Gingival Overgrowth Surgery — ORE Part 1 MCQ

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ModeratePeriodontologyGingival Overgrowth SurgeryORE Part 1

A 45-year-old woman on ciclosporin for a kidney transplant has severe gingival overgrowth despite excellent oral hygiene. Her nephrologist has switched her to tacrolimus but the overgrowth persists. What is the next appropriate step?

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Correct answer: E — Refer for gingivectomy or laser excision of the hyperplastic tissue

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

In severe drug-induced gingival overgrowth (DIGO) persisting after immunosuppressant substitution and despite excellent oral hygiene, surgical management is the evidence-based standard next step. Although tacrolimus carries lower DIGO risk than ciclosporin, established fibrotic overgrowth may persist after drug switching. Gingivectomy or laser-assisted excision addresses the mechanical obstruction and improves function, esthetics and oral hygiene access. Systemic antibiotics (D) for ciclosporin-induced DIGO show equivocal efficacy and are undesirable long-term. Chlorhexidine (C) is adjunctive plaque control, not monotherapy. Weekly cleaning (B) cannot treat established fibrotic tissue in a patient with excellent hygiene compliance. Surgical intervention is reliable and effective for severe DIGO.

Reference: Hall EE. Prevention and treatment considerations in patients with drug-induced gingival enlargement. Curr Opin Periodontol. 1997;4:59–63. PMID: 9655022; corroborated by systematic review of DIGO management (PubMed PMID: 16677333) establishing surgical excision as the main treatment for severe cases. https://pubmed.ncbi.nlm.nih.gov/16677333/