ビスホスホネート長期服用患者に対し薬物性歯肉増殖症の手術的対応を行った１例

drug-induced gingival hyperplasia

北海道歯学会

北海道歯学雑誌

We report a case of surgical treatment of drug-induced gingival hyperplasia in a patient with dementia on prolonged bisphosphonate therapy. An 85-year-old woman became aware of gingival swelling in the bilateral maxillary alveolar regions 4 years before visiting our department, but it caused no pain and she could use complete dentures. Since then, she had used home-visit dental care service. Two months before visiting us, it became difficult for her to use complete dentures due to increase in the swelling and she was referred to our department to check the cause of her gingival swelling. The mucosal surface mucosa was normal, but marked nodular and elastic soft gingival swelling was observed in the bilateral maxillary alveolar part at the time of first examination. Imaging findings revealed three tooth stumps, but no abnormal findings in her maxilla. Therefore, we thought the cause of her gingival swelling was not bisphosphonate related osteonecrosis but inflammation because of teeth stumps. As a malignant lesion was ruled out by a blood test and pathological examination, we made a diagnosis of drug-induced gingival hyperplasia. The three tooth stumps were extracted and she underwent gingivectomy, under general anesthesia. The patient was on alendronate for 12 years, but the operation was performed without cessation because she had a history of fracture of the femur. During surgery, we resected the area of gingival proliferation with periosteal incision and tried to prevent alveolar bone exposure of the tooth extraction cavities by gingival suture. The healing after surgery was stable, and in collaboration with the home-visit dentist complete dentures were fitted. The patient was able to use her new dentures without any problem and there was no recurrence at more than 6-months after the operation.