Calcium channel blocker-induced gingival enlargement

Abstract

Despite the popularity and wide acceptance of the calcium channel blockers (CCBs) by the medical community, their oral impact is rarely recognized or discussed. CCBs, as a group, have been frequently implicated as an etiologic factor for a common oral condition seen among patients seeking dental care: drug-induced gingival enlargement or overgrowth. This enlargement can be localized or generalized, and can range from mild to extremely severe, affecting patient's appearance and function. Treatment options for these patients include cessation of the offending drug and substitution with another class of antihypertensive medication to prevent recurrence of the lesions. In addition, depending on the severity of the gingival overgrowth, nonsurgical and surgical periodontal therapy may be required. The overall objective of this article is to review the etiology and known risk factors of these lesions, their clinical manifestations and periodontal management.

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“…Through this blockage, CCBs cause relaxation of vascular smooth muscles and vasodilatation, this leads to reduction in heart rate and a decrease in conduction velocity with in the heart. CCBs are well tolerated, despite well known side effects mostly at the initiation of treatment, such as flush, headache or palpitation with DHPs and constipation with Verapamil, and gingival enlargement and ankle oedema with Nifedipine 47,48 .…”

Agrandamiento gingival inducido por medicamentos. Reporte de un caso clínico / Drug-Induced Gingival Overgrowth. A Clinical Case Report

“…Asimismo, los bloqueadores de los canales de calcio (BCC) constituyen un grupo heterogéneo de medicamentos que afectan los canales de calcio situados en la membrana plasmática celular. Son ampliamente utilizados para el tratamiento de la hipertensión arterial, la angina de pecho y las arritmias cardiacas (11,12). Un estudio poblacional de riesgo cardiovascular realizado en Colombia mostró que el consumo de BCC es del 30 % en la población que consume antihipertensivos (13).…”

“…Se considera que el mecanismo de acción común se relaciona con el metabolismo del calcio celular en la modulación de la producción celular de la colagenasa, lo cual conlleva a que los fibroblastos sinteticen una forma inactiva de esta enzima aumentando la matriz extracelular. Las manifestaciones clínicas del agrandamiento gingival aparecen dentro de los tres primeros meses después de iniciar el medicamento (11,(16)(17)(18). El agrandamiento comienza en la papila interdental, y es más común en las superficies vestibulares de los dientes anteriores (6,7).…”

“…Las características histopatológicas del agrandamiento gingival inducido por medicamentos son similares para todos los fármacos involucrados (11). El aumento en el volumen del tejido gingival se debe principalmente a una mayor respuesta del tejido conectivo que a una proliferación de células epiteliales (5,11).…”

Drug-induced Gingival Overgrowth Related to Sirolimus and Felodipine

“…The drug categories and representative drugs including the newer drugs are listed in Table 1. [1][2][3][4][5] Ellis et al 6) discussed the overall prevalence of gingival overgrowth related to chronic medication with CCBs, addressing it is considerably lower than finding from previous studies. Therefore, the expression of this effect needs cofactors such as the presence of gingival inflammation or concomitant medications inducing gingival overgrowth.…”