Gingival overgrowth as secondary effect of calcium channel blockers administration. A case report

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Abstract

Gingival overgrowth is, among other things, a side effect of the administration of dihydropyridine antihypertensives, generally associated with irritant factors of marginal periodontium. This case refers to a patient, female, who developed a large gingival enlargement that has a combined etiology: the systemic medication with lercanidipina and the presence of dental bridges, which are incorrectly adjusted to the dental cervix. The treatment for this case, involved a complex local treatment (antimicrobial, surgical, endodontic and prosthetic) and the collaboration with a specialist cardiologist. Maintaining the normal gingival parameters in time depends on the possibility of changing the antihypertensive medication, the accuracy of the new dental bridges and the periodic monitoring of the patient.

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Drug-induced gingival overgrowth: a study in the French Pharmacovigilance Database.

Emmanuelle Bondon-Guitton, Haleh Bagheri, Jean-Louis Montastruc (2012)

Gingival overgrowth is an adverse drug reaction (ADR) well known with phenytoin, cyclosporine or calcium channel blockers but can be related to other drugs. We reviewed spontaneous notifications of drug-induced gingival overgrowth (DIGO), in France. We selected DIGO cases registered in the French Pharmacovigilance Database, between 1984 and 2010. We found 147 DIGO cases (0.04% of all cases), most of them (86.4%) "non serious". Patients were more frequently men (58.5%) and between 40 and 69 years (58.5%). Evolution was favourable in 47.5% of cases. The most frequently "suspected" drugs were calcium channel blockers (30.6%) followed by immunosuppressants (15.2%) and anticonvulsants (10.1%). The DIGO was also reported with drugs for which the ADR was "unlabelled" (mycophenolate mofetil, valproic acid, clarithromycin, ethynylestradiol, levonorgestrel, desogestrel, etc.). There were two peaks of occurrence (0-3 and >12 months) for immunosuppressants or calcium channel blockers and only one (>12 months) for anticonvulsants. Gingival overgrowth is often a "non serious" ADR but evolution was favourable in only half of cases. This ADR is "labelled" for calcium channel blockers, cyclosporine and phenytoin but can also occur with other immunosuppressants or anticonvulsants, antibiotics, oral contraceptives, etc. © 2012 John Wiley & Sons A/S.

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Nifedipine induces gingival overgrowth in rats through a reduction in collagen phagocytosis by gingival fibroblasts.

T. Nagata, H Azuma, M. Kataoka … (2001)

Nifedipine is used as a long-acting vasodilator, and a primary side effect is the induction of gingival overgrowth, which is characterized by an accumulation of collagenous components within the gingival connective tissue. To elucidate the mechanisms of nifedipine-induced gingival overgrowth, we investigated the effect of nifedipine on Type I collagen metabolism in the gingiva of rats. Twenty-day-old rats were fed a powdered diet containing or lacking nifedipine for 3 to 55 days. Immunohistochemical analysis with anti-Type I collagen antibody was employed to examine the density of Type I collagen in the gingival connective tissue. Total RNAs were isolated from mandibular molar gingiva on days 0, 3, 15, 30, and 55, and reverse transcription polymerase chain reaction was performed to investigate the mRNA levels of Type I collagen. In addition, we performed a flow cytometric analysis with collagen-coated latex beads and cultured fibroblasts derived from rat gingiva to measure collagen phagocytosis. Immunohistochemical analysis revealed that Type I collagen was more prevalent in the connective tissue of nifedipine-treated gingiva than in controls on day 55. In the nifedipine-treated group, the expression of Type I collagen mRNA gradually decreased to 1.5% on day 55 compared to day 0. In the control group, Type I collagen mRNA also decreased to 32%; however, mRNA expression was significantly lower in the nifedipine-treated group than in the controls. When the rate of phagocytic cells derived from nifedipine-treated gingiva and controls was represented as the mean +/- SE of the percentage from 3 different experiments, the values were as follows: on day 15, 13.5 +/- 2.1% and 15.0 +/- 1.5%; on day 30, 12.2 +/- 4.3% and 34.5 +/- 6.7% in the nifedipine-treated and the control group, respectively, indicating that phagocytic cells were considerably fewer in the nifedipine-treated gingiva on day 30. This finding demonstrates that the decrease in phagocytosis caused by nifedipine appeared before the detection of severe macroscopic gingival overgrowth. These findings suggest that the decrease in collagen degradation due to lower phagocytosis is closely associated with the increase in Type I collagen accumulation in nifedipine-treated rat gingiva.

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Effects of cyclosporin, phenytoin, and nifedipine on the synthesis and degradation of gingival collagen in tufted capuchin monkeys (Cebus apella): histochemical and MMP-1 and -2 and collagen I gene expression analyses.

José Oliveira, Marcelo Crivelini, Vivianne O. L. Castro … (2007)

The purpose of this experimental study was to evaluate the collagen fiber distribution histologically after phenytoin, cyclosporin, or nifedipine therapy and to correlate it with collagen I and matrix metalloproteinase (MMP)-1 and -2 gene expression levels. Gingival samples from the canine area were obtained from 12 male monkeys (Cebus apella). The mesial part of each sample was assessed by reverse transcription-polymerase chain reaction, whereas the distal part was processed histologically for picrosirius red and hematoxylin and eosin stainings, as well as for collagen IV immunostaining. One week after the first biopsy, the animals were assigned to three groups that received daily oral dosages of cyclosporin, phenytoin, or nifedipine for 120 days. Additional gingival samples were obtained on days 52 and 120 of treatment from two animals from each group on the opposite sides from the first biopsies. Picrosirius red staining showed a predominance of mature collagen fibers in the control group. Conversely, there was an enlargement of areas occupied by immature collagen fibers in all groups at days 52 and 120, which was not uniform over each section. There was a general trend to lower levels of MMP-1 gene expression on day 52 and increased levels on day 120. Phenytoin led to increased levels of MMP-2 and collagen I gene expression on day 120, whereas the opposite was observed in the nifedipine group. Cyclosporin, phenytoin, and nifedipine led to phased and drug-related gene expression patterns, resulting in impaired collagen metabolism, despite the lack of prominent clinical signs.

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Author and article information

Journal

Journal ID (nlm-ta): J Med Life

Journal ID (iso-abbrev): J Med Life

Journal ID (publisher-id): JMedLife

Title: Journal of Medicine and Life

Publisher: Carol Davila University Press (Romania )

ISSN (Print): 1844-122X

ISSN (Electronic): 1844-3117

Publication date (Print): 15 June 2014

Publication date (Electronic): 25 June 2014

Volume: 7

Issue: 2

Pages: 241-245

Affiliations

[* ]Department of Periodontology, Faculty of Dental Medicine, „Carol Davila" University of Medicine and Pharmacy, Bucharest

[** ]Department of Operative Dentistry, Faculty of Dental Medicine, „Carol Davila" University of Medicine and Pharmacy, Bucharest

[*** ]Department of Biochemistry, Faculty of Medicine, „Carol Davila" University of Medicine and Pharmacy, Bucharest

Author notes

Correspondence to:Irina-Maria Gheorghiu, MD, Professor Assistant, Department of Operative Dentistry, Faculty of Dental Medicine, „Carol Davila" University of Medicine and Pharmacy, Bucharest, 18 Libertatii Blvd., bl. 104, st. 2, ap. 23, District 5, Bucharest, Phone: +40744305591, E-mail: igheorghiu@hotmail.com

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Publisher ID: JMedLife-07-241

PMC ID: 4197502

SO-VID: 77878b9d-3bb1-492f-ab26-e9f441538728

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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.

Gingival overgrowth as secondary effect of calcium channel blockers administration. A case report

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Most cited references 8

Drug-induced gingival overgrowth: a study in the French Pharmacovigilance Database.

Nifedipine induces gingival overgrowth in rats through a reduction in collagen phagocytosis by gingival fibroblasts.

Effects of cyclosporin, phenytoin, and nifedipine on the synthesis and degradation of gingival collagen in tufted capuchin monkeys (Cebus apella): histochemical and MMP-1 and -2 and collagen I gene expression analyses.

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