Abstract
Background. The paper describes the case of a 62 years non-smoking male patient who was referred to the Department of Periodontology, “Carol Davila” University of Medicine and Pharmacy, complaining of gingival overgrowth. The patient’s medical history revealed that he suffers from autosomal dominant polycystic kidney disease chronic renal failure and hypertension; the patient was under treatment with amlodipine, a calcium channel blocker for 18 months. Case presentation. The patient underwent cause-related periodontal therapy and flap surgery in areas where only partial resolution of the gingival overgrowth was obtained after completion of initial phase therapy; amlodipine was not substituted because of medical reasons. Results. We obtained complete resolution of the gingival enlargement, even without any change in the causative drug regimen; the patient was placed in a maintenance program, with regular appointments at 3 months; he successfully managed to maintain periodontal and oral health. Conclusions. If possible, all patients who are about to receive calcium channel blockers, should have a detailed periodontal assessment performed and if any periodontal disease discovered, treated properly. In case of established gingival overgrowth, non-surgical and/or surgical periodontal therapy could induce partial or complete remission of enlargement. Change of medication is also an option.
Highlights
Autosomal dominant polycystic kidney disease (ADPKD) is the most common of the congenital renal cystic disorders, a group of diseases with related but distinct pathogenesis, described by the development of renal cysts and multiple extra-renal manifestations
Patient evaluation A 62 years non-smoking male patient was referred to the Department of Periodontology for periodontal assessment with chief complaints of gingival overgrowth and tooth mobility
The prevalence of gingival overgrowth in patients taking amlodipine was reported to be 3.3% [6], 1.7% in the study of Ellis et al in 1999 [7] and 1.3% in the study conducted by Ono and co-workers in 2010 [8], all values being lower than the prevalence rate reported in patients taking nifedipine 47.8% [9]
Summary
Autosomal dominant polycystic kidney disease (ADPKD) is the most common of the congenital renal cystic disorders, a group of diseases with related but distinct pathogenesis, described by the development of renal cysts and multiple extra-renal manifestations. Patient evaluation A 62 years non-smoking male patient was referred to the Department of Periodontology for periodontal assessment with chief complaints of gingival overgrowth and tooth mobility. Initial treatment phase aimed at eliminating and preventing the recurrence of local supra- and subgingival bacterial plaque deposits from the tooth surfaces and included the following procedures: oral hygiene instructions and improvement of selfperformed plaque control in association with chemical plaque control (mouthwashes with chlorhexidine 0.2% twice a day), supra- and subgingival scaling and root planning, removal of local plaque retentive factors such as overhanging restorations, endodontic treatment of teeth no 16, 26, 47, extraction of compromised teeth (i.e. 31, 38). At 1, 2 and 3 months after initial therapy the patient was re-evaluated and additional surgical and corrective treatment was considered to be necessary in order to completely eliminate periodontal pockets and to restore masticatory and occlusal function. Blood investigations were performed at 11 month from initial presentation; negative C reactive protein and normal erythrocyte sedimentation rate were found
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