1
|
Gingival Enlargement Caused by Calcium Channel Blockers. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
Calcium channel blockers, a group of drugs widely used in the treatment of cardiovascular patients, although effective, often cause gingival enlargement, a side effect that is rarely recognized in clinical practice and is not given sufficient importance. Gingival enlargement caused by calcium channel blockers can be localized or generalized, mild or severe. It can negatively affect patients’ appearance, mastication, and speech, thus considerably reducing the quality of life of patients. Risk factors and pathogenesis of this side effect have been the subject of many studies but are still unknown, making this condition a major therapeutic challenge, especially if the cessation of the offending drug is not possible. This study aimed to review the etiology, potential risk factors, pathogenesis, clinical features, and therapy possibilities for gingival enlargement caused by calcium channel blockers.
Collapse
|
2
|
Morikawa S, Nasu M, Miyashita Y, Nakagawa T. Treatment of calcium channel blocker-induced gingival overgrowth without modifying medication. Drug Ther Bull 2021; 60:44-47. [PMID: 34911794 DOI: 10.1136/dtb.2021.238872rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mana Nasu
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoko Miyashita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
3
|
Morikawa S, Nasu M, Miyashita Y, Nakagawa T. Treatment of calcium channel blocker-induced gingival overgrowth without modifying medication. BMJ Case Rep 2021; 14:14/1/e238872. [PMID: 33431541 PMCID: PMC7802645 DOI: 10.1136/bcr-2020-238872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Gingival overgrowth is a common side effect of calcium channel blockers used in the treatment of cardiovascular diseases. While controversial, management includes discontinuing the calcium channel blocker. We report the case of a 66-year-old Japanese man with hypertension and type 2 diabetes mellitus who was diagnosed with severe periodontitis covering almost all the teeth. The patient had been on nifedipine (40 mg/day) and amlodipine (10 mg/day) medication for 5 years. With his physician's consent, nifedipine was discontinued during his treatment for periodontitis, which consisted of oral hygiene instructions and scaling and root planing on all areas. Gingivectomy was performed on the areas of hard fibrous swelling. Nifedipine was resumed during periodontal treatment when the patient's hypertension worsened. His periodontal scores improved when he resumed treatment. We report that significant improvement in gingival overgrowth can occur with basic periodontal treatment, surgery and sustained intensive follow-up without adjusting calcium channel blockers.
Collapse
Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mana Nasu
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoko Miyashita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
4
|
Lu SL, Chang JH, Huang CF, Chen LS. Therapeutic potential of proteasome inhibitors for dihydropyridine-induced gingival overgrowth. Oral Dis 2020; 26:630-636. [PMID: 31856317 DOI: 10.1111/odi.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/14/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES NF-κB plays a crucial role in collagen overproduction in dihydropyridine-induced gingival overgrowth (DIGO) fibroblasts. We aim to investigate the role of the kappa B (IκB) kinase (IKK)-NF-κB pathway and downstream collagen type I (Col I) synthesis in DIGO cells and to demonstrate the therapeutic strategy of interference of this pathway with proteasome inhibitors. METHODS Gingival fibroblasts from DIGO (n = 5) and healthy (n = 5) patients were selected and stimulated with IL-1β, nifedipine, or both. All experiments were run in triplicate and independently for each primary cell sample. RESULTS The results demonstrated that both drugs additively mediated NF-κB activity by activating IKKα/β phosphorylation. They also triggered nuclear translocation of NF-κB, Rela, and p50 (*p < .05) and increased Col I production in both healthy and DIGO cells. The addition of proteasome inhibitors, including bortezomib and MG132, promoted the accumulation of phosphorylated p-IκBα, prevented the subsequent cytosol-to-nuclear translocation of p50 and Rela (*p < .05), and abbreviated the biosynthesis of Col I in DIGO cells. CONCLUSIONS We suggested that IKK-IκBα activation is mediated by proinflammatory cytokines and CCBs in DIGO cells and triggers downstream NF-κB-Col I synthesis. Proteasome inhibitors may strategically interfere with the IKK-IκBα-NF-κB-Col I pathway and inhibit the etiopathogenesis of DIGO.
Collapse
Affiliation(s)
- Sao-Lun Lu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Division, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jui-Hung Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Division, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiung-Fang Huang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Family and Operative Dentistry, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
5
|
Beaumont J, Chesterman J, Kellett M, Durey K. Gingival overgrowth: Part 1: aetiology and clinical diagnosis. Br Dent J 2017; 222:85-91. [DOI: 10.1038/sj.bdj.2017.71] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/30/2022]
|
6
|
Sukuroglu E, Güncü GN, Kilinc K, Caglayan F. Using Salivary Nitrite and Nitrate Levels as a Biomarker for Drug-Induced Gingival Overgrowth. Front Cell Infect Microbiol 2015; 5:87. [PMID: 26649282 PMCID: PMC4664664 DOI: 10.3389/fcimb.2015.00087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/16/2015] [Indexed: 12/13/2022] Open
Abstract
Aim: Drug-induced gingival overgrowth has a multifactorial nature and the pathogenesis is still uncertain. It has been suggested that Nitric Oxide (NO) might play a role in the pathogenesis of drug-induced gingival overgrowth due to the contribution of NO to immune response and matrix degradation. NO levels in biological fluids have been used as a diagnostic biomarker in many diseases. The aim of this study is to determine whether NO levels in plasma, saliva, and gingival crevicular fluid (GCF) can serve as a potential biomarker for the evaluation of drug-induced gingival overgrowth risk. Materials and Methods: A total of 104 patients, receiving cyclosporine A (n = 35), phenytoin (n = 25), nifedipine (n = 26), or diltiazem (n = 18) participated in the study. The amount of gingival overgrowth was evaluated with two indices and was given as percentage. Periodontal clinical parameters including plaque index (PI), gingival index (GI), gingival bleeding time index (GBTI), and probing depth (PD) were also assessed. Saliva, GCF, and plasma samples were obtained from each participants. Nitrite and nitrate levels in saliva, GCF, and plasma were analyzed by Griess reagent. Results: Salivary nitrite and nitrate levels in responders were significantly higher than those in non-responders in only phenytoin group (p < 0.05). Nitrite and nitrate levels of gingival crevicular fluid and plasma did not significantly differ between responders and non-responders in all study groups (p > 0.05). Salivary nitrite levels exhibited a significant correlation with PD, GBTI, severity of gingival overgrowth (%GO), and GCF volume (p < 0.05). Additionally, a strong positive correlation was detected between saliva and plasma nitrate levels (p < 0.005). However, both nitrite and nitrate levels in GCF and plasma demonstrated no significant correlation with clinical parameters, GO severity, and GCF volume (p > 0.05). Conclusion: Salivary nitrite and nitrate levels could be used as periodontal disease biomarkers in phenytoin induced gingival overgrowth, and that saliva seems to have a better diagnostic potential than GCF and plasma for the evaluation of drug-induced gingival overgrowth risk. However, when all drug groups were considered, saliva nitrite and nitrate levels could not be used as a biomarker for drug-induced gingival overgrowth.
Collapse
Affiliation(s)
- Erkan Sukuroglu
- Department of Periodontology, Faculty of Dentistry, Karadeniz Technical University Trabzon, Turkey
| | - Güliz N Güncü
- Department of Periodontology, Faculty of Dentistry, Hacettepe University Ankara, Turkey
| | - Kamer Kilinc
- Department of Biochemistry, TOBB University of Economics and Technology Ankara, Turkey
| | - Feriha Caglayan
- Department of Periodontology, Faculty of Dentistry, Hacettepe University Ankara, Turkey
| |
Collapse
|
7
|
Jacobs DM, Duggan JM, Sahloff EG. Gingival Hypertrophy Associated with Amlodipine Use in an HIV-Infected Woman. J Pharm Technol 2013. [DOI: 10.1177/875512251302900405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective: To report the case of a 46-year-old woman with HIV infection who developed gingival hypertrophy while taking amlodipine for hypertension and review the literature discussing gingival hypertrophy associated with amlodipine and other calcium channel blockers. Case Summary: A 46-year-old HIV-infected female was taking amlodipine 5 mg daily to manage hypertension. After 4 1/2 years of exposure to amlodipine, the patient presented with new-onset gingival hypertrophy. Concurrent medications included atazanavir, ritonavir, tenofovir/emtricitabine, a multivitamin, and ibuprofen and tramadol as needed. Amlodipine was discontinued and lisinopril was initiated to manage hypertension. Resolution of gingival hypertrophy was noted at 3- and 12-month follow-up visits. Discussion: Drug-induced gingival hypertrophy has been associated with anticonvulsants, immunosuppressants, and calcium channel blockers. Cases of gingival hypertrophy are uncommon, especially after such extended exposure. The Naranjo probability scale classified the reaction as probable. Discontinuation of amlodipine led to resolution of gingival hypertrophy. Conclusions: Patients with new-onset gingival hypertrophy should have a complete medication review to identify potential causative agents. Development of gingival hypertrophy may present acutely or with extended exposure. Resolution of gingival hypertrophy generally occurs with discontinuation of the inciting agent.
Collapse
Affiliation(s)
- David M Jacobs
- DAVID M JACOBS PharmD BCPS, PGY-2 Resident, Infectious Diseases, College of Pharmacy University of Houston, Houston, TX
| | - Joan M Duggan
- JOAN M DUGGANMD FACP AAHIVS, Professor of Medicine, Physiology, Pharmacology, Metabolism, & Cardiovascular Science and Medical Microbiology and Immunology, Division of Infectious Diseases, College of Medicine, University of Toledo, Toledo, OH
| | - Eric G Sahloff
- ERIC G SAHLOFF PharmD AAHIVP, Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, Health Science Campus, University of Toledo
| |
Collapse
|
8
|
Kwok V, Caton JG, Polson AM, Hunter PG. Application of evidence-based dentistry: from research to clinical periodontal practice. Periodontol 2000 2012; 59:61-74. [DOI: 10.1111/j.1600-0757.2011.00437.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
9
|
|
10
|
Yamori M, Njelekela M, Mtabaji J, Yamori Y, Bessho K. Hypertension, periodontal disease, and potassium intake in nonsmoking, nondrinker african women on no medication. Int J Hypertens 2011; 2011:695719. [PMID: 21826260 PMCID: PMC3150144 DOI: 10.4061/2011/695719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/05/2011] [Accepted: 06/15/2011] [Indexed: 11/20/2022] Open
Abstract
The purpose of this cross-sectional study was to investigate the association of periodontitis and/or tooth loss with hypertension by excluding the common confounders. Eighty-one Tanzanian women who were aged 46-58 years, nonsmokers, nonalcoholic drinkers, and on no medication underwent clinical examination. Multiple-regression analysis showed that the severity of periodontitis was significantly correlated with increased systolic blood pressure and diastolic blood pressure. Simple-regression analysis indicated that the severity of periodontitis was inversely correlated with 24-hour urinary excretion of potassium (r = -0.579, P = 0.0004) and also inversely with the frequency of intakes of green vegetables (r = -0.232, P = 0.031) and fruits (r = -0.217, P = 0.0043). Low-potassium intake in the diet mostly accompanied by low dietary fiber intake increases BP as well as periodontal inflammation. Potassium intake may be an important factor linking periodontitis and hypertension in middle-aged nonsmoking and nonalcoholic women on no medication, although chronic inflammation such as periodontitis may cause hypertension through a more direct mechanism.
Collapse
Affiliation(s)
- Masashi Yamori
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | | | | | | | | |
Collapse
|
11
|
Agnihotri R, Bhat GS, Bhat KM. Amlodipine-induced gingival overgrowth: considerations in a geriatric patient. Geriatr Gerontol Int 2011; 11:365-8. [PMID: 21696531 DOI: 10.1111/j.1447-0594.2010.00659.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Moriya S, Tei K, Toyoshita Y, Koshino H, Inoue N, Miura H. Relationship between periodontal status and intellectual function among community-dwelling elderly persons. Gerodontology 2011; 29:e368-74. [DOI: 10.1111/j.1741-2358.2011.00483.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
13
|
Kaur G, Verhamme KMC, Dieleman JP, Vanrolleghem A, van Soest EM, Stricker BHC, Sturkenboom MCJM. Association between calcium channel blockers and gingival hyperplasia. J Clin Periodontol 2010; 37:625-30. [PMID: 20642630 DOI: 10.1111/j.1600-051x.2010.01574.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To study the effect of the dose and type of calcium channel blockers (CCBs) on the risk of gingival hyperplasia and to quantify this association. METHODS The study was conducted within the Integrated Primary Care Information Project in The Netherlands. A nested case-control study was designed within a cohort of all patients who were new users of either CCBs or drugs interacting with the renin-angiotensin system (RAS). Cases were all individuals with a validated diagnosis of gingival hyperplasia. Controls were matched on age, gender and index date. RESULTS Within the study population, 103 cases of gingival hyperplasia were identified and matched to 7677 controls. The risk of gingival hyperplasia was higher in current users of CCBs [adjusted odds ratio (OR(adj)) 2.2, 95% confidence intervals (95% CI): 1.4-3.4], especially in dihydropyridines (OR(adj) 2.1, 95% CI: 1.3-3.5) and benzothiazepine derivatives (OR(adj) 2.9, 95% CI: 1.3-6.5) than in RAS drug users. The risk increased in patients using more than the recommended daily dose (OR(adj) 3.0, 95% CI: 1.6-5.5) and when the duration of current use was <1 month (OR(adj) 5.2, 95% CI: 2.1-12.6). CONCLUSION This study shows that the risk of gingival hyperplasia is twofold higher in current users of CCBs than in users of RAS drugs. The association was dose dependent and the highest for dihydropyridines or benzothiazepine derivates.
Collapse
Affiliation(s)
- Gaganpreet Kaur
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
14
|
Lu HK, Tseng CC, Lee YH, Li CL, Wang LF. Flutamide inhibits nifedipine- and interleukin-1 beta-induced collagen overproduction in gingival fibroblasts. J Periodontal Res 2010; 45:451-7. [PMID: 20337887 DOI: 10.1111/j.1600-0765.2009.01255.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE To understand the role of the androgen receptor in gingival overgrowth, the effects of flutamide on interleukin-1 beta- and nifedipine-induced gene expression of connective tissue growth factor (CTGF/CCN2) and collagen production in gingival fibroblasts were examined. MATERIAL AND METHODS Gingival fibroblasts from healthy subjects and patients with dihydropyridine-induced gingival overgrowth (DIGO) were used. Confluent cells were treated with nifedipine, interleukin-1 beta or both. The mRNA expression was examined using real-time polymerase chain reaction, and the concentration of total soluble collagen in conditioned media was analysed by Sircol Collagen Assay. In addition, the protein expressions of androgen receptor, CTGF/CCN2 and type I collagen in gingival tissue were determined by western blot. RESULTS Interleukin-1 beta was more potent than nifedipine in stimulating CTGF/CCN2 and procollagen alpha1(I) mRNA expression, and there was an additive effect of the two drugs. Healthy cells exhibited an equal or stronger response of procollagen alpha1(I) than those with DIGO, but DIGO cells displayed a stronger response in the secretion of soluble collagen in the same conditions. Flutamide, an androgen receptor antagonist, inhibited stimulation by nifedipine or interleukin-1 beta. Additionally, the protein expressions of androgen receptor and type I collagen were higher in DIGO gingival tissue than those in healthy gingival tissue. CONCLUSION The data suggest that both nifedipine and interleukin-1 beta play an important role in DIGO via androgen receptor upregulation and that gingival overgrowth is mainly due to collagen accumulation. Flutamide decreases the gene expression and protein production of collagen from dihydropyridine-induced overgrowth cells.
Collapse
Affiliation(s)
- H-K Lu
- Periodontal Department, Taipei Medical University College of Oral Medicine, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
15
|
Kushiyama M, Shimazaki Y, Yamashita Y. Relationship Between Metabolic Syndrome and Periodontal Disease in Japanese Adults. J Periodontol 2009; 80:1610-5. [DOI: 10.1902/jop.2009.090218] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
de Carvalho Farias B, Cabral PA, Gusmão ES, Jamelli SR, Cimões R. Non-surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient. Gerodontology 2009; 27:76-80. [PMID: 19545325 DOI: 10.1111/j.1741-2358.2009.00273.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Drug-induced gingival overgrowth (DIGO) is a significant problem for periodontologists and this side effect is frequently associated with three particular drugs: phenytoin, cyclosporin A and nifedipine. A case report of gingival overgrowth induced by nifedipine in an elderly patient treated with non-surgical periodontal therapy is described. A 75-year-old male with generalised gingival overgrowth reported the problem of oral malodour and significant gingival bleeding. The medical history revealed a controlled hypertensive state and Cerebral Vascular Accident (CVA) 3 years prior to consultation. The diagnosis was gingival overgrowth associated with nifedipine, no other risk factors being identified. The patient had been taking nifedipine for 18 months, but after the consultation with the patient's doctor, nifedipine was suspended, as the hypertension was controlled. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation and prophylaxis. Six months after the first intervention, clinical parameters revealed a significant improvement with a considerable reduction in gingival overgrowth, demonstrating the effect of non-surgical periodontal therapy in severe cases of gingival overgrowth. Non-surgical treatment of DIGO is a far less invasive technique than surgical approaches and has demonstrated an impressively positive treatment response. It should therefore be considered as a first treatment option for DIGO.
Collapse
Affiliation(s)
- Bruna de Carvalho Farias
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Pernambuco, Brazil
| | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- A.H. Tajani
- From the Texas A & M Health Science Center; and
| | | |
Collapse
|
18
|
Lu HK, Chou HP, Li CL, Wang MY, Wang LF. Stimulation of cells derived from nifedipine-induced gingival overgrowth with Porphyromonas gingivalis, lipopolysaccharide, and interleukin-1beta. J Dent Res 2007; 86:1100-4. [PMID: 17959904 DOI: 10.1177/154405910708601115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to clarify the main contributory factor of nifedipine-induced gingival overgrowth either by Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) or interleukin-1beta (IL-1beta). Human gingival fibroblasts from healthy tissues and nifedipine-induced gingival overgrowth tissues were stimulated with nifedipine, IL-1beta, Escherichia coli lipopolysaccharide (Ec-LPS), and Pg-LPS, and the gene expressions were analyzed by RT-PCR. Analysis of the data showed no strong evidence of a synergistic effect of nifedipine and Pg-LPS on IL-6, connective tissue growth factor (CTGF), and type 1 collagen gene expression of either healthy cells or nifedipine-induced gingival overgrowth cells. Among the three stimulants--IL-1beta, Pg-LPS, and Ec-LPS--androgen receptor and IL-6 gene expressions in both the healthy and nifedipine-induced gingival overgrowth groups were strongly up-regulated by the presence of IL-1beta only. Furthermore, the responses to IL-1beta in the nifedipine-induced gingival overgrowth group were stronger than those of the healthy group. It can be concluded that IL-1beta is an important mediator responsible for the higher IL-6 and androgen receptor expression of nifedipine-induced gingival overgrowth cells.
Collapse
Affiliation(s)
- H-K Lu
- Periodontal Clinic of the Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
19
|
Omori K, Naruishi K, Yamaguchi T, Li SA, Yamaguchi-Morimoto M, Matsuura K, Arai H, Takei K, Takashiba S. cAMP-response element binding protein (CREB) regulates cyclosporine-A-mediated down-regulation of cathepsin B and L synthesis. Cell Tissue Res 2007; 330:75-82. [PMID: 17724614 DOI: 10.1007/s00441-007-0457-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 06/21/2007] [Indexed: 11/29/2022]
Abstract
Cyclosporin A (CsA) is an immunosuppressant with severe side effects including gingival overgrowth. We have previously reported that CsA impairs the activity of the lysosomal enzymes cathepsin B and L in human gingival fibroblasts (HGFs). Here, we have examined the effects of CsA on the DNA-binding activity of the cyclic AMP response element-binding protein (CREB) and cell viability, and the effects of CREB on cathepsin B and L synthesis and activity in HGFs. We have confirmed that CsA down-regulates cathepsin B and L synthesis. Further, CsA has no effect on cell viability and dramatically impairs CREB-DNA binding activity. Importantly, the synthesis of cathepsin B and L is down-regulated, and their activity is also significantly impaired in HGFs transfected with plasmid expressing dominant-negative CREB. These results suggest that CREB is essential for the CsA-mediated down-regulation of cathepsin B and L synthesis in HGFs.
Collapse
Affiliation(s)
- Kazuhiro Omori
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Brkić Z. [Histometric analysis of gingival hyperplasia in Wistar rats during nifedipine administration]. VOJNOSANIT PREGL 2007; 64:19-23. [PMID: 17304720 DOI: 10.2298/vsp0701019b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM The use of calcium channel blockers, especially nifedipine, causes gingival hyperplasia which leads to the destruction of the deeper periodontal tissues. During this process, inflammatory changes and the changes of colagen fibers occur. The aim of this study was to metrically compare the extent of proliferation of connective tissue in the deeper periodontal tissue in experimental animals regarding the dose and duration of nifedipine administration. METHODS The study involved 50 Wistar rats to which water solution of nifedipine was given in certain time intervals and doses. Before starting the experiment, i.e. before nifedipine administration, and in the defined time intervals, measuring of the morphology of gingival size was performed including the buccolingual and mesiodistal wideness and vertical altitude of the central interdental papilla. The measurement was performed by the use of a special graduated probe. Histometric analyses of the tissue samples were done on the sagital cross-sections in the direction from the top to the bottom of papilla on five levels. For the statistical analysis of the data, the established values to the extent of the most present changes were used. The mesiodistal and buccolingual diameters for the levels L2 and L3 were quantitively determined and compared. These values were compared to the vertical diameter of gingival growth determined before the onset of patohistologic analyses of the tissue samples. RESULTS At the begining of the experiment, the volume of the lower incisive central papilla in the rats was 12 mm(3). The central interdental papilla vertical altitude was 6.6 mm in rats which had received a lower dose of nifedipine, 8 mm in rats which had received a higher dose in the defined time intervals while the value for the control group was 3.8 mm. CONCLUSION The obtained results showed that the administration of nifedipine led to the extensive gingival hyperplasia in the experimental animals. Gingival hyperplasia correlates with both the dose of nifedipine and the duration of its administration.
Collapse
Affiliation(s)
- Zlata Brkić
- Vojnomedicinska akademija, Klinika za stomatologiju, Beograd, Srbija
| |
Collapse
|
21
|
Brkić Z. Histopathologic investigations of nifedipine-induced gingival hyperplasia in Wistar rats. VOJNOSANIT PREGL 2005; 62:207-11. [PMID: 15790049 DOI: 10.2298/vsp0503207b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. Nifedipine, a calcium channel blocker, used in the therapy of cardiovascular diseases, can induce gingival overgrowth. The aim of the study was to assess the influence of nifedipine on the deeper periodontal tissues of the experimental animals concerning connective tissue and blood vessels proliferation. Methods. The research was performed on Wistar rats, and they received the precise doses of nifedipine water suspension while the changes were followed up in pre-determined time intervals. The analyses of samples of tissues were done on the cross-sections of papilla from the top to the bottom on five levels. Results. Considerable level of changes was observed in the area of dental alveolar edge and in the gingivo-dental interspace. Epithelial hyperplasia and inflammatory subepithelial infiltration of lymphoplasmocyte type were also present. Alveolar bone destruction, the increased number of osteoclasts and periodontal destruction were found, as well. Conclusion. The results of this study showed a significant gingival hyperplasia in the experimental animals which received high doses of drug during extended period of time.
Collapse
Affiliation(s)
- Zlata Brkić
- Vojnomedicinska akademija, Klinika za stomatologiju, Beograd
| |
Collapse
|
22
|
Maguin B, Yachouh J, Goudot P. [Nicardipine-induced gingival hyperplasia: case report]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2004; 105:219-21. [PMID: 15510073 DOI: 10.1016/s0035-1768(04)72311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Several types of therapeutic agents may induce gingival hyperplasia. An unusual case induced by nicardipine, a calcium antagonist, is presented. The other drugs concerned are: several anticonvulsants, cyclosporin, and several other calcium antagonists. In the majority of patients for whom drug discontinuation or substitution is not possible, and for whom prophylactic measures have failed, surgical excision of gingival tissue remains the only treatment option.
Collapse
Affiliation(s)
- B Maguin
- Service de Chirurgie Maxillo-Faciale et Stomatologie, Hôpital Lapeyronie, 371, av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | | | | |
Collapse
|
23
|
Abstract
Noninflammatory hyperplastic growth of gingiva induced by calcium channel blockers, mostly nifedipine, is often seen in everyday dental practice. In order to establish an association of nifedipine and gingival hyperplasia, experimental model was used. Wistar rats were given water solution of nifedipine in different daily doses, using specially designed cannula. At the beginning of the experiment, before the application of nifedipine and in the determined time periods, gingival volume was measured. The volume of lower incisors interdental central papillas, represented multiplied values of vertical hight, mesio-distal width, and bucco-lingual depth, expressed in millimeters. The results indicated that gingival hyperplasia was more excessive in the experimental animals, which were given higher doses of the drug for longer time period. Nifedipine is a drug which induces gingival fibroblasts to produce higher quantity of collagen that causes gingival overgrowth.
Collapse
Affiliation(s)
- Zlata Brkić
- Vojnomedicinska akademija, Klinika za stomatologiju, Beograd
| |
Collapse
|
24
|
Huang WT, Lu HK, Chou HH, Kuo MYP. Immunohistochemical analysis of Th1/Th2 cytokine profiles and androgen receptor expression in the pathogenesis of nifedipine-induced gingival overgrowth. J Periodontal Res 2003; 38:422-7. [PMID: 12828661 DOI: 10.1034/j.1600-0765.2003.00672.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous studies have demonstrated that gingival overgrowth may be associated with androgen and cytokine expression in tissues. OBJECTIVES The aim of this study was to compare the expression of androgen receptor-presenting cells (AR+ cells) and Th1/Th2 cytokine [Th1: interleukin (IL)-2, interferon-gamma (IFN-gamma); Th2: IL-4, IL-10, IL-13] expression cells in tissue sections of patients with gingival overgrowth. MATERIALS AND METHODS Tissue samples were collected from patients with healthy periodontium (H group), adult periodontitis (P group), surgically extracted teeth (S group), and nifedipine-induced gingival overgrowth (NIGO group). The clinical periodontal parameters of pocket depth (PD), bleeding on probing (BOP), and plaque control record (PCR) were measured around selected sample teeth. Gingival biopsies were further processed by immunohistochemical staining method. The expressions of cells positive for AR, IL-2, IFN-gamma, IL-4, IL-10, and IL-13 were counted by predetermined semiquantitative methods. RESULTS Our results indicated that AR, IL-2, IFN-gamma, IL-4, IL-10, and IL-13 were intensively expressed in the nuclei of inflammatory cells and fibroblasts of gingival connective tissue. Stronger expressions of AR, IL-2, and IFN-gamma were found in the NIGO group. The AR+ cells/0.01 mm2 in gingival fibroblasts were significantly higher in the NIGO group (80.2 +/- 10.7) than those of the periodontitis group (52.5 +/- 11.8) and control group (37.4 +/- 11.3) (P < 0.05). The cytokine expression of the NIGO group showed a trend towards Th1-type expression (IL-2; P = 0.0001). In the surgically extracted tooth group, a stronger expression of Th2-type cytokine (IL-4, Il-10, IL-13; P < 0.05) was found in inflammatory cells. In a comparison of the IL-2/IL-4-labeled cell ratio of the four groups, a descending sequence was discovered as NIGO group (0.92 +/- 0.97) > H group (0.81 +/- 0.61) > P group (0.77 +/- 0.82) > S group (0.58 +/- 1.77). CONCLUSIONS Our data support the following: (i) taking nifedipine may elevate the expression of AR in susceptible oral tissue, e.g. gingiva; (ii) the cytokine profile of T-cells in NIGO tissue indicates a trend preferentially towards Th1 activity; and (iii) elevation of AR expression cells and prominent Th1 cytokine-labeled cells are two significant factors in the pathogenesis of NIGO.
Collapse
Affiliation(s)
- W-T Huang
- College of Oral Medicine, School of Dentistry and Graduate Institute of Oral Rehabilitation, Taipei Medical University, Taipei, Taiwan
| | | | | | | |
Collapse
|
25
|
Handajani J, Santoso ALS, Haniastuti T, Utoro T, Sosroseno W. Effect of nifedipine on the expression of bcl-2 protein in rat gingiva. Clin Oral Investig 2003; 7:56-8. [PMID: 12673440 DOI: 10.1007/s00784-003-0194-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2002] [Accepted: 12/30/2002] [Indexed: 10/25/2022]
Abstract
Bcl-2 is a family of proteins involved in protecting the cell against death stimuli or in promoting cell death. The aim of the present study was to determine the effect of nifedipine treatment on the expression of bcl-2 protein in rat gingival tissues. Rats were given gastric intubation with various concentrations and durations of nifedipine. Nifedipine-untreated and dimethylsulfoxide (DMSO)-treated animals served as control groups. The gingival tissues were dissected and the expression of bcl-2 protein was determined immunohistochemically. The results showed that the numbers of bcl-2-positive cells in the gingiva of nifedipine-treated animals were significantly higher than in the control groups. These numbers increased parallel to increased concentration and duration of nifedipine treatment. The results suggest that nifedipine treatment may induce the expression of bcl-2 protein in rat gingival tissue in a dose- and duration-dependent fashion and that this proto-oncogenic protein may play a role in nifedipine-induced gingival hyperplasia.
Collapse
Affiliation(s)
- Juni Handajani
- Department of Oral Biology, Faculty of Dentistry, Gadjah Mada University, Yogyakarta 55281, Indonesia
| | | | | | | | | |
Collapse
|
26
|
Haniastuti T, Santoso AS, Agustiono P, Agustina D, Sosroseno W. Effect of nifedipine on the expression of p53 protein in rat gingiva. Biomed Pharmacother 2002; 56:235-40. [PMID: 12199622 DOI: 10.1016/s0753-3322(02)00183-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of the present study was to determine the profile of p53 protein expression in gingival tissues after treatment with nifedipine in rats. Rats were treated daily by gastric intubation with or without DMSO alone or DMSO-dissolved nifedipine at concentrations of 15, 30 or 60 mg/kg body weight for 1, 3 or 6 week(s). Gingival width and height were measured macroscopically. Monoclonal antibodies recognizing both wild-type and mutant p53 protein were applied on paraffin-embedded gingival sections using microwave pretreatment and immunohistochemical methods. The gingival width and height were increased in the animals treated with nifedipine at concentrations of 30 and 60 mg/kg body weight. Increased gingival width and height were already seen in the animals treated with 60 mg of nifedipine for 1 week, whereas treatments with 30 mg of nifedipine resulted in increased gingival width and height after treatment for at least 3 weeks. The expression of p53 protein was elevated in the animals treated with 30 or 60 mg of nifedipine. Treatments with nifedipine at the concentration of 60 mg/kg body weight for 1 week induced the expression of p53 protein in the gingival tissues. Treatment with nifedipine in rats led to the inducement of gingival hyperplasia and increase in the numbers of p53-positive gingival epithelial cells by a dose and frequency dependent mechanism, suggesting that p53 protein may play a crucial role in the regulation of nifedipine-induced gingival hyperplasia.
Collapse
Affiliation(s)
- T Haniastuti
- Department of Oral Biology, Faculty of Dentistry, Gadjah Mada University, Yogyakarta, Indonesia
| | | | | | | | | |
Collapse
|
27
|
Camargo PM, Melnick PR, Pirih FQ, Lagos R, Takei HH. Treatment of drug-induced gingival enlargement: aesthetic and functional considerations. Periodontol 2000 2001; 27:131-8. [PMID: 11551304 DOI: 10.1034/j.1600-0757.2001.027001131.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P M Camargo
- Division of Assorted Clinical Specialties, UCLA School of Dentistry, Los Angeles, California, USA
| | | | | | | | | |
Collapse
|
28
|
Fujimori Y, Maeda S, Saeki M, Morisaki I, Kamisaki Y. Inhibition by nifedipine of adherence- and activated macrophage-induced death of human gingival fibroblasts. Eur J Pharmacol 2001; 415:95-103. [PMID: 11245857 DOI: 10.1016/s0014-2999(01)00810-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The effects of nifedipine on the death and proliferation of gingival fibroblasts were investigated to elucidate the mechanism of gingival overgrowth that is associated with chronic administration of Ca2+ channel blockers. The number of adhered viable and dead fibroblasts obtained from healthy human gingiva increased after confluence, whereas cell death was inhibited by nifedipine in a concentration-dependent manner. A similar inhibition was also observed in the presence of other calcium channel blockers, such as nicardipine, diltiazem, and verapamil. When gingival fibroblasts were co-cultured with RAW264 (macrophage-like) cells, lipopolysaccharide (LPS) caused the concentration-dependent death of fibroblasts. Nifedipine significantly inhibited the LPS-induced cell death. Although neither LPS nor N-ethyl-2-(1-ethyl-2-hydroxy-2-nitroso-hydrazino)-ethanamine, a nitric oxide donor, directly caused fibroblast death, 3-morpholino-sydnonimine (SIN-1), a peroxynitrite donor, induced fibroblast death, regardless of the presence of RAW cells. The cell death induced by SIN-1 was not affected by nifedipine treatment. LPS stimulation caused an increase in the immunoreactivity of inducible nitric oxide synthase (iNOS) and in the nitrite concentration in the incubation medium of RAW cells. The induction of iNOS was completely prevented by the incubation with nifedipine. The inhibition by nifedipine of nitrite production in RAW cells was also observed after treatment with nicardipine, but not with either diltiazem or verapamil. Therefore, the inhibition by nifedipine of both adherence- and LPS-stimulated macrophage-induced death of fibroblasts may be the mechanism of gingival overgrowth seen during chronic treatment with Ca(2+) channel blockers.
Collapse
Affiliation(s)
- Y Fujimori
- Department of Pharmacology, Graduate School of Dentistry, Osaka University, 1-8 Yamada-Oka, Suita 565-0871, Japan.
| | | | | | | | | |
Collapse
|
29
|
Morisaki I, Dol S, Ueda K, Amano A, Hayashi M, Mihara J. Amlodipine-induced gingival overgrowth: periodontal responses to stopping and restarting the drug. SPECIAL CARE IN DENTISTRY 2001; 21:60-2. [PMID: 11484582 DOI: 10.1111/j.1754-4505.2001.tb00226.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A case history of a woman with gingival overgrowth (GO) induced by amlodipine is presented. A 49-year-old Japanese woman, who was taking amlodipine, had gingival overgrowth and swelling on examination. No specific periodontal treatment was provided to the patient for the GO; however, the amlodipine was replaced with an ACE inhibitor after consultation with her medical practitioner. Within two months, the suspension of amlodipine resulted in a significant improvement in her periodontal condition. Failure to control the hypertension caused the physician to re-prescribe amlodipine. After three months, the gingival overgrowth returned; however, its severity was less when compared with the original periodontal condition, due to reduction in drug dose and periodontal therapy. This experience suggests that temporary suspension of a drug which can induce GO can improve the periodontal condition without the aid of surgical treatment.
Collapse
Affiliation(s)
- I Morisaki
- Division of Special Care Dentistry, Osaka University Faculty of Dentistry, 1-8 Yamadaoka, Suita-Osaka 565-0871, Japan.
| | | | | | | | | | | |
Collapse
|
30
|
Nurmenniemi PK, Pernu HE, Knuuttila ML. Mitotic activity of keratinocytes in nifedipine- and immunosuppressive medication-induced gingival overgrowth. J Periodontol 2001; 72:167-73. [PMID: 11288789 DOI: 10.1902/jop.2001.72.2.167] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of the study was to compare mitotic activity in the basal cell layer of normal human gingiva and in nifedipine- and immunosuppressive medication-induced gingival overgrowth. METHODS Gingival samples were collected from 19 generally healthy individuals, 12 nifedipine-medicated cardiac patients, and 22 immunosuppression-medicated (azathioprine, prednisolone, and cyclosporin A) organ transplant recipients. The transplant recipients were divided into those not taking nifedipine and those taking nifedipine. Cryostat sections were stained with monoclonal antibody for Ki-67, using an avidin-biotin-enzyme complex method. The mitotic activities of epithelial cells were determined as percentages of Ki-67 labeled cells in relation to total numbers of epithelial cells in the basal layer of oral, oral sulcular, and sulcular epithelium. RESULTS Mitotic activities were significantly higher in all 3 medication groups in the oral epithelium (P < or =0.003), and in the immunosuppression group in the sulcular epithelium (P= 0.032) than in the controls. In the oral sulcular epithelium, mitotic activity was fairly similar in all medication groups. In the nifedipine group a significant negative correlation was found between duration of nifedipine medication and the percentage of Ki-67 labeled cells in the oral epithelium (P= 0.025). CONCLUSIONS The results suggest that the increased epithelial thickness observed in nifedipine- and cyclosporin A-induced gingival overgrowth is associated with increased mitotic activity, especially in the oral epithelium.
Collapse
|
31
|
Abstract
There is an increasing number of medications associated with gingival overgrowth. These medications are used to treat a number of common conditions in the Australian population and as such dentists can expect to manage a number of patients with medication-related gingival overgrowth. This review highlights the clinical features and management of the common overgrowths associated with anticonvulsants, immunosuppressants and the calcium channel blockers.
Collapse
Affiliation(s)
- R I Marshall
- Department of Dentistry, University of Queensland
| | | |
Collapse
|
32
|
Abstract
This informational paper was prepared by the Research, Science, and Therapy Committee of The American Academy of Periodontology, and is intended for the information of the dental profession. The purpose of the paper is to provide an overview of current knowledge relating to the pathogenesis of periodontal diseases. The paper will review biological processes thought to provide protection against periodontal infections. It will further discuss the mechanisms thought to be responsible for both overcoming and subverting such protective mechanisms and those that lead to destruction of periodontal tissues. Since an understanding of pathogenic mechanisms of disease is one foundation upon which new diagnostic and therapeutic modalities are based, the practitioner can use this information to help make decisions regarding the appropriate application of such new modalities in patient care settings.
Collapse
|
33
|
Abstract
A number of idiopathic, pathological and pharmacological reactions may result in an overgrowth of the gingiva. This review concentrates on those overgrowths associated with various pharmacological agents. The pharmaco-kinetics and side effects of each drug associated with gingival overgrowth are discussed along with the clinical and histological features and treatment. By examining the possible pathogeneses for these overgrowths we propose a unifying hypothesis for the causation based around inhibition of apoptosis and decreased collagenase activity modulated by cytoplasmic calcium.
Collapse
Affiliation(s)
- R I Marshall
- Department of Dentistry, University of Queensland, Brisbane, Australia.
| | | |
Collapse
|
34
|
Abstract
Calcium channel blockers are known to contribute to gingival hyperplasia. The vast majority of reports discuss patients taking the drug nifedipine. During the past few years a newer calcium channel blocker, amlodipine, has been used with increasing frequency. To date, six cases have been published indicating that amlodipine may also promote gingival hyperplasia; however, no data have been reported regarding the prevalence of this phenomenon. The purpose of this study was to examine a large group of patients taking amlodipine and determine the prevalence of gingival hyperplasia. One hundred fifty dentate patients who had been taking amlodipine, 5 mg per day for at least 6 months, volunteered to undergo a screening examination for gingival hyperplasia. Mild hyperplasia (< 1/3 clinical crown) was found in five patients-a prevalence of 3.3%. This is significantly less (P < .001) than rates reported for patients taking nifedipine, and not significantly different from rates previously reported in control groups of cardiac patients not taking calcium channel blockers. The results from this group of patients indicated that amlodipine, 5 mg per day, did not induce gingival hyperplasia.
Collapse
Affiliation(s)
- M G Jorgensen
- Department of Dentistry, Naval Medical Center, San Diego, CA, USA
| |
Collapse
|
35
|
Abstract
The presence of systemic disease in patients requiring periodontal therapy creates challenges for management. Alteration of treatment plans, with emphasis on physician consultation and preventive periodontal care, is frequently needed to minimize the impact of periodontal disease on the systemic condition. Conversely, detection and treatment of systemic disorders may impact upon the status of the periodontium and the success of periodontal therapy. The goal of holistic patient management is facilitated by a free flow of information between the patients and their medical and dental health care providers.
Collapse
Affiliation(s)
- B L Mealey
- Department of Periodontology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA
| |
Collapse
|