Is dental plaque the only etiological factor in Amlodipine induced gingival overgrowth? A systematic review of evidence.

S Gaur,R Agnihotri

doi:10.4317/jced.54715

Abstract

BackgroundAmlodipine, 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 MethodsLiterature 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.ResultsAbout 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.ConclusionsIt 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.

Highlights

Hypertension, a “silent killer” is one of the most important modifiable risk factors for cardiovascular and associated conditions like stroke, dementia, ischemic heart disease, vision loss, heart and kidney failures (1)
13 original research articles were included in the systematic review and processed for data extraction. b
The total number of subjects involved in these studies ranged from 25 to 4290 with the number of males having amlodipine induced gingival overgrowth (AIGO) being more than females

Summary

Introduction

Hypertension, a “silent killer” is one of the most important modifiable risk factors for cardiovascular and associated conditions like stroke, dementia, ischemic heart disease, vision loss, heart and kidney failures (1). It may be used either alone or in combination therapy These medications often require lifelong administration, exposing the patients to side effects including adverse oral reactions like gingival overgrowths (GO). More than 20 prescription medications are associated with gingival enlargement These include anticonvulsants (e.g. phenytoin), immunosuppressants (e.g. cyclosporine A) and CCB’s like nifedipine, diltiazem and verapamil (4). It has been suggested that age, genetics, drug variables and pre-existing gingival inflammation all influence the response of gingiva to these medications (6) They produce massive enlargements which may be localized or generalized. Conclusions: It was concluded that AIGO is no longer a rare phenomenon It is 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

Methods

Results

Conclusion