Conservative management of amlodipine influenced gingival enlargement

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Abstract

Gingival enlargement is a well recognized unwanted effect associated mainly with anticonvulsant drugs, immunosuppressant drugs and calcium channel blockers. Amlodipine influenced gingival enlargement is comparatively less prevalent amongst calcium channel blockers. It causes aesthetic disfigurement, speech disturbances, abnormal tooth movement and difficulty in mastication. The management of drug influenced gingival enlargement is a challenge for the periodontist, mainly due to less understanding of its pathogenesis, difficulties in selection of proper line of management and recurrence of the enlargement. This report discusses the importance of conservative approach (scaling and root planning along with drug replacement) in the management of a case of amlodipine influenced gingival enlargement. The need for extensive surgery was decreased after this approach.

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The pathogenesis of drug-induced gingival overgrowth.

Richard Ellis, J Thomason, Lisa R Seymour (1996)

Gingival overgrowth is a well-documented unwanted effect, associated with phenytoin, cyclosporin, and the calcium channel blockers. The pathogenesis of drug-induced gingival overgrowth is uncertain, and there appears to be no unifying hypothesis that links together the 3 commonly implicated drugs. In this review, we consider a multifactorial model which expands on the interaction between drug and/or metabolite, with the gingival fibroblasts. Factors which impact upon this model include age, genetic predisposition, pharmacokinetic variables, plaque-induced inflammatory and immunological changes and activation of growth factors. Of these, genetic factors which give rise to fibroblast heterogeneity, gingival inflammation, and pharmacokinetic variables appear to be significant in the expression of gingival overgrowth. A more thorough understanding of the pathogenesis of this unwanted effect will hopefully elucidate appropriate mechanisms for its control.

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Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study.

J Thomason, J. Douglas Steele, Lisa R Seymour … (1998)

The prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. Although there have been several studies examining this question, the results are conflicting, with previous estimates ranging from 20% to 83%. There have been only 2 studies examining the prevalence of overgrowth induced by diltiazem and amlodipine, with estimates of 74% and 3.3%, respectively. The current study aimed to address the problems associated with these studies by examining a sample of patients taking one of 3 calcium channel blockers, who were drawn from a community-based population in northeastern England. Nine hundred eleven (911) subjects were recruited from general medical practices in the area. Of these, 442 were taking nifedipine, 181 amlodipine, and 186 diltiazem. In addition, 102 control subjects were examined. Drug and demographic data for each subject were recorded. The periodontal condition of all subjects was assessed including plaque index, papillary bleeding index, and a photograph of the anterior gingivae for subsequent analysis of overgrowth severity. More than six percent (6.3%) of subjects taking nifedipine were seen to have significant overgrowth. This overgrowth was statistically greater than the amount of overgrowth seen in either of the other 2 drug groups or the control population. The prevalence of gingival overgrowth induced by amlodipine or diltiazem was not statistically significant when compared to the control group. The severity of overgrowth within the nifedipine group was found to be related to the amount of gingival inflammation and also to the gender of the subject, with males being 3 times as likely to develop overgrowth than females. The prevalence of clinically significant overgrowth related to chronic medication with calcium channel blockers is low, i.e., 6.3% for nifedipine. Males are 3 times as likely as females to develop clinically significant overgrowth. The presence of gingival inflammation is an important cofactor for the expression of this effect.

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Prevalence of amlodipine-related gingival hyperplasia.

M G Jorgensen (1997)

Calcium channel blockers are known to contribute to gingival hyperplasia. The vast majority of reports discuss patients taking the drug nifedipine. During the past few years a newer calcium channel blocker, amlodipine, has been used with increasing frequency. To date, six cases have been published indicating that amlodipine may also promote gingival hyperplasia; however, no data have been reported regarding the prevalence of this phenomenon. The purpose of this study was to examine a large group of patients taking amlodipine and determine the prevalence of gingival hyperplasia. One hundred fifty dentate patients who had been taking amlodipine, 5 mg per day for at least 6 months, volunteered to undergo a screening examination for gingival hyperplasia. Mild hyperplasia (< 1/3 clinical crown) was found in five patients-a prevalence of 3.3%. This is significantly less (P < .001) than rates reported for patients taking nifedipine, and not significantly different from rates previously reported in control groups of cardiac patients not taking calcium channel blockers. The results from this group of patients indicated that amlodipine, 5 mg per day, did not induce gingival hyperplasia.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Soc Periodontol

Journal ID (publisher-id): JISP

Title: Journal of Indian Society of Periodontology

Publisher: Medknow Publications (India )

ISSN (Print): 0972-124X

ISSN (Electronic): 0975-1580

Publication date (Print): Jan-Apr 2009

Volume: 13

Issue: 1

Pages: 41-43

Affiliations

Postgraduate Student, Department of Periodontics, Government Dental College and Hospital, Aurangabad – 431 001, Maharashtra, India

[1 ] Associate Professor and Head, Department of Periodontics, Government Dental College and Hospital, Aurangabad – 431 001, Maharashtra, India

Author notes

Address for correspondence: Dr. Rashmi Dhale, Department of Periodontics, Government Dental College and Hospital, GHATI, Aurangabad-431001, Maharashtra, India. E-mail: drrashmicherry@ 123456rediffmail.com

Article

Publisher ID: JISP-13-41

DOI: 10.4103/0972-124X.51894

PMC ID: 2846674

PubMed ID: 20376240

SO-VID: 6a599c48-13e6-4bf4-8473-d88db30be87f

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Conservative management of amlodipine influenced gingival enlargement

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Malaysian Management Journal

Most cited references 11

The pathogenesis of drug-induced gingival overgrowth.

Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study.

Prevalence of amlodipine-related gingival hyperplasia.

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