Amlodipine-induced gingival overgrowth

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Gingival overgrowth represents an over-exuberant response to a variety of local and systemic conditions. Certain anticonvulsants, immuno-suppressive drugs and a number of calcium channel blockers have been shown to produce similar gingival overgrowths in certain susceptible patients. Amlodipine is a comparatively new calcium channel blocker and has been used with increasing frequency in the management of hypertension and angina.

Although amlodipine is considered as a safe drug, very rarely it may induce gingival overgrowth also. A rare case of amlodipine-induced gingival overgrowth has been reported herein in a year-old female patient. The treatment aspect included Phase-1 therapy, substitution of the drug, the surgical excision and the maintenance and supportive therapy resulting in excellent clinical outcome.

Gingival overgrowth is one of the most norvasc and tooth loss clinical features of gingival pathology. It has multifactorial etiologies and has been frequently associated with inflammatory changes in the gingiva.

Other factors related to this condition are hereditary familialmalignancies and norvasc and tooth loss resulting from adverse effects associated with systemic administration of certain drugs. Drug-induced gingival overgrowth DIGO remains a significant problem for the dental clinicians and the periodontologists.

Patients medicated with certain drugs may be implicated in this unwanted side effect DIGOwhich may interfere with esthetics, mastication or speech. Norvasc and tooth loss gingival overgrowth triggered by these medications is not only esthetically displeasing but also often impairing nutrition and access for oral hygiene resulting in an increased susceptibility to oral infection, caries and periodontal diseases.

An increasing number of medications are associated with gingival overgrowth. Currently, more than 20 prescription medications are associated with gingival enlargement. Anticonvulsants, calcium channel blockers, and immunosuppressants, norvasc and tooth loss.

Although the pharmacologic norvasc and tooth loss of each of these drugs is different and directed toward various primary target tissues, all of them seem to act similarly on a secondary target tissue, that is, the gingival connective tissue causing common clinical and histopathological findings. Amlodipine is a new dihydropyridine calcium channel blocker that is used in the management of both hypertension and angina, norvasc and tooth loss.

Since then, very few isolated cases of AIGO have appeared in the dental literature although norvasc and tooth loss are numerous reports of nifedipine another member of calcium channel blockers -induced gingival overgrowth till date.

Clinical manifestations of gingival enlargement frequently appear within one to three months, after initiation of treatment with the associated medications. Gingival overgrowth normally begins at the interdental papillae and is more frequently found in the anterior segment of the labial surfaces. Gradually, gingival lobulations are formed that may appear inflamed or fibrotic in nature depending on the degree of local factor-induced inflammation.

However, the fibrotic enlargement is normally confined to the attached gingiva, but may extend coronally causing the extensive disfigurement of gingiva. In the present report, a case of amlodipine-induced gingival overgrowth has been presented wherein the AIGO was treated in the following phases: A year-old female patient came to the Department of Periodontics, Bapuji Dental College and Hospital, Davangere with the chief complaint of enlarged gums in the upper and lower front tooth region for three months.

Patient was not aware of such growth until three months back when she noticed a small bead-like nodular enlargement of the gums that gradually progressed to the present size covering almost the entire front teeth. Enlargement was not associated with bleeding from the gums and loosening of teeth, norvasc and tooth loss. Her past medical history revealed that the patient was hypertensive for last four years and was under medication Amlodipine 5 mg, once daily.

However, norvasc and tooth loss, her past dental history was noncontributory. Her personal history reveled that she was a regular betel nut chewer, norvasc and tooth loss. She used to clean her teeth once daily with brush and paste, which she discontinued recently because of the coverage of teeth with the enlarged gums.

Her general physical examination revealed that the patient was moderately built and her vital signs were within the normal range. There were no significant extraoral findings. Gingiva was pink in colour with erythematous area and lobulated surface. Margins of the gingiva were rolled out with loss of normal gingival scalloping. On palpation, gingiva was firm and resilient in consistency. Hypertrophied areas were painless and did not bleed on touch.

Poor oral hygiene status of the patient was assessed from the presence of local irritating norvasc and tooth loss contributing to the mild inflammatory component of the gingival enlargement. The probing of gingival sulcus revealed presence of pseudo-pockets and elicited the bleeding.

Preoperative view showing gingival overgrowth in lingual side of lower anteriors lingual view. Patient was subjected to complete hemogram and all the parameters were found to be within normal range.

Orthopantomogram revealed complete set of dentition with generalized bone loss. Histopathological report revealed mixture of dense and loose fibrous component with inflammatory cell infiltrate and few areas of calcifications in the stroma. The treatment of the patient was started with nonsurgical approach. Patient was subjected to Phase-1 therapy including the planned sessions of scaling and root planing.

The physician substituted the drug with tab. Normadate mg Labetolol. Patient was instructed to maintain good oral hygiene with the use of chlorhexidine oral rinses. A dramatic response was noticed after three months of drug substitution and maintenance of regular oral hygiene.

There was regression in the size of gingival enlargement with minimal of fibrotic component left [ Figure 3 ]. These earlier terms do not accurately reflect our current understanding of the macroscopically enlarged and histologically altered gingiva. Drugs associated with gingival overgrowth can be broadly categorized into three major groups according to their therapeutic actions, namely, anticonvulsants, immunosuppressants and calcium channel blockers.

The widespread use of calcium channel blockers began in s. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of drug-induced gingival enlargement. Amlodipine is a third generation dihydropyridine calcium antagonist, which has norvasc and tooth loss mode of action pharmacodynamically comparable to nifedipine.

The associated slow elimination of amlodipine with resulting long duration of its action means that only a single-daily dose is required. This in turn results in better patient compliance and norvasc and tooth loss until now been associated with similar or reduced severity of side effects compared with nifedipine. Patients taking nifedipine appear to be at increased risk for developing significant overgrowth than those on amlodipine.

Norvasc and tooth loss difference between nifedipine and amlodipine is of interest, as both drugs are dihydropyridones and hence structurally similar. Also, both are secreted in the gingival crevicular fluid, but differ in their physico-chemical profile.

Amlodipine is more polar than the other dihydropyridones, with a p K a value of 8. In contrast, nifedipine is intensely lipophilic and will readily dissolve within the cell membrane and pass into the cytoplasm. The clinician should emphasize plaque control as the first step in the treatment of drug-induced gingival enlargement. Although the exact role played by bacterial plaque in drug-induced gingival enlargement is unclear, there is evidence that elimination of local factors and regular maintenance of good oral hygiene decrease the degree and severity of the gingival enlargement and improve the overall gingival health.

Usually, a three-month interval for periodontal maintenance therapy has been recommended in DIGO. The treatment options for drug-induced gingival enlargement should be based on the medication being used and the clinical presentation of the individual case. First, consideration should be given to the possibility of discontinuing or substituting the drug. Simple discontinuation of the offending agent is usually not a practical solution. However, its replacement with another medication might be the practical solution.

It may take from 1 to 8 weeks for resolution of gingival overgrowth. Consideration may be given to the use of another class of antihypertensive medications, which are known to be not-associated with the gingival enlargement. In the present case, substitute drug, that is, Normadate mg along with Phase-1 therapy resulted in clinically significant improvement in six weeks time, norvasc and tooth loss. The need for, and timing of, any surgical intervention needs to be carefully assessed.

The classical surgical approach has been the external bevel gingivectomy. However, a total or partial internal gingivectomy approach has been suggested as an alternative. In the present report, as the gingival overgrowth was not associated with the true periodontal pockets and the osseous defects, external bevel gingivectomy followed by gingivoplasty was carried out.

The postoperative results were found to be extremely satisfactory both esthetically and functionally. National Center for Biotechnology Informationnorvasc and tooth loss, U. J Indian Soc Periodontol. Rudrakshiand D.

Norvasc and tooth loss Oct 14; Accepted Dec 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. This article has been cited by other articles in PMC, norvasc and tooth loss. Abstract Gingival overgrowth represents an over-exuberant response to a variety of local and systemic conditions. Amlodipine, calcium channel blockers, gingival overgrowth.

Open in a separate window. Preoperative view showing extensive gingival overgrowth facial view. Immediate postoperative view after gingivectomy and gingivoplast. Footnotes Source of Support: Nil Conflict of Interest: Amlodipine induced gingival hyperplasia: Drug associated gingival enlargement. Gingival sequestration of amlodipine and amlodipine-induced gingival overgrowth letter Lancet. Prevalence of amlodipine-related gingival hyperplasia.

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