrowth to develop is about 40 days; 4) the gingival overgrowth regresses spontaneously after discontinuing the drug; 5) accumulation of dental plaque is not essential for the onset of overgrowth, but plays a role in its severity; and 6) more severe overgrowth is induced in young than in old rats. Furthermore, male rats are more susceptible than females to nifedipine-induced gingival overgrowth. These results suggest that drug-induced gingival overgrowth in rats is dependent on the oral drug dose, blood drug level, age, and sex and that preexisting gingival inflammation is a factor relevant to its severity. Since these factors have also been suggested to be important determinants for human drug-induced gingival overgrowth, the rat model may prove valuable in the future for elucidating the molecular pathogenesis of the disorder.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Age Factors
  • Animals
  • Anticonvulsants / blood
  • Anticonvulsants / toxicity*
  • Calcium Channel Blockers / blood
  • Calcium Channel Blockers / toxicity*
  • Cyclosporine / blood
  • Cyclosporine / toxicity*
  • Dental Plaque / complications
  • Disease Models, Animal
  • Dogs
  • Dose-Response Relationship, Drug
  • Gingival Hyperplasia / chemically induced*
  • Gingival Hyperplasia / etiology
  • Gingivitis / complications
  • Humans
  • Immunosuppressive Agents / blood
  • Immunosuppressive Agents / toxicity*
  • Male
  • Nifedipine / blood
  • Nifedipine / toxicity*
  • Phenytoin / blood
  • Phenytoin / toxicity*
  • Rats
  • Rats, Inbred F344
  • Sex Factors
  • Specific Pathogen-Free Organisms

Substances

  • Anticonvulsants
  • Calcium Channel Blockers
  • Immunosuppressive Agents
  • Phenytoin
  • Cyclosporine
  • Nifedipine