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. 1. Introduction Drug-induced gingival enlargement was first reported in 1939 by Kimball with chronic usage of the antiepileptic drug phenytoin [1]. Currently, more than 20 prescription medications are associated with gingival enlargement [2]. Drugs associated with gingival overgrowth can be broadly categorized into three major groups according to their therapeutic actions, namely, anticonvulsants, immunosuppressants, and calcium channel blockers [3, 4]. Amlodipine is a new dihydropyridine calcium channel blocker that is used in the management of both hypertension and angina. Ellis et al. [5] first reported gingival sequestration of amlodipine and amlodipine-induced gingival overgrowth. Since then, very few cases of amlodipine-induced gingival hyperplasia have been reported in the dental literature although there are numerous reports of nifedipine- (another member of calcium channel blockers) induced gingival overgrowth till date. There are less data on reports of hyperplasia with amlodipine at a dose of 5？mg, even after taking it for more than 6 months [6, 7]. But, in the present case, the gingival hyperplasia occurred at a dose of 5？mg within 6 months of use. 2. Case Report A 45-year-old male patient came to the department with the chief complaint of loose teeth in upper and lower front jaw regions since 1 year with swollen and bleeding gums. Patient first noted bead like nodular growth over the gums which progressively enlarged to the present size covering almost entire teeth interfering with further cleaning of teeth. The patient was hypertensive since 1.5 years and was under medication Coronol-AM (atenolol, 50？mg + amlodipine, 5？mg) once daily. He denied the history of any adverse habits. The patient was moderately built and nourished with no signs of anaemia and jaundice and noncyanosed. His vital signs
References
[1]
S. Pradhan and P. Mishra, “Gingival enlargement in antihypertensive medication,” Journal of the Nepal Medical Association, vol. 48, no. 174, pp. 149–152, 2009.
[2]
T. D. Rees and R. A. Levine, “Systemic drugs as a risk factor periodontal disease initiation and progression,” Compendium of Continuing Education in Dentistry, vol. 16, no. 1, pp. 20–42, 1995.
[3]
“Drug associated gingival enlargement,” Journal of Periodontology, vol. 75, no. 10, pp. 1424–1431, 2004.
[4]
P. Garzino-Demo, M. Carbone, M. Carrozzo, R. Broccoletti, and S. Gandolfo, “An increase in gingival volume induced by drugs (phenytoin, cyclosporine and calcium antagonists). A review of the literature,” Minerva Stomatologica, vol. 47, no. 9, pp. 387–398, 1998.
[5]
J. S. Ellis, R. A. Seymour, J. G. Steele, P. Robertson, T. J. Butler, and J. M. Thomason, “Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study,” Journal of Periodontology, vol. 70, no. 1, pp. 63–67, 1999.
[6]
M. G. Jorgensen, “Prevalence of amlodipine-related gingival hyperplasia,” Journal of Periodontology, vol. 68, no. 7, pp. 676–678, 1997.
[7]
M. G. Triveni, C. Rudrakshi, and D. S. Mehta, “Amlodipine-induced gingival overgrowth,” Journal of Indian Society of Periodontology, vol. 13, no. 3, pp. 160–163, 2009.
[8]
R. A. Seymour, J. M. Thomason, and J. S. Ellis, “The pathogenesis of drug-induced gingival overgrowth,” Journal of Clinical Periodontology, vol. 23, no. 3, pp. 165–175, 1996.
[9]
A. Nyska, M. Shemesh, H. Tal, and D. Dayan, “Gingival hyperplasia induced by calcium channel blockers: mode of action,” Medical Hypotheses, vol. 43, no. 2, pp. 115–118, 1994.
[10]
R. I. Marshall and P. M. Bartold, “A clinical review of drug-induced gingival overgrowths,” Australian Dental Journal, vol. 44, no. 4, pp. 219–232, 1999.
[11]
A. Lafzi, R. M. Z. Farahani, and M. M. Shoja, “Amlodipine-induced gingival hyperplasia,” Medicina Oral, Patología Oral y Cirugía Bucal, vol. 11, no. 6, pp. E480–E482, 2006.
[12]
R. A. Seymour, “Calcium channel blockers and gingival overgrowth,” British Dental Journal, vol. 170, no. 10, pp. 376–379, 1991.
[13]
S. Sonmez, C. Cavdar, C. Gunduz et al., “Do MMP-1 levels of gingival fibroblasts have a role in the gingival overgrowth of cyclosporine-treated patients?” Transplantation Proceedings, vol. 40, no. 1, pp. 181–183, 2008.
[14]
P. G. Raman, V. N. Mishra, and D. Singh, “Nifedipine induced gingival hyperplasia,” The Journal of the Association of Physicians of India, vol. 36, no. 3, pp. 231–233, 1988.
[15]
M. Mavrogiannis, J. S. Ellis, J. M. Thomason, and R. A. Seymour, “The management of drug-induced gingival overgrowth,” Journal of Clinical Periodontology, vol. 33, no. 6, pp. 434–439, 2006.
