Risk Factors and Management of Gingival Enlargement: A Systematic Review and Meta-Analysis

Abstract

Objective: To identify risk factors/indicators of gingival enlargement (GE) and to summarise evidence for its management. Methods: A systematic review was undertaken following PRISMA guidelines and divided into PECOTS and PICOTS questions, related to risk factors/indicators and treatment studies, respectively. Literature search was performed on the electronic databases PubMed in Medline and Ovid in EMBASE. Results: From an initial screening of 3609 entries, 349 papers were eventually included, including 299 for PECOT and 50 for PICOT. In most studies, GE was drug-influenced (DIGE), while in other cases it was related to fixed orthodontic treatment, dental prostheses, hormones, medical conditions, hereditary gingival fibromatosis or idiopathic. Meta-analyses revealed that a substantial proportion of patients on phenytoin, calcium-channel blockers (CCBs) and cyclosporine A (CsA) were affected by DIGE. Patients on CCBs had significantly higher DIGE than those on other antihypertensives, while those on cyclosporine A had significantly more DIGE risk than those on tacrolimus. Poor oral hygiene was the most consistent risk factor associated with a higher risk of GE, while other factors (e.g., younger age in immunosuppressed patients) showed associations in specific contexts. Among treatment studies, oral hygiene instructions (OHIs) and professional mechanical plaque removal (PMPR) appeared effective at improving GE. Among potential adjuncts, systemic azithromycin or change of the offending medication emerged as valid options. Conclusions: Use of phenytoin, CCBs and CsA and fixed orthodontic treatment were associated with the incidence of GE, particularly in the presence of poor oral hygiene. Based on consistent evidence, OHIs and PMPR appear to be necessary in patients who need to start or are undergoing therapy with phenytoin, CCBs, cyclosporine A or orthodontic treatment. Adjunctive treatments may be beneficial in severe or recurrent cases of gingival enlargement.