Drug-induced gingival overgrowth in cardiovascular patients

Abstract

Drug-induced gingival overgrowth (DIGO) is a pathological growth of gingival tissue, primarily associated with calcium channel blockers and immunosuppressants. Consequently, it is mainly seen in cardiovascular and transplanted patients. Nifedipine remains the main calcium channel blocker related to the development of this unpleasant side-effect. As for immunosuppressants, cyclosporin is the leading causative agent, whereas other drugs from this drug-group, including tacrolimus, have better safety profiles. Accumulated collagen with inflammatory infiltrates is the histological hallmark of this condition. Several factors are involved in the pathogenesis and can increase the risk, such as male gender, younger age, pre-existing periodontal inflammation, and concomitant use of other DIGO-inducing medications. Patients with DIGO may experience severe discomfort, trouble with speech and mastication, pain, and teeth loss, aside from cosmetic implications. Furthermore, these patients also have an increased risk for cardiovascular diseases. The interdisciplinary approach and cooperation with dental care experts are necessary for patient management. Treatment includes discontinuing the drug and switching to one with a better profile, improving oral hygiene, and surgical removal of enlarged tissue. Recognizing the potential of commonly used medications to cause DIGO and its effect on patients' health is necessary for early detection and adequate management of this complication.

Keywords: Calcineurin inhibitor; Calcium channel blocker; Cardiovascular; Cyclosporin; Drug-induced gingival overgrowth; Nifedipine.

Figure 1

A complete response of a severe drug-induced gingival overgrowth case following seven weeks after amlodipine removal and six consecutive tooth scaling and cleaning treatments. A: Amlodipine induced gingival overgrowth successfully treated by vigorous weekly plaque control; B: Calculus removal during seven weeks following the drug withdrawal and substitution by angiotensin-converting enzyme inhibitor (courtesy of Prof. Vlaho Brailo).

Figure 2

An improvement in a heart transplant patient, whose medication included both cyclosporin and amlodipine, four weeks following professional teeth cleaning and switching to tacrolimus and alternative antihypertensive drug. A and B: Gingival overgrowth in a heart transplant patient receiving both cyclosporin and amlodipine; C and D: An improvement is observed following conservative periodontal treatment and four weeks of switching to tacrolimus and angiotensin-converting enzyme inhibitor.