1
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Casu C, Murgia MS, Orrù G, Scano A. Photodynamic therapy for the successful management of cyclosporine-related gum hypertrophy: A novel therapeutic option. J Public Health Res 2022; 11:22799036221116177. [PMID: 36226306 PMCID: PMC9549190 DOI: 10.1177/22799036221116177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Drug-induced gingival overgrowth is associated with the intake of three classes of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. It is clinically characterized by hyperplasia of the gingival connective tissue which appears edematous, bloody, and purplish-red in color. In more severe cases, drug-induced gingival hyperplasia negatively affects the patient's quality of life, making it difficult to eat and practice good oral hygiene. Drug-induced gingival overgrowth therapy is controversial and, in fact, no studies in the literature highlight a well-defined therapeutic protocol. The therapies that are described provide primarily for non-surgical periodontal treatment and second-line surgical treatment. The aim of this work is to highlight a case of drug-induced gingival hyperplasia which was completely resolved thanks to photodynamic therapy which is completely free from side effects. Design and Methods Photodynamic therapy was performed on an 18 year-old female patient with LEDs at a power of 450-470 nm and 5500 mW/cm2 + 7500 mW/cm2, combined with a Curcuma longa-based photosensitizer. A single session was performed, with applications of approximately 30 s for each interdental papilla. Results The patient improved markedly after only one cycle of PDT. There was an absence of clinically detectable inflammation, edema, and rubor of the involved dental papillae. At the 4, 6, and 12 week follow-ups there were no recurrences. Conclusions This case report highlights the first case of drug-induced gingival hypertrophy entirely treated with photodynamic therapy to be described in the literature. Therefore, although it is only a case report, this therapy which is free from side effects should be investigated as an alternative to current therapies.
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Affiliation(s)
- Cinzia Casu
- International Ph.D. in Innovation
Sciences and Technologies, University of Cagliari, Cagliari, Italy,Department of Surgical Science, Oral
Biotechnology Laboratory, University of Cagliari, Cagliari, Italy,Cinzia Casu, International Ph.D. in
Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy,
Cagliari 09124 Emails: ;
| | | | - Germano Orrù
- Department of Surgical Science, Oral
Biotechnology Laboratory, University of Cagliari, Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Science, Oral
Biotechnology Laboratory, University of Cagliari, Cagliari, Italy
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2
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Damdoum M, Varma SR, Nambiar M, Venugopal A. Calcium Channel Blockers Induced Gingival Overgrowth: A Comprehensive Review from a Dental Perspective. J Int Soc Prev Community Dent 2022; 12:309-322. [PMID: 35966914 PMCID: PMC9369783 DOI: 10.4103/jispcd.jispcd_57_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gingival overgrowth (GO) as a manifestation of calcium channel blockers (CCBs) was first introduced in the literature by Ramon et al. in 1984. Since then, the use of CCBs as a treatment modality for hypertension has been recorded extensively in the literature for its association with GO. AIM The aim of our study is to evaluate histopathology, treatment, and follow-up for the cases detailed in various studies and also to highlight the protocol mentioned to identify these presentations. MATERIALS AND METHODS A broad search was conducted from the period 1980 to 2021 using electronic databases PubMed Central, Scopus, Cochrane, and SciELO databases. About 293 articles were initially chosen. The articles further excluded did not fit the criteria for the study and eventually 50 articles which met the inclusion criteria were chosen as part of this literature review. RESULTS A comparative analysis was carried out regarding histopathology, treatment modalities, drug dosage, and duration to evaluate the differences in cases between 1980 and 2021. From the available studies, it was found that the histopathological and clinical findings were varied. Treatment strategies employed were different, though follow-ups in most cases were uniform. CONCLUSION CCBs and their relationship with GO have been widely reported in the literature. Dentists should approach this condition by taking appropriate medical and dental history and follow evidence-based treatment guidelines to provide more relevant and judicious management of this condition. Inter-disciplinary treatment approaches would provide better outcomes.
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Affiliation(s)
- Marah Damdoum
- Department of Periodontics, University of Buffalo, New York, USA
| | - Sudhir R Varma
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE,Centre of Medical and Biomedical Allied Health Sciences Research, Ajman University, Ajman, UAE,Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Sudhir Rama Varma, Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE. E-mail:
| | - Manjusha Nambiar
- Department of Periodontics, Sr Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Adith Venugopal
- Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India,University of Puthisastra, Phnom Penh, Cambodia
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3
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Tateno RY, Palma LF, Sendyk WR, Campos L. High-Power Diode Laser for Second-Stage Implant Surgery in an Anticoagulated Patient: A Clinical Case Letter. J ORAL IMPLANTOL 2021; 47:154-157. [PMID: 32663276 DOI: 10.1563/aaid-joi-d-20-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ricardo Yudi Tateno
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro. São Paulo, SP, Brazil
| | - Luiz Felipe Palma
- Department of Morphology and Genetics, Federal University of São Paulo. São Paulo, SP, Brazil.,MSc Program, Ibirapuera University. São Paulo, SP, Brazil
| | - Wilson Roberto Sendyk
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro. São Paulo, SP, Brazil
| | - Luana Campos
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro. São Paulo, SP, Brazil.,Oral Medicine. Brazilian Institute of Cancer Control. São Paulo, SP, Brazil
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4
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Yolcu A, Aydogdu I. Amlodipine-induced gingival hypertrophy. Eur J Intern Med 2020; 78:127-128. [PMID: 32616341 DOI: 10.1016/j.ejim.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alkim Yolcu
- Department of Internal Medicine, Celal Bayar University, School of Medicine, Manisa, Turkey.
| | - Ismet Aydogdu
- Division of Hematology, Department of Internal Medicine, Celal Bayar University, School of Medicine, Manisa, Turkey
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5
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Lauritano D, Martinelli M, Baj A, Beltramini G, Candotto V, Ruggiero F, Palmieri A. Drug-induced gingival hyperplasia: An in vitro study using amlodipine and human gingival fibroblasts. Int J Immunopathol Pharmacol 2020; 33:2058738419827746. [PMID: 31663449 PMCID: PMC6822186 DOI: 10.1177/2058738419827746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast’s function in gingival overgrowth. To determine whether amlodipine alters the inflammatory responses, we investigated its effects on gingival fibroblast gene expression as compared with untreated cells. Fragments of gingival tissue of healthy volunteers (11 years old boy, 68 years old woman, and 20 years old men) were collected during operation. Gene expression of 29 genes was investigated in gingival fibroblast cell culture treated with amlodipine, compared with untreated cells. Among the studied genes, only 15 (CCL1, CCL2D, CCL5, CCL8, CXCL5, CXCL10, CCR1, CCR10, IL1A, IL1B, IL5, IL7, IL8, SPP1, and TNFSF10) were significantly deregulated. In particular, the most evident overexpressed genes in treated cells were CCR10 and IL1A. These results seem to indicate a possible role of amlodipine in the inflammatory response of treated human gingival fibroblasts.
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Affiliation(s)
- Dorina Lauritano
- Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milano-Bicocca, Milan, Italy
| | - Marcella Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Baj
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Beltramini
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Candotto
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Francesco Ruggiero
- Military Policlinic of Rome, Medical Department, Cardiological Unit, Rome, Italy
| | - Annalisa Palmieri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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6
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Synergistic Application of Platelet-Rich Fibrin and 1% Alendronate in Periodontal Bone Regeneration: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9148183. [PMID: 31531371 PMCID: PMC6720370 DOI: 10.1155/2019/9148183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023]
Abstract
Periodontal bone regeneration relies on coupled and cooperative bone formation and resorption. Accordingly a novel strategy on concurrent use of platelet-rich fibrin (PRF) (anabolic agent) and 1% alendronate (ALN) (anticatabolic agent) was proposed recently in regenerative periodontal treatment. It was supposed to enhance bone formation and reduce bone resorption simultaneously. However, there is a lack of evidence-based studies to answer whether this concurrent application was superior to single application until now. Besides, concerns on ALN lead to some reservation on this synergistic way. ALN may impair new bone formation and necrotize jaws. Thus, in order to compare the clinical efficacy between PRF plus 1%ALN and PRF alone on periodontal bone regeneration, we performed present systematic review and meta-analysis. Because it is the prerequisite for measuring the combined efficacy of PRF plus 1%ALN, firstly we evaluated the effectiveness of 1%ALN. Our data indicated that adjunctive 1%ALN was effective in promoting periodontal bone repair. Further, PRF plus 1%ALN showed a greater capacity for periodontal regeneration than PRF alone with statistical significance. The findings of this study revealed the promising prospects on synergistic application of bone anabolic agents (PRF) and antiresorption medications (1%ALN) in regenerative periodontal treatment.
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7
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Molecular Aspects of Drug-Induced Gingival Overgrowth: An In Vitro Study on Amlodipine and Gingival Fibroblasts. Int J Mol Sci 2019; 20:ijms20082047. [PMID: 31027273 PMCID: PMC6514768 DOI: 10.3390/ijms20082047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast’s function in gingival overgrowth. To determine whether amlodipine alters the fibrotic response, we investigated its effects on treated gingival fibroblast gene expression as compared with untreated cells. Materials and Methods: Fibroblasts from ATCC® Cell Lines were incubated with amlodipine. The gene expression levels of 12 genes belonging to the “Extracellular Matrix and Adhesion Molecules” pathway was investigated in treated fibroblasts cell culture, as compared with untreated cells, by real time PCR. Results: Most of the significant genes were up-regulated. (CTNND2, COL4A1, ITGA2, ITGA7, MMP10, MMP11, MMP12, MMP26) except for COL7A1, LAMB1, MMP8, and MMP16, which were down-regulated. Conclusion: These results seem to demonstrate that amlodipine has an effect on the extracellular matrix of gingival fibroblast. In the future, it would be interesting to understand the possible effect of the drug on fibroblasts of patients with amlodipine-induced gingival hyperplasia.
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8
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Asif SM, Shaik N, Barthunia B, Kaleem SM, Zakirulla M, Kota MZ, Baig FAH. Nifedipine induced gingival enlargement in an edentulous patient: a case report with one year follow up. BMC Oral Health 2018; 18:227. [PMID: 30587167 PMCID: PMC6307157 DOI: 10.1186/s12903-018-0690-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/07/2018] [Indexed: 12/25/2022] Open
Abstract
Background Gingival enlargement due to calcium channel blockers is a common complaint reported by patients. It can be localized or generalized and can range from mild to severe, affecting patients appearance and function. Nifedipine induced gingival enlargement is noticed only in 10 % of patients and very few cases of Nifedipine induced gingival enlargement in an edentulous patient have been documented in the literature. Case presentation Here in, we report a case of gingival enlargement in a 70 year old hypertensive edentulous patient who was on low dose Nifedipine therapy. Patient wanted complete dentures. We planned to excise the overgrowth and followed up for 1 year. Conclusion Nifedipine induced gingival enlargement noticed only in 10 % of patients. Hence, there is a need for physicians and dentist to make a coordinated treatment plan and practice care while prescribing these drugs which are associated with gingival overgrowth.
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Affiliation(s)
- Shaik Mohammed Asif
- Department of Diagnostic Sciences and Oral biology , College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Naheeda Shaik
- Department of Periodontology, Mamata Dental College, Khammam, India
| | - Bhavna Barthunia
- Department of Oral Medicine and Radiology, Daswani Dental College and Research Hospital, Kota, Rajasthan, India
| | - Sultan Mohammed Kaleem
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - M Zakirulla
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Zahir Kota
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Fawaz Abdul Hamid Baig
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
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9
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Campos L, Gallottini M, Pallos D, Simões A, Martins F. High-power diode laser on management of drug-induced gingival overgrowth: Report of two cases and long-term follow-up. J COSMET LASER THER 2018; 20:215-219. [PMID: 29351498 DOI: 10.1080/14764172.2017.1400165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Drug-induced gingival overgrowth (DIGO) is attributed mainly to the prolonged use of calcium channel blocking agents, anticonvulsants, and anti-calcineurin inhibitors . The management of DIGO depends on the severity of the disease and includes surgical intervention and plaque control. Compared to conventional surgical treatment, the recent literature data have shown that gingivectomy using a high-power laser (HPL) is a short and easy procedure, which results in minimal postoperative discomfort and greater patient accep- tance. OBJECTIVE AND METHODS The purpose of this study was to report two cases of recurrent DIGO treated surgically using HPL (λ 808nm, 1.5W). RESULTS Minimal bleeding and discomfort were observed during surgery, and patients reported no pain or bleeding after the procedure. After 1 year of follow-up, patients presented a minimal increase of gingival volume, indicating that laser technology can improve the efficiency and prognosis of DIGO. CONCLUSIONS The HPL was able to preventing hemorrhage and improving the patient's collaboration with the treatment and quality of life.
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Affiliation(s)
- Luana Campos
- a Department of Oral Medicine, Brazilian Institute of Cancer Control , São Paulo , Brazil
| | - Marina Gallottini
- b Special Care Dentistry Center, Dental School , University of São Paulo , São Paulo , Brazil
| | - Débora Pallos
- c School of Dentistry , Santo Amaro University , São Paulo , Brazil
| | - Alyne Simões
- d Laboratory of Oral Biology, School of Dentistry , University of São Paulo , São Paulo , Brazil
| | - Fabiana Martins
- c School of Dentistry , Santo Amaro University , São Paulo , Brazil
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10
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Gopal V, Quo BC, Chainani-Wu N. Amlodipine-Induced Gingival Overgrowth With Unusual Presentation as a Gingival Mass and Rapid Regression After Dose Reduction. Clin Adv Periodontics 2017; 7:25-29. [PMID: 32689727 DOI: 10.1902/cap.2016.160013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/24/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gingival overgrowth, a known side effect of calcium channel blockers, particularly nifedipine, usually presents as a diffuse overgrowth. An unusual presentation of amlodipine-induced gingival overgrowth is presented here, with a large, erythematous gingival mass as the most prominent feature, and rapid, almost complete resolution of the mass after reduction of amlodipine dosage. CASE PRESENTATION A boy, aged 7 years, presented with a gingival mass first noticed a week previously, with no associated discomfort or bleeding. His medical history was significant for Wiskott-Aldrich syndrome, bone marrow transplant 5 years previously, and subsequent development of severe chronic graft-versus-host-disease. His medication included: 1) amlodipine; 2) enalapril; 3) tacrolimus; 4) sulfamethoxazole/trimethoprim; 5) voriconazole; 6) hydrocortisone cream; and 7) intravenous immunoglobulin infusions. Allergies included: 1) vancomycin; 2) metoclopramide; 3) clonidine; and 4) latex. Examination revealed mild generalized gingival overgrowth and the presence of a large, erythematous, sessile, soft, non-tender mass on the mandibular right gingiva between the primary lateral incisor and canine, resembling a pyogenic granuloma. No suppuration, bleeding on probing, or radiographic abnormalities were noted. A recommendation was made to the physician of the patient to replace amlodipine with a different class of antihypertensive. In response, amlodipine dosage was decreased by 50% to 2.5 mg daily. At a 2-week follow-up visit, considerable reduction in size of the gingival mass had occurred, and shortly after complete resolution was reported by his parents. No other intervention, such as scaling or excision, had been performed. CONCLUSION Discontinuation or reduction of the amlodipine dose to <5 mg daily prior to any surgical intervention should be considered in patients taking amlodipine presenting with a gingival mass.
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Affiliation(s)
| | - Brian C Quo
- Private practice, Palo Alto, CA.,Craniofacial Department, The Lucile Packard Children's Hospital at Stanford, Palo Alto, CA
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11
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Guollo A, Vivas APM, Lopes RN, Porta G, Alves FA. Amlodipine-induced gingival overgrowth in a child after liver transplant. AUTOPSY AND CASE REPORTS 2016; 6:47-51. [PMID: 27818959 PMCID: PMC5087984 DOI: 10.4322/acr.2016.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/12/2016] [Indexed: 01/28/2023] Open
Abstract
Drug-induced gingival overgrowth (GO) has been associated with phenytoin, cyclosporine, and calcium channel blocker therapies. This study reports the case of an 11-year-old girl who was referred for evaluation of GO, which had occurred over the last 6 months. Her medical history included a liver transplant due to biliary atresia 3 years ago, immunosuppressive therapy, and hypertension, which is why she was started on a daily intake of amlodipine. The intraoral examination showed generalized GO, and the treatment consisted of a gingivectomy. Subsequently, amlodipine was replaced with captopril and oral hygiene instructions. There was no recurrence of GO after 28 months of follow-up. Although GO may be related to the chronic use of amlodipine, such an association is uncommon in pediatrics, and the treatment consists of the replacement of medication combined with a surgical approach and plaque control.
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Affiliation(s)
- André Guollo
- Stomatology Department - A.C. Camargo Cancer Center, São Paulo/SP - Brazil
| | | | | | - Gilda Porta
- Department of Liver Transplantation - A.C. Camargo Cancer Center, São Paulo/SP - Brazil
| | - Fábio Abreu Alves
- Stomatology Department - A.C. Camargo Cancer Center, São Paulo/SP - Brazil.; Stomatology Department - Universidade de São Paulo, São Paulo/SP - Brazil
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12
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Samudrala P, Chava VK, Chandana TS, Suresh R. Drug-induced gingival overgrowth: A critical insight into case reports from over two decades. J Indian Soc Periodontol 2016; 20:496-502. [PMID: 29242684 PMCID: PMC5676330 DOI: 10.4103/jisp.jisp_265_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.
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Affiliation(s)
- Pramod Samudrala
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Vijay Kumar Chava
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Tanguturi Sri Chandana
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Rachakonda Suresh
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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13
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Amlodipine-induced Gingival Hyperplasia - A Case Report and Review. W INDIAN MED J 2015; 64:279-82. [PMID: 26426184 DOI: 10.7727/wimj.2014.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/23/2014] [Indexed: 11/18/2022]
Abstract
Anticonvulsants, antihypertensive calcium channel blockers and immunosuppressants are the three main classes of drugs known to cause drug-induced gingival hypertrophy or hyperplasia. Among the calcium channel blockers, nifedipine administration has most frequently been associated with medication-related gingival hyperplasia. The incidence with amlodipine, which has a mode of action pharmacodynamically comparable to nifedipine, has rarely been reported. Here, we present a rare case of amlodipine-induced gingival hyperplasia in a hypertensive patient.
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14
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Untypical amlodipine-induced gingival hyperplasia. Case Rep Dent 2015; 2015:756976. [PMID: 25692048 PMCID: PMC4322315 DOI: 10.1155/2015/756976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/17/2022] Open
Abstract
Amlodipine is a third generation dihydropyridine calcium channel blocker that is frequently used in therapy of hypertension. Among many side effects, amlodipine has been found associated with gingival overgrowth (GO) which usually occurs within the first three months of starting therapy at a dose of 10 mg/day. However, there are very few reports on amlodipine-induced gingival overgrowth (AIGO) at a lower dose (5 mg/day) and only after short term administration. A 64-year-old male patient with hypertension, who received amlodipine (5 mg/day) for four years, sought medical attention at the Department of Periodontology and Oral Medicine, Institute of Dentistry, Banja Luka, Bosnia and Herzegovina. The patient complained of masticatory problems due to extensive maxillary GO along with pain, bleeding, and foul odor. The clinical and the histological evidences were consistent with AIGO. The first line treatment consisted of the amlodipine substitution (amlodipine was replaced with enalapril, 5 mg/day) and the scaling and root planning/SRP. At one-month follow-up, drug replacement and SRP resulted in some reduction of the inflammation and significant reduction of symptoms. Further, gingivectomy/gingivoplasty helped overcome the effect of these drugs. The possibility of AIGO should be considered for a lower dose, as well as a late presentation.
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15
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Tejnani A, Gandevivala A, Bhanushali D, Gourkhede S. Combined treatment for a combined enlargement. J Indian Soc Periodontol 2014; 18:516-9. [PMID: 25210271 PMCID: PMC4158598 DOI: 10.4103/0972-124x.138747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/29/2013] [Indexed: 12/30/2022] Open
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.
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Affiliation(s)
- Avneesh Tejnani
- Department of Dental, Unit II, Consultant Periodontist, GSBS Medical Trust, Mumbai, Maharashtra, India
| | - Adil Gandevivala
- Department of Oral and Maxillofacial Surgery, MGM Dental College, Navi Mumbai, Maharashtra, India
| | - Devang Bhanushali
- Department of Plastic Surgery, House officer, KEM Hospital, Maharashtra, India
| | - Sonal Gourkhede
- Department of Periodontology, Late Shri Yashwantrao Chavan Memorial Medical and Rural Development Foundation's Dental College, Ahmednagar, Maharashtra, India
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16
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Nonsurgical management of nifedipine induced gingival overgrowth. Case Rep Dent 2014; 2014:741402. [PMID: 25165585 PMCID: PMC4137614 DOI: 10.1155/2014/741402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/08/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022] Open
Abstract
Drug-induced gingival overgrowth is frequently associated with three particular drugs: phenytoin, cyclosporin, and nifedipine. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and cyclosporin. The frequency of gingival enlargement associated with chronic nifedipine therapy remains controversial. Within the group of patients that develop this unwanted effect, there appears to be variability in the extent and severity of the gingival changes. Although gingival inflammation is considered a primary requisite in their development, few cases with minimal or no plaque induced gingival inflammation have also been reported. A case report of gingival overgrowth induced by nifedipine in a patient with good oral hygiene and its nonsurgical management with drug substitution is discussed in this case report.
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Bharti V, Bansal C. Drug-induced gingival overgrowth: The nemesis of gingiva unravelled. J Indian Soc Periodontol 2013; 17:182-7. [PMID: 23869123 PMCID: PMC3713748 DOI: 10.4103/0972-124x.113066] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 03/27/2013] [Indexed: 12/11/2022] Open
Abstract
Drug-induced gingival overgrowth or enlargement manifests as abnormal growth of the gingiva due to an adverse drug reaction (ADR) in patients treated with anticonvulsants, immunosuppressants, and calcium channel blockers. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. It gradually becomes a source of pain and the condition often leads to disfiguration. Within the group of patients that develop this unwanted effect, there appears to be variability in the extent and severity of the gingival changes. It would seem pertinent to identify and explore possible risk factors and relating them with the treatment plan. This article throws light on respective drugs and their association with gingival overgrowth and approaches to treatment based on current knowledge and investigative observations.
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Affiliation(s)
- Vipin Bharti
- Department of Periodontology, Government Dental College and Hospital, Patiala, Punjab, India
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Jacobs DM, Duggan JM, Sahloff EG. Gingival Hypertrophy Associated with Amlodipine Use in an HIV-Infected Woman. J Pharm Technol 2013. [DOI: 10.1177/875512251302900405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective: To report the case of a 46-year-old woman with HIV infection who developed gingival hypertrophy while taking amlodipine for hypertension and review the literature discussing gingival hypertrophy associated with amlodipine and other calcium channel blockers. Case Summary: A 46-year-old HIV-infected female was taking amlodipine 5 mg daily to manage hypertension. After 4 1/2 years of exposure to amlodipine, the patient presented with new-onset gingival hypertrophy. Concurrent medications included atazanavir, ritonavir, tenofovir/emtricitabine, a multivitamin, and ibuprofen and tramadol as needed. Amlodipine was discontinued and lisinopril was initiated to manage hypertension. Resolution of gingival hypertrophy was noted at 3- and 12-month follow-up visits. Discussion: Drug-induced gingival hypertrophy has been associated with anticonvulsants, immunosuppressants, and calcium channel blockers. Cases of gingival hypertrophy are uncommon, especially after such extended exposure. The Naranjo probability scale classified the reaction as probable. Discontinuation of amlodipine led to resolution of gingival hypertrophy. Conclusions: Patients with new-onset gingival hypertrophy should have a complete medication review to identify potential causative agents. Development of gingival hypertrophy may present acutely or with extended exposure. Resolution of gingival hypertrophy generally occurs with discontinuation of the inciting agent.
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Affiliation(s)
- David M Jacobs
- DAVID M JACOBS PharmD BCPS, PGY-2 Resident, Infectious Diseases, College of Pharmacy University of Houston, Houston, TX
| | - Joan M Duggan
- JOAN M DUGGANMD FACP AAHIVS, Professor of Medicine, Physiology, Pharmacology, Metabolism, & Cardiovascular Science and Medical Microbiology and Immunology, Division of Infectious Diseases, College of Medicine, University of Toledo, Toledo, OH
| | - Eric G Sahloff
- ERIC G SAHLOFF PharmD AAHIVP, Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, Health Science Campus, University of Toledo
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