Amlodipine-induced Gingival Overgrowth Research Articles

Targeting SRD5A1 and MMP-2/NLRP3/TGF-β1 axis alleviates the amlodipine-induced gingival hyperplasia in rats: Emerging role of saw palmetto and folic acid

Saw palmetto (SAW), the herbal drug used to treat prostatic hyperplasia, exerts its antiproliferative effects by blocking steroid 5 alpha-reductase (SRD5A1) activity, that has also been involved in gingival hyperplasia (GH) pathogenesis. Concurrently, folic acid (FA) could reduce GH prevalence via its antioxidant and anti-inflammatory effects. Thus, this study tended to assess the potential therapeutic efficacy of SAW, alone and along with FA, against amlodipine-induced gingival inflammation and overgrowth in rats. Rats were grouped into (CONT, AIGH, SAW, SAW-treated, FA-treated, and SAW + FA-treated). SAW and FA were administered once daily for 4 weeks. Gingival SRD5A1, CTGF, GSK-3β, and NLRP3 expressions, as well as T, DHT, MDA, TAC, ET-1, and MMP2 levels were determined. In addition, histopathological and immunohistochemical analyses of TNF-α, IL-6, TGF-β1, and α-SMA were documented. Results declared that SAW and FA administration markedly ameliorated amlodipine-associated GH and may be presenting a novel therapeutic avenue in the future.

Amlodipine-induced gingival overgrowth in a patient with hypertension

Amlodipine-induced gingival overgrowth (AIGO) is characterized by an increase in the volume of connective tissue matrix in the gingiva. Amlodipine is one of the commonly prescribed antihypertensive drugs, and gingival hyperplasia is one overlooked side effect in patients taking amlodipine. Many factors can contribute to the development of gingival overgrowth, including: plaque control; periodontal variables; medications and their relative dose; age; sex; and, genetic factors. Currently, more than 20 prescription medications are associated with gingival enlargement. Drugs associated with gingival overgrowth can be broadly divided into three categories: Anticonvulsants, calcium channel blockers, and immunosuppressant. In the present case, a 66 year old male patient who presented with gingival overgrowth and was found taking Amlodipine for 20 year.

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

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.

Amlodipine-induced gingival overgrowth in older patients: a report of four cases

Amlodipine-induced gingival overgrowth in older patients: a report of four cases

A Rare Case of Severe Amlodipine-Induced Gingival Overgrowth: A Case Report

Gingival overgrowth, or gingival hyperplasia is the hypertrophy of periodontium caused by local systemic diseases or medications. These medications can be broadly categorized into three main groups including immunosuppressants, anticonvulsants, and calcium channel blockers (CCBs). Amlodipine-induced gingival overgrowth (AIGO) is a less documented phenomenon. This is a unique case of 68-year-old African American woman who developed severe AIGH after taking amlodipine for three years for essential hypertension. The gingival overgrowth happened over a period of two weeks and was so extreme that the patient was unable to approximate her lips or tolerate any oral intake. Labs, images, and biopsies were performed to rule out any other cause of the gingival overgrowth and were negative. AIGO was suspected, and the patient's amlodipine was stopped. At the three-month follow-up, full resolution was noted.

A clinico-histopathological report on low dose of amlodipine: A third-generation calcium channel blocker-induced gingival overgrowth

This clinical & histopathological report describes the clinical features, mechanism of action on drugs causing drug-induced gingival overgrowth (DIGO), diagnosis and management of patients with arterial hypertension with the regular usage of amlodipine drug. The report also highlights the importance of an involvement of cardiologist and his/her vital role in the management of amlodipine-induced gingival overgrowth.

Elevated Interleukin-17A expression in amlodipine-induced gingival overgrowth.

Amlodipine, a calcium channel blocker derivative, is frequently used by patients with high blood pressure. Studies reported that it can induce gingival overgrowth. However, the underlying mechanism is not fully described yet. Interleukin-17A (IL-17A) is known as a proinflammatory cytokine, but current studies indicate that it has a role in fibrotic disorders and epithelial-mesenchymal transition (EMT). The aim of this study was to figure out the possible role of IL-17A in amlodipine-induced gingival overgrowth. Twenty-nine (29) individuals participated in the study, and they were assigned into 3 groups based on medical status and clinical periodontal examination; 9 patients with amlodipine-induced gingival overgrowth, 11 patients with inflammatory gingival overgrowth, and 9 healthy individuals as a control group. Clinical periodontal parameters including plaque index (PI), gingival index (GI), and gingival overgrowth index (GOI) were recorded. Blood and gingival crevicular fluid (GCF) samples were obtained. Gingival tissues were taken by appropriate periodontal surgery following initial periodontal therapy. To detect IL-17A on tissue samples, immunohistochemistry (IHC) was performed. Quantitative analysis was done, and the expression level of IL-17A was given as the percent positively stained cells. Enzyme-linked immunosorbent assay (ELISA) kits were used to analyze IL-17A in serum and GCF samples. All recorded clinical parameters were significantly higher in gingival overgrowth groups compared with control. Evaluation of inflammation on tissue sections did not show any significant change within the groups. Immunohistochemistry findings showed that IL-17A expression was increased in amlodipine samples (81.90%) compared with control samples (42.35%) (P<.001). There was an increase in the inflammatory group (66.08%) which is significantly less than the amlodipine group (P<.05). IL-17A levels in serum and GCF samples were not different within the study groups. In this study, elevated IL-17A expression regardless of inflammation shows that amlodipine might cause an increase of IL-17A in gingival tissues. This increase might induce fibrotic changes and EMT in gingival overgrowth tissues. The association of IL-17A with fibrosis and EMT in gingival tissues requires further investigation.

The gingival crevicular fluid levels of growth factors in patients with amlodipine-induced gingival overgrowth: A pilot study.

Amlodipine, calcium channel blocker (CCB), is used in the management of cardiovascular diseases which causes gingival overgrowth (GO). The growth factors may have a role in the pathogenesis of amlodipine-induced GO. This pilot study aimed to investigate the growth factors including transforming growth factor-b1 (TGF-b1), platelet-derived growth factor-BB (PDGF-BB), and basic fibroblast growth factor (bFGF) in gingival crevicular fluid (GCF) of patients with amlodipine-induced GO and compare with of healthy subjects. GCF samples were collected from 56 sites presenting GO (GO + group) and from 38 sites not presenting GO (GO- group) of 5 patients using amlodipine for more than one year, and from 45 sites (control group) of 5 healthy subjects. The levels of TGF-b1, PDGF-BB, and bFGF were determined by using ELISA kits. The mean concentration of TGF-b1 in GCF samples of GO + group (9.50 ± 7.30 ng/ml) was higher than both GO- group (2.07 ± 0.50 ng/ml) and control group (2.74 ± 1.01 ng/ml) (P = 0.014). No significant difference was found among the groups in the GCF levels of PDGF-BB (P = 0.767). bFGF was detected in only 33% of the sites from patients. These preliminary results suggest that TGF-b1 may play a crucial role in the pathogenesis of amlodipine-induced GO.

Amlodipine Induced Gingival Overgrowth, Unusual Defect and The Impact of Oral Environment: A Case Report

Introduction: Calcium-channel blockers are known for their buccal side effect as Gingival Overgrowth (GO). Although Amlodipine is considered a safe drug, it may induce gingival overgrowth for some individuals, inducing then, an aesthetic prejudice for the patient and causing serious managerial problems for clinicians. This case reports unusual defects of Amlodipine-induced gingival overgrowth, with a large gingival mass that almost completely disappeared only after improving the buccal environment. Case Study: A 51-year old Moroccan woman was complaining of gingival bleeding swelling. The examination revealed a general GO on the labial side, from the 22 to 15. It involved the entire height of the keratinized gingiva, including papillae on the buccal side. The oral hygiene was really defective with abundant plaque and calculus. The patient had hypertension and daily treated by Amlodipine 5mg for one year. But she developed the GO just few months before her first visit. The mass, associated with a chronic periodontitis, almost disappeared after scaling and root planning. Such a minimal surgical treatment showed improvement with no drug substitution or reduction. She was regularly followed up for 10 months. Conclusion: Improvement of oral hygiene, associated to periodontal non-surgical treatment alone, can afford clinical satisfaction. Changing the patient’s medication should be the last solution when local measures fail.

Amlodipine Induced Gingival Overgrowth and its Nonsurgical Management– A Case Report

Amlodipine Induced Gingival Overgrowth and its Nonsurgical Management– A Case Report

Amlodipine-induced gingival overgrowth in the peri-implant region: a review and case report

Gingival overgrowth is a known side-effect of the antihypertensive drug amlodipine, but the risk of mucosal overgrowth around dental implants has been less well documented. This article discusses the role of calcium channel blockers in drug-induced mucosal overgrowth around dental implants and describes the preventive and surgical management of the case. CPD/Clinical Relevance: The report describes the management of a patient with an implant-supported restoration who presented with peri-implantitis and drug-induced mucosal overgrowth. The review discusses how amlodipine and other medications, commonly associated with drug-induced gingival overgrowth, impact on the management of implant patients.

PC241: A case report of severe chronic periodontitis with Amlodipine‐induced gingival overgrowth

PC241: A case report of severe chronic periodontitis with Amlodipine‐induced gingival overgrowth

The Management of Amlodipine-induced Gingival Overgrowth Associated to Generalized Chronic Periodontitis- A Case Report

The Management of Amlodipine-induced Gingival Overgrowth Associated to Generalized Chronic Periodontitis- A Case Report

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

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.

Amlodipine‐Induced Gingival Overgrowth With Unusual Presentation as a Gingival Mass and Rapid Regression After Dose Reduction

Gingival overgrowth, a known side effect of calcium channel blockers, particularly nifedipine, usually presents as a diffuse overgrowth. An unusual presentation of amlodipine-induced gingival overgrowth is presented here, with a large, erythematous gingival mass as the most prominent feature, and rapid, almost complete resolution of the mass after reduction of amlodipine dosage. A boy, aged 7 years, presented with a gingival mass first noticed a week previously, with no associated discomfort or bleeding. His medical history was significant for Wiskott-Aldrich syndrome, bone marrow transplant 5 years previously, and subsequent development of severe chronic graft-versus-host-disease. His medication included: 1) amlodipine; 2) enalapril; 3) tacrolimus; 4) sulfamethoxazole/trimethoprim; 5) voriconazole; 6) hydrocortisone cream; and 7) intravenous immunoglobulin infusions. Allergies included: 1) vancomycin; 2) metoclopramide; 3) clonidine; and 4) latex. Examination revealed mild generalized gingival overgrowth and the presence of a large, erythematous, sessile, soft, non-tender mass on the mandibular right gingiva between the primary lateral incisor and canine, resembling a pyogenic granuloma. No suppuration, bleeding on probing, or radiographic abnormalities were noted. A recommendation was made to the physician of the patient to replace amlodipine with a different class of antihypertensive. In response, amlodipine dosage was decreased by 50% to 2.5 mg daily. At a 2-week follow-up visit, considerable reduction in size of the gingival mass had occurred, and shortly after complete resolution was reported by his parents. No other intervention, such as scaling or excision, had been performed. Discontinuation or reduction of the amlodipine dose to <5 mg daily prior to any surgical intervention should be considered in patients taking amlodipine presenting with a gingival mass.

Amlodipine-induced gingival overgrowth

Amlodipine-induced gingival overgrowth

A rare case of amlodipine-induced gingival overgrowth circumferential to dental implant healing abutments and its management: A 2-year follow-up study

Calcium channel blockers have been implicated throughout literature for gingival hyperplasia around natural teeth as an untoward side effect, with amlodipine exhibiting the least prevalence rate. This clinical report describes a rare case of hyperplasia of tissues around titanium dental implants in a 62-year-old hypertensive Caucasian male patient receiving Amlodipine® 5 mg/day for 10 years. Clinically, the enlargement appeared circumferentially enveloping the healing abutments placed 4 months, following the placement of the implants. Elimination of local factors followed by surgical resection to facilitate the insertion of prosthesis with supportive periodontal therapy was planned. The area healed satisfactorily with no recurrence observed for the next 2 years, thus confirming that periodontal treatment alone without any drug substitution or withdrawal can efficiently generate agreeable gingival response.

Amlodipine induced gingival enlargement

Drug-induced gingival overgrowth or enlargement is an abnormal growth of the gingiva due to an adverse drug reaction in patients treated with anticonvulsants, immunosuppressants, and calcium channel blockers (CCBs). CCBs are considered as one of the etiologic factors among patients seeking dental care for drug-induced gingival enlargement or overgrowth. This enlargement can be localized or generalized and can range from mild to extremely severe, affecting patient's appearance, and function. CCBs are one of the most commonly used drugs for the management of cardiovascular disorders and are known for causing gingival over growth. Amlodipine is a new CCB and has been used with increasing frequency in the management of hypertension and angina. Although amlodipine is considered as a safe drug, very rarely it may induce gingival overgrowth. A rare case of amlodipine-induced gingival overgrowth has been reported herein a 45-year-old female patient. The treatment aspect included scaling and root planing, substitution of the drug, the surgical excision, and the maintenance and supportive therapy resulting in an excellent clinical outcome.

Untypical amlodipine-induced gingival hyperplasia.

Amlodipine is a third generation dihydropyridine calcium channel blocker that is frequently used in therapy of hypertension. Among many side effects, amlodipine has been found associated with gingival overgrowth (GO) which usually occurs within the first three months of starting therapy at a dose of 10 mg/day. However, there are very few reports on amlodipine-induced gingival overgrowth (AIGO) at a lower dose (5 mg/day) and only after short term administration. A 64-year-old male patient with hypertension, who received amlodipine (5 mg/day) for four years, sought medical attention at the Department of Periodontology and Oral Medicine, Institute of Dentistry, Banja Luka, Bosnia and Herzegovina. The patient complained of masticatory problems due to extensive maxillary GO along with pain, bleeding, and foul odor. The clinical and the histological evidences were consistent with AIGO. The first line treatment consisted of the amlodipine substitution (amlodipine was replaced with enalapril, 5 mg/day) and the scaling and root planning/SRP. At one-month follow-up, drug replacement and SRP resulted in some reduction of the inflammation and significant reduction of symptoms. Further, gingivectomy/gingivoplasty helped overcome the effect of these drugs. The possibility of AIGO should be considered for a lower dose, as well as a late presentation.

Incidence of amlodipine-induced gingival overgrowth in the rural population of Loni.

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-induced overgrowth was verified by disappearance or decreased severity of gingival overgrowth after withdrawal of the causative drug.Results:The prevalence rate of amlodipine-induced gingival hyperplasia among experimental patients was 3.4%, while it was not observed among the control subjects. Oral examination revealed gingival overgrowth as a lobular or nodular enlargement on interdental papilla located in the anterior interproximal regions.Conclusions:In this study, there was a significant relationship between gingival inflammation resulting from dental plaque and drug dosage, and hyperplasia.