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CASE REPORT: DRUG INDUCED GINGIVAL ENLARGEMENT CAUSING A DIAGNOSTIC
DILEMMA
Gurnam Singh RRKS, Hamzah SZ, Francis J

Introduction: Gingival overgrowth is a well-documented side effect associated with three
major classes of drugs namely anticonvulsants, calcium channel blockers and
immunosuppressants. Despite our greater understanding of pathogenesis of Drug Induced
Gingival Overgrowth (DIGO), its treatment still remains a challenge for general dentists and
dental specialists. The dental management is still largely limited to maintenance of
improved level of oral hygiene and surgical removal of the overgrown tissue. This report
aims to show the importance of collaboration between dentists and medical professionals
in managing a case of Drug Induced Gingival Overgrowth (DIGO) in patient with kidney
transplant receiving calcium channel blocker and immunosuppressant. Case report: A 46-
year-old, chinese female presented to Special Needs Dentistry Clinic, Hopsital Kajang after
she was referred by Nephrology team of Hospital Kuala Lumpur to rule out other suspicious
pathology causing gingival enlargement which the patient claimed was slowly increasing in
size for the past 6 months. She appeared very anxious during the visit. She was under
amlodipine (calcium channel blocker) and cyclosporine (immunosuppressant), which could
be possible causes of gingival enlargement. This patient was a known case of renal
transplant who received a donated kidney from her mother who passed away due to
Endometrial Carcinoma. It was clinically challenging to achieve a diagnosis as the gingival
overgrowth was confined to only one area and it was ipsilateral to the kidney transplant
side. Hence an incisional biopsy was done to confirm the diagnosis. Behavioural guidance
was also incorporated to reduce patient’s anxiety. The diagnosis of drug induced gingival
overgrowth was given and patient was reassured. The nephrology team of Hospital Kuala
Lumpur was notified about the biopsy results. Hence, cyclosporine was changed to
tacrolimus. Upon review after 3 months, the gingival overgrowth had significantly reduced
in size.

th
Oral presentation at the National Oral Health Research Day on 23 – 24 April 2019 at Eastin Hotel, Petaling Jaya
Dr Reena Raj Kaur Sandhu Gurnam Singh
Faculty of Dentistry
University of Malaya
Kuala Lumpur

Dr Siti Zaleha Hamzah
Special Care Dentistry Unit
Kajang Hospital
Kajang Selangor
Dr Jessica Francis
Special Care Dentistry Unit
Umum Sarawak Hospital
Kuching Sarawak

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