The clinical features of gingival enlargement usually presents as enlarged interdental papillae and resulting in a lobulated or nodular morphology. The effects normally limited to the attached and marginal gingivae and more frequently observed anteriorly. Histologically, in drug induced gingival overgrowth it was described as thickening of the spinous cell layer, slight to moderate hyperkeratosis, fibroblastic proliferation and fibrosis of lamina propria .

The local delivery of antimicrobials, such as Arestin (Orapharma), offer the dentist a statistical and significant system for the treatment of periodontitis.18 The Agency for Health Care Research and Quality (the federal agency assigned to improve quality, safety, efficiency, and effectiveness of healthcare) evaluated literature on these antimicrobials in 2004.¹⁹ They concluded that scaling/root planing, when accompanied by the placement of an antimicrobial agent (Arestin) as a supplement or adjunct treatment, resulted in an improved clinical outcome in adults with chronic periodontitis. (This was compared to scaling/root planing that was done alone.) Systemic and locally placed antimicrobial drugs are therefore suggested for use when active disease is detected. They have clearly shown in the studies mentioned to be of significant help in resolving the diseased condition and restore periodontal health as quickly as possible. 

Patients usually understand medical treatment with medication. It is a natural addition to periodontal treatment, following the medical model. These drugs can be used on a routine basis as a standard of care, in successfully managing periodontal disease.

ROLE OF PROBIOTICS IN MANAGING PERIODONTAL DISEASE 
Periodontal disease may be impacted by the use of new probiotic products, such as GUM PerioBalance (Sunstar Americas) and Evora Plus (Oragenics). Probiotics consist of microorganisms in oral tablet/lozenge form that confer a health benefit to the patient. Current research has indicated that periodontal disease may be impacted by probiotics through the reduction of the body’s inflammatory mediators. Twetman et al²⁰, in 2009, using 2 strains of Lactobacillus reuteri, found that there was a reduction in bleeding on probing and the amount of cytokines present in the gingival crevicular fluid, a reduction in the periodontal inflammatory response. This may help to reduce oral disease. GUM Perio Balance is designed to be used once daily, immediately following flossing and brushing. The lozenge dissolves in the mouth in 10 minutes, and it is recommended that nothing be used in the mouth immediately after the use of the lozenge for 30 minutes (Figure 3).