Combined treatment for a combined enlargement

Abstract

Calcium channel blockers are widely used in medical practice for the management of hypertension and in the prophylaxis of angina. Gingival overgrowth is now a recognized unwanted effect associated with many of calcium channel blockers. This can have a significant effect on the quality of life as well as increasing the oral bacterial load by generating plaque retention sites. Amlodipine, a third generation calcium channel blockers has been shown to promote gingival overgrowth, although reported in very limited cases. The management of gingival overgrowth seems to be directed at controlling gingival inflammation through a good oral hygiene regimen. However, in severe cases, surgical excision is the most preferred method of treatment, followed by rigorous oral hygiene procedures. This case report describes the management of gingival overgrowth in a hypertensive patient taking amlodipine.

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

“…Reported cases of gingival enlargements were induced by different drugs; CCBs (50/119 – of which amlodipine-25;[8910111213141516171819202122232425262728] nifedipine-13;[26293031323334353637383940] verapamil-4;[41] felodipine-2;[4243] nisoldipine-1;[44] manidipine-1;[45] and unspecified CCBs-4[46]); phenytoin (11/119);[4748495051525354555657] cyclosporine (31/119);[3546585960616263646566676869707172737475] phenobarbital (4/119);[767778] sodium valproate (3/119 - including one report of congenital drug-induced gingival hyperplasia);[798081] d-penicillamine (2/119);[82] combination oral contraceptive pill-lynestrenol and ethinyl estradiol (1/119);[83] vigabatrin (1/119). [84] Cases of gingival enlargement after combination drug therapy have also been reported; a combination of cyclosporine and CCBs (11/119);[354685...…”

Is dental plaque the only etiological factor in Amlodipine induced gingival overgrowth? A systematic review of evidence

“…For decades, amlodipine was regarded as a “safe drug” when compared to other CCB’s as it was associated with relatively few adverse reactions ( 21 ). This was mainly related to its longer duration of action requiring reduced dosage.…”

“…In the past the prevalence of AIGO was 1.7% to 3.3% ( 21 ). Lately, the data suggests that there has been an increase in the number of these cases ( 7 ).…”

Nifedipine-Induced Gingival Enlargement - A Systematic Treatment Approach: A Case Report

“…[10] Most articles suggest the surgical approach as a gold standard for treatment while others have advocated a non-surgical approach and some have proposed a combined approach to manage cases of drug-induced gingival enlargement. [1,2,6,7,13,14] However, some studies have failed to confirm the success of non-surgical approaches, such as those by Seymour and Smith. [15] Furthermore, it has been reported that adequate plaque control may aid in preventing or retarding the recurrence of gingival enlargement in surgically treated cases.…”

“…Multiple case reports have demonstrated similar positive results when DIGO was treated with supra-gingival and sub-gingival scaling and an intensive oral hygiene program along with surgical intervention. [12,13,16] CONCLUSION It is very important for the periodontist to work in conjunction with the patient's doctor in an attempt to change medication or determine the possibility of discontinuing a drug. As demonstrated by this report, in some cases, the doctor can suspend the drug or exchange it for another that does not produce this adverse effect and can help decrease the degree of the gingival enlargement.…”