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Victory Rodríguez G, Ruiz Gutiérrez ADC, Gómez Sandoval JR, Lomelí Martínez SM. Gingival enlargement induced by cyclosporine in Medullary aplasia: A case report. World J Clin Cases 2022; 10:12750-12760. [PMID: 36579122 PMCID: PMC9791507 DOI: 10.12998/wjcc.v10.i34.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia. This drug prevents several side effects, including gingival enlargement (GE) which compromises aesthetics, phonetics and chewing, and also predisposes patients to periodontitis.
CASE SUMMARY This clinical case reports a 41-year-old woman who presented with cyclosporine-induced GE with underlying periodontitis and medullary aplasia. The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology. The diagnosis was confirmed through histopathological analysis. The treatment was carried out in phases: Initial (oral hygiene motivation, mechanical supragingival plaque control, and non-surgical therapy); systemic treatment, corrective treatment, and maintenance.
CONCLUSION Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.
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Affiliation(s)
- Giovanna Victory Rodríguez
- Periodontics Program, Department of Integrated Dentistry Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Alondra del Carmen Ruiz Gutiérrez
- Periodontics Program, Department of Integrated Dentistry Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Juan Ramón Gómez Sandoval
- Research Institute of Dentistry, Department of Integrated Dentistry Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco , Mexico
| | - Sarah Monserrat Lomelí Martínez
- Department of Medical and Life Sciences, Centro Universitario de la Ciénega, Universidad de Guadalajara, Ocotlán 47810, Jalisco, Mexico
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2
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Lo Y, Lin LY, Tsai TF. Use of calcium channel blockers in dermatology: a narrative review. Expert Rev Clin Pharmacol 2021; 14:481-489. [PMID: 33612036 DOI: 10.1080/17512433.2021.1894128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Calcium channel blockers (CCB) are commonly used for cardiovascular diseases. The evidence supporting the use of CCB in dermatology is mostly anecdotal and limited to case reports or small case series.Areas covered: This review article is divided into two parts. The first part discusses the therapeutic use of CCB in dermatology. The second part focuses on mucocutaneous adverse reactions due to the administration of CCB.Expert opinion: The use of CCB in dermatology is mainly based on its properties as a vasodilator and the inhibition of muscle contractions, such as pernio, anal fissures, facial wrinkles, and painful leiomyoma. However, there remain other modes of action to explain its clinical use in calcinosis, keloid, pressure ulcer, and fibromatosis. Compared to oral CCB, the lack of systemic side effects would make topical use of CCB an attractive alternative in the treatment of skin diseases, but the evidence for topical CCB is still limited, and there is a lack of standardized topical formulation. The main mucocutaneous adverse effects of CCB include gingival hyperplasia, phototoxicity, eczema, psoriasis and risk of skin cancers. Plausible factors for these adverse events include CCB's photoinstability, aldosterone synthesis inhibition, disturbed calcium homeostasis and immunosuppressive properties.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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3
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Lauritano D, Martinelli M, Baj A, Beltramini G, Candotto V, Ruggiero F, Palmieri A. Drug-induced gingival hyperplasia: An in vitro study using amlodipine and human gingival fibroblasts. Int J Immunopathol Pharmacol 2020; 33:2058738419827746. [PMID: 31663449 PMCID: PMC6822186 DOI: 10.1177/2058738419827746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast’s function in gingival overgrowth. To determine whether amlodipine alters the inflammatory responses, we investigated its effects on gingival fibroblast gene expression as compared with untreated cells. Fragments of gingival tissue of healthy volunteers (11 years old boy, 68 years old woman, and 20 years old men) were collected during operation. Gene expression of 29 genes was investigated in gingival fibroblast cell culture treated with amlodipine, compared with untreated cells. Among the studied genes, only 15 (CCL1, CCL2D, CCL5, CCL8, CXCL5, CXCL10, CCR1, CCR10, IL1A, IL1B, IL5, IL7, IL8, SPP1, and TNFSF10) were significantly deregulated. In particular, the most evident overexpressed genes in treated cells were CCR10 and IL1A. These results seem to indicate a possible role of amlodipine in the inflammatory response of treated human gingival fibroblasts.
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Affiliation(s)
- Dorina Lauritano
- Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milano-Bicocca, Milan, Italy
| | - Marcella Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Baj
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Beltramini
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Candotto
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Francesco Ruggiero
- Military Policlinic of Rome, Medical Department, Cardiological Unit, Rome, Italy
| | - Annalisa Palmieri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Nanda T, Singh B, Sharma P, Arora KS. Cyclosporine A and amlodipine induced gingival overgrowth in a kidney transplant recipient: case presentation with literature review. BMJ Case Rep 2019; 12:12/5/e229587. [PMID: 31142490 DOI: 10.1136/bcr-2019-229587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Drug-induced gingival overgrowth is a condition caused by side effects of treatment with one of three types of drugs: phenytoin (used in epilepsy treatment), cyclosporine A (used in transplantology after allogenic organ transplants) and calcium channel blockers (used in the treatment of hypertension). Gingival overgrowth leads to inflammation within the gums and periodontium and can amplify the existing periodontal disease leading to tooth loss. Patients who have undergone kidney transplant are given immunosuppressants to prevent transplant rejection and mostly it is accompanied with calcium channel blockers to treat hypertension associated with kidney transplant. This article reports a case of recent gingival enlargement associated with cyclosporine A and amlodipine given to a kidney transplant patient from the past 11 years.
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Affiliation(s)
- Tarun Nanda
- Department of Periodontology, Bhojia Dental College and Hospital, Budh, Himachal Pradesh, India
| | - Baljeet Singh
- Department of Periodontology, Bhojia Dental College and Hospital, Budh, Himachal Pradesh, India
| | - Parul Sharma
- Department of Periodontology, Bhojia Dental College and Hospital, Budh, Himachal Pradesh, India
| | - Karandeep Singh Arora
- Oral Medicine & Radiology, Maharishi Markandeshwar College of Dental Sciences & Research, Mullana, Haryana, India
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5
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Molecular Aspects of Drug-Induced Gingival Overgrowth: An In Vitro Study on Amlodipine and Gingival Fibroblasts. Int J Mol Sci 2019; 20:ijms20082047. [PMID: 31027273 PMCID: PMC6514768 DOI: 10.3390/ijms20082047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast’s function in gingival overgrowth. To determine whether amlodipine alters the fibrotic response, we investigated its effects on treated gingival fibroblast gene expression as compared with untreated cells. Materials and Methods: Fibroblasts from ATCC® Cell Lines were incubated with amlodipine. The gene expression levels of 12 genes belonging to the “Extracellular Matrix and Adhesion Molecules” pathway was investigated in treated fibroblasts cell culture, as compared with untreated cells, by real time PCR. Results: Most of the significant genes were up-regulated. (CTNND2, COL4A1, ITGA2, ITGA7, MMP10, MMP11, MMP12, MMP26) except for COL7A1, LAMB1, MMP8, and MMP16, which were down-regulated. Conclusion: These results seem to demonstrate that amlodipine has an effect on the extracellular matrix of gingival fibroblast. In the future, it would be interesting to understand the possible effect of the drug on fibroblasts of patients with amlodipine-induced gingival hyperplasia.
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Koratala A, Jamalpur I, Mogili HR. Amlodipine-induced gingival enlargement. Clin Case Rep 2017; 5:1714-1715. [PMID: 29026579 PMCID: PMC5628204 DOI: 10.1002/ccr3.1132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/26/2017] [Indexed: 01/23/2023] Open
Abstract
The three most common classes of medications implicated in drug‐induced gum enlargement are anticonvulsives, calcineurin inhibitors, and calcium channel blockers. Treatment primarily consists of withdrawing the offending agent whenever possible, in addition to maintaining good oral hygiene. Gingivectomy or flap surgery may be needed in resistant cases.
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7
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Samudrala P, Chava VK, Chandana TS, Suresh R. Drug-induced gingival overgrowth: A critical insight into case reports from over two decades. J Indian Soc Periodontol 2016; 20:496-502. [PMID: 29242684 PMCID: PMC5676330 DOI: 10.4103/jisp.jisp_265_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.
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Affiliation(s)
- Pramod Samudrala
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Vijay Kumar Chava
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Tanguturi Sri Chandana
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Rachakonda Suresh
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Amlodipine-induced Gingival Hyperplasia - A Case Report and Review. W INDIAN MED J 2015; 64:279-82. [PMID: 26426184 DOI: 10.7727/wimj.2014.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/23/2014] [Indexed: 11/18/2022]
Abstract
Anticonvulsants, antihypertensive calcium channel blockers and immunosuppressants are the three main classes of drugs known to cause drug-induced gingival hypertrophy or hyperplasia. Among the calcium channel blockers, nifedipine administration has most frequently been associated with medication-related gingival hyperplasia. The incidence with amlodipine, which has a mode of action pharmacodynamically comparable to nifedipine, has rarely been reported. Here, we present a rare case of amlodipine-induced gingival hyperplasia in a hypertensive patient.
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9
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Untypical amlodipine-induced gingival hyperplasia. Case Rep Dent 2015; 2015:756976. [PMID: 25692048 PMCID: PMC4322315 DOI: 10.1155/2015/756976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/17/2022] Open
Abstract
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.
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10
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Tripathi AK, Mukherjee S, Saimbi CS, Kumar V. Low dose amlodipine-induced gingival enlargement: A clinical case series. Contemp Clin Dent 2015; 6:107-9. [PMID: 25684923 PMCID: PMC4319326 DOI: 10.4103/0976-237x.149303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Gingival enlargement sometimes has an adverse effect of certain systemic drugs such as the use of anticonvulsants, phenytoin, antihypertensive, calcium channel blockers and immunosuppressant, cyclosporine. Amlodipine, a relatively newer calcium channel blocker drugs, exhibit adverse effect of gingival enlargement in middle to older aged adults. There are very few reports of amlodipine-induced gingival enlargement at a lower dose (5 mg). In this article, three cases of amlodipine-induced gingival enlargement in the age range of 50-65 years old hypertensive patient with a lower dose of amlodipine (5 mg).
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Affiliation(s)
- Amitandra Kumar Tripathi
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Sudarshana Mukherjee
- Department of Periodontology, Dr. R. Ahmed Dental College, Kolkata, West Bengal, India
| | - Charanjit Singh Saimbi
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
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11
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Tejnani A, Gandevivala A, Bhanushali D, Gourkhede S. Combined treatment for a combined enlargement. J Indian Soc Periodontol 2014; 18:516-9. [PMID: 25210271 PMCID: PMC4158598 DOI: 10.4103/0972-124x.138747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/29/2013] [Indexed: 12/30/2022] Open
Abstract
Calcium channel blockers are widely used in medical practice for the management of hypertension and in the prophylaxis of angina. Gingival overgrowth is now a recognized unwanted effect associated with many of calcium channel blockers. This can have a significant effect on the quality of life as well as increasing the oral bacterial load by generating plaque retention sites. Amlodipine, a third generation calcium channel blockers has been shown to promote gingival overgrowth, although reported in very limited cases. The management of gingival overgrowth seems to be directed at controlling gingival inflammation through a good oral hygiene regimen. However, in severe cases, surgical excision is the most preferred method of treatment, followed by rigorous oral hygiene procedures. This case report describes the management of gingival overgrowth in a hypertensive patient taking amlodipine.
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Affiliation(s)
- Avneesh Tejnani
- Department of Dental, Unit II, Consultant Periodontist, GSBS Medical Trust, Mumbai, Maharashtra, India
| | - Adil Gandevivala
- Department of Oral and Maxillofacial Surgery, MGM Dental College, Navi Mumbai, Maharashtra, India
| | - Devang Bhanushali
- Department of Plastic Surgery, House officer, KEM Hospital, Maharashtra, India
| | - Sonal Gourkhede
- Department of Periodontology, Late Shri Yashwantrao Chavan Memorial Medical and Rural Development Foundation's Dental College, Ahmednagar, Maharashtra, India
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12
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Pejcic A, Djordjevic V, Kojovic D, Zivkovic V, Minic I, Mirkovic D, Stojanovic M. Effect of periodontal treatment in renal transplant recipients. Med Princ Pract 2014; 23:149-53. [PMID: 24356398 PMCID: PMC5586861 DOI: 10.1159/000357274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 11/14/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the effect of periodontal treatment on gingival overgrowth in a group of renal transplant patients. SUBJECTS AND METHODS Twenty-five renal transplant recipients receiving immunosuppressive therapy with cyclosporine A (CsA) were randomly assigned to 2 groups. Group 1 (n = 15) included patients who had been specifically referred to a dental clinic to prevent gingival overgrowth and were given full periodontal therapy. Group 2 (n = 10) was comprised of patients who did not receive any professional periodontal cleaning. Patients from both groups were examined to determine their periodontal status before and after 3, 6 and 12 months in terms of their plaque index, gingival index and gingival overgrowth. During the examination, their overall health was stable. RESULTS For group 1, the scores were 1.89 (baseline), 0.98 (6 months) and 0.56 (12 months), and hence there were significant reductions (p = 0.0001). The gingival indices were 1.71 (baseline), 0.76 (6 months) and 0.35 (12 months), and the reductions were also significant (p = 0.0001). A significant association was observed between poor oral hygiene and the degree of gingival overgrowth. The 1-year post-treatment follow-up showed that patients in group 1 did not develop gingival overgrowth due to the use of CsA as group 2 did without prior periodontal therapy. CONCLUSION Oral hygiene status was the most important variable related to the development and degree of gingival overgrowth due to the use of CsA.
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Affiliation(s)
- Ana Pejcic
- Department of Periodontology and Oral Medicine, University of Nis, Nis, Serbia
- *Ana Pejcic, DDM, PhD, Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Bul. Dr. Z. Djindjica 81, RS –18000 Nis (Serbia), E-Mail
| | | | - Draginja Kojovic
- Department of Periodontology and Oral Medicine, University of Nis, Nis, Serbia
| | | | - Ivan Minic
- Department of Periodontology and Oral Medicine, University of Nis, Nis, Serbia
| | | | - Mariola Stojanovic
- Institute for Public Health, Medical Faculty, University of Nis, Nis, Serbia
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13
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A rare case report of amlodipine-induced gingival enlargement and review of its pathogenesis. Case Rep Dent 2013; 2013:138248. [PMID: 24024043 PMCID: PMC3758839 DOI: 10.1155/2013/138248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/18/2013] [Indexed: 01/21/2023] Open
Abstract
Gingival enlargement is a common clinical feature of gingival and periodontal diseases. It is an unwanted side effect of certain systemic drugs given for nondental treatment. It is being reported with three main groups of drugs like calcium channel blockers (CCBs), immunosuppressants, and anticonvulsants. Among calcium channel blockers, nifedipine causes gingival hyperplasia in about 10% of patients, whereas the incidence of amlodipine-, a third generation calcium channel blocker, induced gingival hyperplasia is very limited. There are very few reports of amlodipine-induced gingival enlargement at a dose of 5 mg. We report a case of amlodipine-induced gingival enlargement in a 45-year-old hypertensive patient taking amlodipine at a dose of 5 mg.
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14
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Pasupuleti MK, Musalaiah S, Nagasree M, Kumar PA. Combination of inflammatory and amlodipine induced gingival overgrowth in a patient with cardiovascular disease. Avicenna J Med 2013; 3:68-72. [PMID: 24251234 PMCID: PMC3818782 DOI: 10.4103/2231-0770.118462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Gingival overgrowth (GO) is among one of the most important clinical features of gingival pathology frequently seen in periodontal clinic. Amlodipine is a comparatively new calcium channel blocker and is being used with increasing frequency in the management of hypertension and angina. A 48-year-old Indian woman who was on amlodipine for 3 years for hypertension reported to the department of periodontics with the complaint of swollen, un esthetic gums. The patient developed GO 6 months before her first visit to dental hospital. She developed GO very rapidly due to the increase in amlodipine dose due to the severe angina attack 6 months before and due to the use of cholesterol (CHO) lowering drug. The main aim of the case report is to study the severity of amlodipine induced GO in a patient with cardiovascular disease (CVD) and to identify the role of subgingival microorganisms on inflammatory gingival enlargement in the same patient. The severity and rapidity of gingival enlargement in this report could have been triggered by doubling the dose of amlodipine and concomitant use of CHO lowering drug.
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Affiliation(s)
| | - S.V.V.S. Musalaiah
- Department of Periodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India
| | - M. Nagasree
- Department of Periodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India
| | - P. Aravind Kumar
- Department of Periodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India
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15
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Griwan MS, Kumar A, Sen J, Singh SK. Comparative evaluation of periprostatic nerve block and diclofenac patch in transrectal ultrasound-guided prostatic needle biopsy. Nephrourol Mon 2012; 4:560-4. [PMID: 23573486 PMCID: PMC3614287 DOI: 10.5812/numonthly.4015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 01/10/2012] [Accepted: 01/25/2012] [Indexed: 11/28/2022] Open
Abstract
Background The aim of the present study was to compare two analgesic techniques for transrectal ultrasound (TRUS)-guided biopsy: diclofenac patch versus periprostatic nerve block with 1% lidocaine. Objectives To study the efficacy of and compare diclofenac patch and periprostatic nerve block as analgesia in TRUS-guided prostate needle biopsy. Patients and Methods In total, 60 patients were prospectively randomized into three groups: those in whom a diclofenac patch was used (n = 20), those in whom periprostatic nerve block was used (n = 20), and a control group (n = 20). Prostate biopsy was performed after administration of analgesia according to group. Results The three groups were similar in terms of age, prostate volume, and PSA (prostate-specific antigen) levels. Pain scores were significantly lower in the nerve block group (P = 0.000) at the time of biopsy until 2 h postprocedure, but not at 4 h postprocedure (P = 0.068). No significant difference in pain score was observed in the diclofenac patch group at the time of biopsy (P = 0.106) as compared to the control group, but the diclofenac patch provided adequate pain relief 1 h (P = 0.000), 2 h (0.000), and 4 h (0.002) postprocedure. No significant difference was observed in pain score between the nerve block (P = 0.520) and control groups (0.057) at probe insertion. The pain score at 4 h was significantly lower in the patch group compared to the nerve block and control groups. Conclusions Periprostatic nerve block provides superior analgesia for TRUS-guided biopsy. Diclofenac patch is useful as an adjunct.
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Affiliation(s)
- Mahavir Singh Griwan
- Department of Surgery, Pandit B.D.Sharma University of Health Sciences, Rohtak, India
- Corresponding author: Mahavir Singh Griwan, Department of Surgery, Pt. B.D.S. University of Health Sciences, Rohtak 124001, India. Tel.: +91-9416176351, Fax: 91-1262211308, E-mail:
| | - Ashok Kumar
- Department of Surgery, Pandit B.D.Sharma University of Health Sciences, Rohtak, India
| | - Jyotsna Sen
- Department of Radiodiagnosis, Pandit B.D. Sharma University of Health Sciences, Rohtak, India
| | - Santosh Kumar Singh
- Department of Urology, Pandit B.D. Sharma University of Health Sciences, Rohtak, India
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16
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Rostami Z, Einollahi B, Einollahi MJ, lessan S. The impact of amlodipine on gingival enlargement after kidney transplantation. Nephrourol Mon 2012; 4:565-70. [PMID: 23573487 PMCID: PMC3614294 DOI: 10.5812/numonthly.5427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 04/19/2012] [Accepted: 05/07/2012] [Indexed: 11/16/2022] Open
Abstract
Abstract Background: Although cyclosporine (CsA) and calcium channel blockers (CCBs) parallel to each other may provoke gingival enlargement (GE), there are few considerations about combined effects of CsA and CCBs on gingival tissues. Objectives: This study aimed to determine prevalence of GE among renal transplant recipients and to compare its occurrence in patients who received only CsA and those who were on CsA and amlodipine. Patients and Methods: We conducted a prospective randomized case-control trial including 213 renal transplant recipients between February 2010 and August 2010. They were randomly divided into two groups including control group (on continuous treatment with CsA alone; n = 112) and trial group (treated with combined CsA and amlodipine; n = 101). Buccal, lingual, and inter-proximal membranes at last 12 anterior teeth were assessed for GE and packet depth (PD) using Gingival Index of McGaw and others, and Packet Index of Turesky–Gilmore–Glickman, respectively. Results: Marked GE was observed in 26 patients (25.7%) in trial group and only in 4 individuals (3.6%) in control group (P = 0.000). In logistic regression analysis, obese (OR = 3, P = 0.04), older (OR = 2.8, P = 0.03), and female (OR = 1.3, P = 0.03) recipients as well as who received high dose amlodipine (OR = 4.4, P = 0.000) were at risk for marked GE. Conclusions: There is a strong correlation between GE, in particular marked GE, and combination therapy with CsA and amlodipine in transplant patients compared to those treated by CsA alone. We suggest CsA dose reduction may restrain this adverse effect.
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Affiliation(s)
- Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Zohreh Rostami, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Molla Sadra Ave, Vanak Sq. Tehran, IR Iran. Tel.: +98-9121544897, Fax: +98-81262073, E-mail:
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Javad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Simin lessan
- Oral Medicine Department, Islamic Azad University-DentalBranch, Tehran, IR Iran
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