Management of initial and surgical management of amlodipine-induced gingival enlargement with multifactorial etiology: a case report with 6 months follow-up

Abstract

Drug-induced gingival enlargement can be seen as a side effect of systemically used drugs such as calcium channel blockers, anticonvulsants, and immunosuppressants. One of these drugs is amlodipine, a dihydropyridine derivative calcium channel blocker used in the treatment of high blood pressure and coronary artery disease. Amlodipine-induced gingival overgrowth is rarely seen compared to other calcium channel blockers. The aim of this case is to present the diagnosis of gingival overgrowth due to amlodipine use and the identification of other etiologic factors such as labial frenulum, phase 1 initial, and phase 2 surgical treatment approaches. A 56-year-old female patient presented to our clinic with severe gingival overgrowth, intense bleeding, difficulty feeding, and pain. The anamnesis revealed that she had hypertension and had been taking amlodipine derivative Norvasc 10 mg once a day for 8 years. A look inside the mouth showed that there was a lot of gum tissue growing over the crowns from the labial and palatal sides, mainly in the front of the maxilla. Phase 1 treatment was initiated. As a result of the consultation with the patient's cardiologist, the hypertension medication Norvasc 10 mg was replaced with Candexil 16 mg by the medical physician. The preoperative tension and blanch test was positive, and the labial frenulum was seen to mobilize the free gingival margin of the central teeth. After the same session of gingivoplasty, the labial frenulum was removed by a frenectomy operation. After the operation, antibiotics, analgesics, and mouthwash were prescribed. The patient stated that he did not have any problems after the operation. 6-month follow-up showed uneventful healing. No recurrence of gingival growth was found in the 1st, 3rd, and 6th month follow-ups. In conclusion, this case report shows that non-surgical periodontal treatment alone isn't always enough to treat drug-induced gingival overgrowths. The gingival shape should be changed so that the patient can properly clean their teeth, and drug-induced gingival overgrowths, like the one in this case, may have more than one cause and may need additional surgery like a labial frenectomy.