Amlodipine-induced massive gingival hypertrophy

Discussion

Amlodipine is a second-generation dihydropyridine CCB that can cause gingival hypertrophy. The prevalence of amlodipine-induced gingival hypertrophy has been shown to be between 1.7% and 3.3%.^{4, 5} The incidence of gingival hypertrophy with nifedipine therapy has been reported to be as high as 20%,⁶ and a 2002 study reported that the prevalence with the use of CCBs might be as high as 38%.⁷

Gingival hypertrophy is 3.3 times more common in men than in women.⁷ The most common form is bacterial plaque–induced gingival disease, which presents as gingivitis. Use of phenytoin, cyclosporine, and CCBs, as well as vitamin C deficiency, can also cause the condition, as can hormonal shifts during pregnancy. The reason for this adverse event is not absolutely known, but mechanisms involving inflammatory and noninflammatory pathways have been suggested.⁸ For example, individual sensitivity to a drug’s metabolic pathway might be a trigger.⁸

Substantial diffuse gingival hypertrophy involving both upper and lower gums

Normal gingiva after full regression of hypertrophy

Untreated gingival hypertrophy might lead to bleeding, infection, abscess, ulceration, cosmetic deficiency, and functional difficulty (eg, chewing, talking).⁷ Treatment of drug-induced gingival hypertrophy includes cessation of the drug and decreasing other risk factors with meticulous mechanical and chemical plaque control. Replacing the affecting drug with another agent is also recommended when possible. Gingivectomy (excision of excessive gingival tissue) should be reserved for severe cases that affect oral hygiene or functionality, or can be performed for cosmetic reasons.