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Clinical appearance of amlodipine-associated gingival overgrowth. Gingival lobulations at the interdental papillae in the anterior segment of the labial surfaces of both lower and upper gingiva
Source publication
Aims:
Since the incidence of gingival overgrowth induced by amlodipine remains poorly defined, this study was carried out with an aim to determine the incidence.
Materials and Methods:
Dental patients who received amlodipine (N = 115), for more than 3 months were studied to determine the drug-induced gingival overgrowth. Clinical diagnosis of drug...
Context in source publication
Context 1
... clinical findings of amlodipine-induced gingival overgrowth were similar to those seen with use of other calcium channel blockers such as nifedipine and diltiazem. Clinical observation in patients with gingival overgrowth showed a lobular or nodular enlargement of interdental papilla in the anterior region [ Figure 1]. Generally, gingival overgrowth was more obvious in the anterior region. ...Similar publications
Cyclosporin A(CsA) - induced gingival overgrowth(GO) is a current problem of tissue-specific mechanism which is still incompletely explained. The apoptotic process has been of particular interest like a new concept in the etiology of this unwanted effect. The aim of our study was to detect the level of apoptosis, expression bcl-2 and p53, associate...
The most common inflammatory reactions in the oral mucosa are found at the gingival
level. The treatment of these inflammations requires, first of all, the removal of the causative factor; often, this maneuver is sufficient. The aim of this retrospective study was to evaluate clinical and histopathological changes that occur in terms of gingival an...
Gingival enlargement is the term now used to describe medication-related gingival overgrowth or gingival hyperplasia, a common reactionary phenomenon that occurs with the use of several types of therapeutic agents, including antiepileptic drugs. Phenytoin induced gingival hyperplasia has been recognized as a distinct pathological entity for more th...
The most important microscopic characteristic of Cyclosporine A-induced gingival overgrowth is fibroepithelial hyperplasia.
Objective:
The objective was to investigate the influence of previous exposure to Cyclosporine A over gingival epithelium in experimental periodontitis in rats.
Methods:
Twenty Wistar rats with 12 weeks-old were divided in...
Anticonvulsants are drugs that can modify the gingival tissues response to inflammatory processes in the presence of dental plaque, inducing gingival overgrowth. Preexisting gingival inflammation induced by dental plaque seems to be a favorable condition to the development and/or expression of gingival overgrowth. This study describes a case in whi...
Citations
... The present study showed a correlation of gingival enlargement with gingival and plaque index similar to Tejnani et al., 18 Taib et al., 16 and Gopal et al. 7 but in contradiction to Kothari et al. 19 The plaque index (PI) and gingival index (GI) were seen to be moderately high for most subjects in the present study. It has been suggested that calcium channel blockers inhibits the intracellular uptake of calcium across cell membranes, and may therefore interfere with the synthesis and function of collagenases, thus resulting in gingival fibroblast proliferation. ...
Background:
The administration of several classes of drugs; anticonvulsants, immunosuppressants, and calcium channel blockers can cause gingival enlargement. The aim of the present study was to evaluate the frequency and severity of gingival enlargement in patients taking calcium channel blocker drug amlodipine.
Methods:
This descriptive cross-sectional study was conducted on 250 patients who visited the dental hospital at Nepal Medical College between November 2021 to April 2022. Using the Bokenkamp and Bornhorst Index, the patients who had been on amlodipine for at least three months were examined for gingival enlargement. Along with gingival and plaque index, medication dosage and duration were also assessed.
Results:
The prevalence of gingival enlargement was 37%. Grade 1 gingival enlargement was present in 18% while grade 3 was seen in only 2%. Both individuals taking amlodipine alone and in combination with other antihypertensive drugs showed the same level of gingival enlargement. The dose and duration of amlodipine ingestion showed a significant correlation with the enlargement. The gingival and plaque index also showed a strong correlation with overgrowth.
Conclusions:
The physicians prescribing amlodipine should well inform the patients about the potential side effects. In such cases, the maintenance of oral hygiene should be prioritized from the beginning. In severe cases, substitution of the drugs followed by oral therapeutic measures should be considered for complete regression.
... Plaque accumula on is usually pronounced in AIGE but who comes earlier is the biggest riddle, yet to be solved. Generally, plaque index and gingival index scores are seen higher in AIGE cases which signify the crucial role of plaque11 in AIGE. Hence, drug induced gingival enlargements (DIGE) are kept under subheading of plaque induced gingival gingivi s and modifying factors in the recent 2017 World Workshop classifica on of periodontal and peri-implant12 ...
ABSTRACT
Drug-induced gingival enlargements are a familiar finding in a dental setup. They are seen especially in the patient on anticonvulsant, immunosuppressive, and calcium channel blockers therapy. Amlodipine used primarily as a monotherapy or in combinaon
therapy in the management of a trailing disease like hypertension is associated with gingival enlargement constantly. This case report unveils the management of amlodipine-induced gingival enlargement and accentuates the important consideraons
regarding etiopathogenesis and practical ways of managing the case on a daily basis.
... 21 Likewise, a retrospective study of about 100 patients in India found a 3.4% prevalence of AIGO. 22 However, other research points to a much higher rate of AIGO. A 2015 Indian study by Gopal et al 23 examined the gums of 133 patients who had been taking amlodipine for at least 3 months. ...
Hypertension is a leading cause of death and disability in the United States and worldwide. As primary care clinicians, nurse practitioners help patients control their blood pressure through lifestyle coaching and medication. Among the first-line medications for hypertension are calcium channel blockers, such as amlodipine. In the US, over 70 million prescriptions for amlodipine are written annually. Here we present a case report of a significant adverse event due to the use of amlodipine—gingival overgrowth. We review the pathophysiology, prevalence, and clinical management of gingival overgrowth. We also expand the understanding of this phenomenon by exploring the serious health justice implications of this adverse effect. Unchecked, gingival overgrowth can lead to tooth movement and eventual loss. Dental changes also cause pain, financial hardship, and psychosocial damage. Patients in poverty are at much greater risk for this adverse outcome due to limited access to dental care. Black patients specifically face a triple threat with higher rates of hypertension and its complications, guidelines that limit therapeutic options for first-line treatment, and high rates of poverty limiting access to dental care.
... Amlodipine, which is both low cost and taken once daily, is the one of the most prescribed agents (Tung et al. 2015). Amlodipine has an inherently long pharmacokinetic half-life (more than 24 hours), whereas, in contrast, nifedipine has an inherently short half-life (Toal, Merdeith & Elliot 2012) In the past the prevalence of Amlodipine-Induced Gingival Overgrowth (AIGO) was 1.7% to 3.3% (Tejnani et al. 2014). Lately, the data suggests that there has been an increase in the number of these cases. ...
... (1.7%), and Tejnani et al. (3.4%), while other studies have reported a higher prevalence. [14][15][16][17][18][19] A recent systematic review revealed that 26.7% of patients on amlodipine developed GH. [20] This broad variation in the prevalence can be explained by differences in the studied populations, drug dosages, and the duration and efficacy of oral hygiene practices. ...
... [21] The patient reviewed in this case study received 10 mg/day of amlodipine, a dosage that many studies have found to be associated with severe GH. [22][23][24][25] Jorgensen suggested that 5 mg/day of amlodipine could not result in GH, but this has been refuted by many later studies, which found that GH occurred with 5 mg/ day or less of amlodipine (see, for example, Jayanthi et al.'s 2017 report). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] More recently, amlodipine has been reported to cause GH in dosages ranging from 2.5 to 10 mg. [20] This variance may be explained by the fact that the majority of such studies evaluated GH within the first 6 months of therapy, even though amlodipineinduced gingival enlargement can occur after this period. ...
... [20] This variance may be explained by the fact that the majority of such studies evaluated GH within the first 6 months of therapy, even though amlodipineinduced gingival enlargement can occur after this period. [14,16,[21][22][23][24][25][26][27] The pathogenesis of drug-induced GH is multifactorial, including genetic predisposition, age, gender, drug variables, and poor oral hygiene. [28,29] Genetic susceptibility plays a central role in its etiopathogenesis: In fact, the inflammatory response to amlodipine seems to be altered by the multidrugresistant gene MDR1. ...
Background: Amlodipine is a third-generation dihydropyridine calcium channel blocker used to treat hypertension and angina. Gingival hyperplasia (GH) is an unwanted side effect associated with this therapy. It causes unsatisfactory esthetics, difficulty in maintaining good oral hygiene, abnormal tooth movement, and difficulty in mastication. GH can be managed by nonsurgical therapy alone or using a combination of nonsurgical and surgical therapy. Case Report: A 55-year-old female patient came to the clinical department of periodontology, University Hospital of Rabat, with a chief complaint of gingival enlargement. It was diagnosed and initially managed by nonsurgical periodontal treatment. Drug substitution and surgical intervention were executed. Regular supportive periodontal therapy showed a good and stable outcome over 2 years of follow-up. Conclusion: Amlodipine-induced GH can be managed using periodontal procedures combined with good oral hygiene and regular supportive periodontal therapy.
... Gingival hyperplasia is a rare side effect of this drug. e prevalence of gingival hyperplasia caused by amlodipine had been estimated by Jorgensen in 1997 as 3.3% for patients in the United States of America, while a study conducted in India in 2014 by Tejnaniet al. arrived at a similar number of 3.4% [2,3]. is suggests that the prevalence of amlodipine induced gingival hyperplasia is similar across populations of different race and geography, and has remained stable over time. Other causes of gingival hyperplasia are drugs (other calcium channel blockers such as nifedipine; cyclosporine and anticonvulsants such as phenytoin), non-Hodgkin's lymphoma, acute monocytic leukemia, granulomatous diseases (sarcoidosis and Crohn's diseases), granulomatosis with polyangiitis, chronic periodontal infections, pyogenic granuloma, benign neoplasms such as fibroma or papilloma, malignant neoplasms such as carcinoma or malignant melanoma, syndromic causes (Rutherford syndrome, Cross syndrome, Ramon syndrome, and Laband syndrome), pregnancy, and idiopathic gingival hyperplasia [4]. ...
Gingival hyperplasia is a rare finding in clinical practice. Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. The present case is a 19-year-old male who was referred for further management of stage 5 chronic kidney disease. On evaluation, he was found to have gingival hyperplasia. He was evaluated for reversible causes of kidney disease, and since none were found, renal replacement therapy was advised. He had been taking amlodipine for blood pressure control. As this was presumed to be the cause of gingival hyperplasia, it was stopped and replaced by a combination of beta-blocker and prazosin. At six-month follow-up, he had complete resolution of gingival hyperplasia. Amlodipine as a cause of gingival hyperplasia is a rare occurrence. However, it is crucial to keep in mind such a possible side effect of this commonly prescribed antihypertensive drug.
... 10 The highest prevalence of gingival enlargement was in the fourth decade of life, with the incidence of overgrowth being higher in males compared to females. 11 The management for amlodipine induced gingival enlargement can be started with the nonsurgical approach of scaling and root planing. Patient's physician has to be consulted regarding drug substitution or withdrawal of the drug. ...
... This inflammation could lead to the upregulation of several cytokine factors such as transforming growth factor-beta 1 [TGF-β1]. 11 Treatment, in general, focuses on the substitution of drug and effective control of local inflammatory factors such as plaque and calculus. When nonsurgical approach fails to resolve the gingival enlargement, surgical intervention is recommended. ...
... The prevalence of amlodipine induced gingival overgrowth was 2.5% in this study which is comparable to those reported in literature of 1.3%, 1 1.4%, 3 3.3%, 8 3.4%. 10 All patients in this study were under amlodipine for six months or more. Drug duration and dosage were significantly associated with DIGO transforming growth factor beta (TGFβ), basic fibroblast growth factor (βFGF) which enhances proliferation of connective tissue fibroblasts and collagen and glycosaminoglycans of the lamina propria. ...
Background: Amlodipine is a commonly prescribed anti-hypertensive in clinical practice. Gingival overgrowth is a rare side effect of this drug; with a reported prevalence of 1.7-3.3% in literature. Gingival overgrowth can cause aesthetic and functional problems as well as cause hindrance to maintain proper oral hygiene, thereby deteriorating the periodontal condition of the patient. The prevalence of Amlodipine induced gingival overgrowth is poorly defined in our country.
Aim: This study aims to assess Amlodipine induced gingival overgrowth in a tertiary level referral hospital of Nepal Army.
Materials and Methods: This study was conducted on hypertensive patients with amlodipine therapy under regular follow up in the Department of Internal Medicine of Shree Birendra Hospital from September to December 2017. The data from record keeping was used for the study. Ethical clearance from Institutional Review committee of Nepal Army Institute of Health Sciences was obtained before conducting the study. duration which was statistically significant (p<0.05). Results: Out of 507 patients taking amlodipine, 240 were eligible for study and six (2.5%) were found to have amlodipine induced gingival overgrowth. These patients were on a dose of 5-10 mg over six months to 25 years. The gingival overgrowth was correlated with dose and duration.
Conclusion: Low prevalence of amlodipine induced gingival overgrowth and correlation with dose and duration was seen in this short-term study. However further large-scale follow-up studies may be required to assess the severity of the problem. Keywords: Amlodipine; drug induced gingival overgrowth; Nepal.
... The prevalence of amlodipine induced gingival overgrowth was 2.5% in this study which is comparable to those reported in literature of 1.3%, 1 1.4%, 3 3.3%, 8 3.4%. 10 All patients in this study were under amlodipine for six months or more. Drug duration and dosage were significantly associated with DIGO transforming growth factor beta (TGFβ), basic fibroblast growth factor (βFGF) which enhances proliferation of connective tissue fibroblasts and collagen and glycosaminoglycans of the lamina propria. ...
Background: Amlodipine is a commonly prescribed anti-hypertensive in clinical practice. Gingival overgrowth is a rare side effect of this drug; with a reported prevalence of 1.7-3.3% in literature. Gingival overgrowth can cause aesthetic and functional problems as well as cause hindrance to maintain proper oral hygiene, thereby deteriorating the periodontal condition of the patient. The prevalence of Amlodipine induced gingival overgrowth is poorly defined in our country. Aim: This study aims to assess Amlodipine induced gingival overgrowth in a tertiary level referral hospital of Nepal Army. Materials and Methods: This study was conducted on hypertensive patients with amlodipine therapy under regular follow up in the Department of Internal Medicine of Shree Birendra Hospital from September to December 2017. The data from record keeping was used for the study. Ethical clearance from Institutional Review committee of Nepal Army Institute of Health Sciences was obtained before conducting the study. Results: Out of 507 patients taking amlodipine, 240 were eligible for study and six (2.5%) were found to have amlodipine induced gingival overgrowth. These patients were on a dose of 5-10 mg over six months to 25 years. The gingival overgrowth was correlated with dose and duration which was statistically significant (p<0.05). Conclusion: Low prevalence of amlodipine induced gingival overgrowth and correlation with dose and duration was seen in this short-term study. However further large-scale follow-up studies may be required to assess the severity of the problem.
... Characteristics of the original studies The characteristics of the original research studies have been summarized in table 1, 1 continue, 1 continue-1. There were 10 cross-sectional (7,(9)(10)(11)(12)14,16,(18)(19)(20) and 3 case control studies (13,15,17). About 7 studies were conducted in India (7,(13)(14)(15)(16)(17)19) and one each in United States of America (9), United Kingdom (10), Japan (11), Germany (12), Sudan (18) and Nigeria (20). ...
... There were 10 cross-sectional (7,(9)(10)(11)(12)14,16,(18)(19)(20) and 3 case control studies (13,15,17). About 7 studies were conducted in India (7,(13)(14)(15)(16)(17)19) and one each in United States of America (9), United Kingdom (10), Japan (11), Germany (12), Sudan (18) and Nigeria (20). The total number of subjects involved in these studies ranged from 25 to 4290 with the number of males having AIGO being more than females. ...
... The mean age of the subjects on amlodipine therapy ranged between 30 to 87 years. c. Clinical Periodontal Parameters estimated The plaque and other triggering factors for AIGO were measured with the help of Plaque index (7,9,(13)(14)(15)17,20), Calculus index (12,16) and simplified oral hygiene index (13,18) in the included studies. The periodontal status was evaluated by measuring Gingival Index (7,(13)(14)(15)17,20), Probing pocket depths (7,12,16) and Clinical attachment loss (12,16). ...
Background:
Amlodipine, a dihydropyridine calcium channel blocker (CCB) is commonly prescribed for cardiovascular conditions. Its administration may produce an uncommon adverse oral manifestation, the gingival overgrowth (GO). Lately, there has been an increase in the rate of GO in patients on amlodipine therapy. The current systematic review was undertaken to evaluate the evidence on plausible risk factors involved in amlodipine induced gingival overgrowth (AIGO).
Material and methods:
Literature search was conducted in the databases like Pubmed (Medline), Scopus and Google Scholar to include the original research articles related to etio-pathogenesis of AIGO.
Results:
About 270 documents were identified through primary search, of which 13 original research articles were included. Most common risk factor for AIGO was administration of amlodipine in subjects with poor plaque control. However, high dosage of drug, duration of therapy and inherent genetic susceptibility were recognized as other plausible risk factors.
Conclusions:
It was concluded that AIGO is no longer a rare phenomenon. It is therefore imperative for the physician to identify and inform patients, about the risk factors associated with the overgrowth at the initiation of therapy. This would prevent the development of GO's and improve the patient's quality of life. Key words:Amlodipine, calcium channel blockers, gingival overgrowth, hypertension.
