Drug-induced gingival overgrowth after renal transplantation

Abstract

A 23-year-old male with a history of posterior urethral valves complicated by chronic kidney disease requiring renal transplantation at age 19 was incidentally found to have extensive gingival overgrowth on physical examination ( Figs. 1 and 2). The gingival overgrowth developed several months after the patient's transplant and progressively worsened. His medications had included mycophenolate mofetil, tacrolimus, and amlodipine since his renal transplant 4 years prior.Medications other than anticonvulsants and cyclosporine can cause gingival overgrowth. 1 This patient's gingival overgrowth was attributed to the combination of amlodipine and tacrolimus. Limited studies have demonstrated low rates of gingival overgrowth with tacrolimus, 1 with prevalence ranging from 0% to 29%. However, the incidence increases with concomitant use of calcium channel blockers and in those with poor oral hygiene. 2 As single agents, calcium channel blockers have also rarely been reported to induce gingival overgrowth. 1Proper oral hygiene can help prevent progression, but will not reverse gingival overgrowth. Treatment options include discontinuation of causative medications and gingivectomy, although recurrence rates with this procedure are as high as 40%.

Appalling Adverse Effects of Amlodipine in a Chronic Kidney Disease Patient: A Case of Drug-Induced Gingival Overgrowth

“…The treatment may consist of surgical gingivectomy and/ or laser gingivectomy, although recurrence rates with this procedure is as high as 40%. [14][15] Laser on the other hand is one of the most promising new technical modalities in periodontal treatment having strong hemostatic and bactericidal effect and providing a relatively dry field which aids in improved visibility. 14 Discontinuation of the related drug has been shown to reduce DIGO, however the growth recurs when the drug is re-administered.…”

Amlodipine-induced gingival overgrowth in older patients: a report of four cases

“…4 Treatment options for drug-induced gingival overgrowth include discontinuation of causative drugs and gingivectomy, although the recurrence rate after gingivectomy can be as high as 40%. 6 Discontinuation or reduction of the dose to <5 mg/day should be considered before any surgical intervention. 7 However, improvement in gingival overgrowth after periodontal treatment, surgery, and intensive follow-up has been reported without adjusting calcium channel blockers.…”