Nitrendipine-induced gingival hyperplasia

Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaque-related inflammation and drug therapy. Its true incidence in the general population is unknown. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. Although gingival overgrowth has been traditionally recognised as an adverse effect of phenytoin therapy, it has recently been reported in association with the use of cyclosporin and calcium antagonists. These 3 classes of drugs produce important changes in fibroblast function, which induce an increase in the extracellular matrix of the gingival connective tissue. In the majority of those patients for whom dosage reduction, or drug discontinuation or substitution is not possible, and for whom prophylactic measures have failed, surgical excision of gingival tissue remains the only treatment of choice.

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“…Single case-reports of gingival overgrowth have been described in relation to nitrendipine, [95] nicardipine [96) and felodipine [97] therapy.…”

Section: Other Dihydropyridinesmentioning

confidence: 99%

Gingival Enlargement Induced by Drugs

et al. 1996

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“…The underlying mechanisms whereby L-type calcium channel blockers cause gingival hyperplasia remains to be fully understood. The proposed mechanisms include defective collagenase activity that was due to decreased uptake of folic acid (Brown et al, 1990) as well as up-regulation of TGF-␤1 and other factors responsible for the production of a fibrous scaffold in the gingiva (Lafzi et al, 2006).…”

Section: Deleterious Effects Of Current Drugs On the Extracellularmentioning

confidence: 99%

Extracellular Matrix Molecules: Potential Targets in Pharmacotherapy

et al. 2009

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“…[18] Some of the calcium channel blockers prescribed for different cardiovascular aliments are listed below and have been found to cause enlargement of gingiva: Nifedipine (Procardia) Diltiazem (Cardizem) Verapamil (Calan) Felodipine (Plendil) Amlodipine (Norvasc) Lacidipine and nitrendipine [7] Nitrendipine, an analog of nifedipine, has also been reported to induce gingival enlargement. [19] Clinical features of nifedipine-associated gingival overgrowth are similar to those of phenytoininduced enlargement. Gingival enlargement due to nifedipine shows extensive inflammation that bleeds on slight provocation [ Figure 2].…”

Section: Managementmentioning

confidence: 89%

Gingival overgrowth and drug association: A review

2011

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Drugs used locally or systemically induce several alterations in micro and macroscopic tissues. However, nearly 20 drugs have been reported so far in the literature associated with gingival enlargement. Many systemic diseases have limited therapeutic options and such drugs or their metabolites have an adverse influence on different systems/organs, and one of these is that they initiate or accelerate the overgrowth of gingival tissue. The increase in size may be to the extent that teeth may be partially or completely covered, and the resultant 'gummy smile' may result in aesthetic concern for the patient.In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. It is apparent that there is a subpopulation of fibroblasts which is sensitive to these drugs. The exuberant growth of gingival tissue is of great aesthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention, and/or substitution of the drug with analogs. A relatively healthy oral environment provided by the dentist will reduce local microflora that will help in eliminating the major focus of infection. Physicians, general practitioners, and dentists need to make a coordinated and concise treatment plan that will be beneficial for the patients. This article will facilitate full information to physicians to involve dentists in the multidisciplinary treatment plan.

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Nitrendipine-induced gingival hyperplasia

Cited by 59 publications

References 30 publications

Gingival Enlargement Induced by Drugs

Gingival Enlargement Induced by Drugs

Extracellular Matrix Molecules: Potential Targets in Pharmacotherapy

Gingival overgrowth and drug association: A review

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