Journal of The Association of Physicians of India ■ Vol. 64 ■ March 2016 87 Amlodipine-Induced Gingival Overgrowth R Jayanthi 1 , P Boopathi Rajan 2 Abstract Gingival overgrowth is a common feature of periodontal diseases. Rarely it occurs as an unwanted side effect of drugs such as anticonvulsants mainly phenytoin, immunosuppressants like cyclosporine and calcium channel blockers particularly nifedipine. Among calcium channel blockers, nifedipine causes gingival overgrowth in 10% of patients whereas amlodipine-induced gingival overgrowth is very limited. Here we report four cases in hypertensives on amlodipine. 1 Professor, 2 Post Graduate, Dept. of Medicine, Govt. Stanley Medical College, Chennai, Tamil Nadu Received: 22.08.2014; Accepted: 14.10.2014 Introduction G ingivae or gum is one of the human health indictor. Increase in size of the gingival tissue is referred to as gingival overgrowth. It is a well known consequence of administration of drugs like anticonvulsants such as phenytoin sodium, ethosuximide, sodium valproate, immunosuppressants such as cyclosporine and calcium channel blockers like nifedipine. Amlodipine- induced gingival overgrowth is uncommon and here we report four such cases of gingival overgrowth secondary to amlodipine. Case Report We report four patients who had different degrees of gingival overgrowth. Cases are summarised in Table 1 (Figures 1, 2, 3 and 4). Discussion Gingival overgrowth is due to fibroblast proliferation in gingival tissue and is graded based on Carranza’s clinical score. Grade-0: No signs of gingival enlargement Grade-1: Enlargement confined to interdental papilla Grade-2: Enlargement involves papillae and marginal gingivae Grade-3: Enlargement covering three quarters or more of the crown Gingival overgrowth may create speech, mastication and aesthetic problems. Gingival overgrowth is strictly clinically descripted term and the accepted current terminology for this condition. Terms such as hypertrophic gingivitis or gingival hyperplasia are no longer used. Treatment is non- specific and discontinuation of drugs cause prompt regression of the gingival enlargement. 1-3 References 1. Raman PG, Mishra VN, Singh D. Nifedipine induced gingival hyperplasia. J Assoc Physicians India 1988; 36:231-233. 2. Pradhan S, Mishra P. Gingival enlargement in Antihypertensive medication. J Nepal Med Assoc 2009; 48:149-152. 3. Joshi S, Bannel S. A Rare case report of Amlodipine- induced gingival enlargement and review of its pathogenesis, case reports in dentistry, Hindawi Publishing Corporation, 2013; 2013:1155-1157. Table 1: Case summaries Case Age Sex Duration# Dose Grade* 1 43 yrs Male 4 yrs 5 mg OD III 2 50 yrs Female 4 yrs 10 mg OD I 3 65 yrs Male 1 yr 2.5 mg OD II 4 72 yrs Male 12 yrs 2.5 mg OD III Case 1 Case 2 Case 3 Case 4 Fig. 1: Amlodipine-induced gingival hyperplasia

Amlodipine-Induced Gingival Overgrowth · had different degrees of gingival overgrowth. Cases are summarised in Table 1 (Figures 1, 2, 3 and 4). Discussion Gingival overgrowth is

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Page 1: Amlodipine-Induced Gingival Overgrowth · had different degrees of gingival overgrowth. Cases are summarised in Table 1 (Figures 1, 2, 3 and 4). Discussion Gingival overgrowth is

Journal of The Association of Physicians of India ■ Vol. 64 ■ March 2016 87

Amlodipine-Induced Gingival OvergrowthR Jayanthi1, P Boopathi Rajan2

AbstractGingival overgrowth is a common feature of periodontal diseases. Rarely it occurs as an unwanted side effect of drugs such as anticonvulsants mainly phenytoin, immunosuppressants like cyclosporine and calcium channel blockers particularly nifedipine. Among calcium channel blockers, nifedipine causes gingival overgrowth in 10% of patients whereas amlodipine-induced gingival overgrowth is very limited. Here we report four cases in hypertensives on amlodipine.

1Professor, 2Post Graduate, Dept. of Medicine, Govt. Stanley Medical College, Chennai, Tamil NaduReceived: 22.08.2014; Accepted: 14.10.2014

Introduction

Gingivae or gum is one of the human health indictor. Increase in size

of the gingival tissue is referred to as gingival overgrowth. It is a well known consequence of administration of drugs like anticonvulsants such as phenytoin s o d i u m , e t h o s u x i m i d e , s o d i u m valproate, immunosuppressants such as cyclosporine and calcium channel blockers like nifedipine. Amlodipine-i n d u c e d g i n g i va l o ve r g r o w t h i s uncommon and here we report four such cases of gingival overgrowth secondary to amlodipine.

Case Report

We r e p o r t f o u r p a t i e n t s w h o

had dif ferent degrees of gingival overgrowth. Cases are summarised in Table 1 (Figures 1, 2, 3 and 4).

Discussion

Gingival overgrowth is due to fibroblast proliferation in gingival tissue and is graded based on Carranza’s clinical score.

Grade-0 : No s igns o f g ingiva l enlargement

Grade-1: Enlargement confined to interdental papilla

Grade-2: Enlargement involves papillae and marginal gingivae

Grade-3: Enlargement covering three quarters or more of the crown

Gingival overgrowth may create speech, masticat ion and aesthetic problems. Gingival overgrowth is strictly clinically descripted term and the accepted current terminology for this condition. Terms such as hypertrophic gingivitis or gingival hyperplasia are no longer used. Treatment is non-specific and discontinuation of drugs cause prompt regression of the gingival enlargement.1-3

References1. Raman PG, Mishra VN, Singh D. Nifedipine induced gingival

hyperplasia. J Assoc Physicians India 1988; 36:231-233.

2. Pradhan S , M ishra P. Gingival enlargement in Antihypertensive medication. J Nepal Med Assoc 2009; 48:149-152.

3. Joshi S, Bannel S. A Rare case report of Amlodipine- induced gingival enlargement and review of its pathogenesis, case reports in dentistry, Hindawi Publishing Corporation, 2013; 2013:1155-1157.

Table 1: Case summaries

Case Age Sex Duration# Dose Grade*1 43 yrs Male 4 yrs 5 mg

ODIII

2 50 yrs Female 4 yrs 10 mg OD

3 65 yrs Male 1 yr 2.5 mg OD

4 72 yrs Male 12 yrs 2.5 mg OD

III

Case 1 Case 2 Case 3 Case 4

Fig. 1: Amlodipine-induced gingival hyperplasia