What is calcium channel blocker-induced gingival enlargement?

This summary is based on the article published in the Journal of Human Hypertension: Calcium channel blocker-induced gingival enlargement (June 2013)

Context

Despite the popularity and wide acceptance of the calcium channel blockers (CCBs) by the medical community, their oral impact is rarely recognized or discussed. CCBs, as a group, have been frequently implicated as an etiologic factor for a common oral condition seen among patients seeking dental care: drug-induced gingival enlargement or overgrowth. This enlargement can be localized or generalized, and can range from mild to extremely severe, affecting patient’s appearance and function.

Treatment options for these patients include cessation of the offending drug and substitution with another class of antihypertensive medication to prevent recurrence of the lesions. In addition, depending on the severity of the gingival overgrowth, nonsurgical and surgical periodontal therapy may be required.

Purpose of the Article

To review the etiology and known risk factors of these lesions, their clinical manifestations and periodontal management.

Key Messages

• The drug-induced gingival enlargement could be detected clinically as early as 1–3 months following the initial dose of CCB.
• In its initial stages, the gingival enlargement may appear as a firm nodular enlargement of the interdental papillae, and its prevalence in the mouth is varied.
• It affects more the anterior rather than the posterior teeth, and is more pronounced on the facial/buccal than the palatal/lingual surfaces. In severe cases the entire papillae and the surrounding tissues are enlarged, giving the gingival tissues a lobulated appearance.
• The enlargement could extend vertically (coronally) and interfere with mastication and speech. It can also create esthetic problems if the anterior teeth are involved. The overgrown tissue creates pockets that harbor pathogenic bacteria that are beyond the reach of a toothbrush or dental floss.
• Treatment :
  • Cessation of the offending medication and a substitution with another class, or a cocktail, of antihypertensive drugs by the medical provider.
  • Nonsurgical management of gingival enlargement is usually a treatment of choice in patients with mild to moderate gingival overgrowth.
  • The surgical intervention’s objective is resection of the excess tissue, elimination of pockets and restoration of tissue contour, appearance and function (Figure 4). The classical surgical approach is gingivectomy and gingivoplasty.

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