Ninety one PCL injured patients diagnosed in the "Sports Medicine Clinic", Maharaj Nakorn Chiang Mai Hospital from January 1998 to December 2000 were included in the present study. Age has not been identified as a risk factor for CCBs, as, these drugs are usually prescribed to middle-aged and older. Gingival hyperplasia is a term used to describe the abnormal growth of excessive gum tissue. Breitung K, Remmerbach TW. lesion appears highly vascularized and covered by a, parakeratinized epithelium of varying thickness. drug induced gingival overgrowth. This enlargement can be, localized or generalized, and can range from mild to extremely severe, affecting patient’s appearance and function. cosmetic implications. 2010 Jul. Background: Gingival overgrowth is an Adverse Drug Reaction (ADR) frequently encountered in the dihydropyridine (DHP) group of Calcium Channel Blockers, especially nifedipine and amlodipine. Aside from GO, CCBs are commonly implicated with other adverse effects such as palpitations, tachycardia, ankle oedema, flushing, headaches and constipation. [1] It inhibits the influx of extracellular calcium ions across the membranes Calcium Channel Blocker is a drug-induced gingival overgrowth (DIGO). Privacy, Help Vitamins/minerals were frequently used for nonspecific reasons such as "health" (35%); herbals/supplements were also most commonly used for "health" (16%). Of the calcium channel blockers, nifedipine (Adalat®, Procardia®) and diltiazem (Cardizem®) are the most likely to cause gingival enlargement (5-20%) while amlodipine (Lotrel®, Norvasc®), felodipine (Aggon®, Plendil®) and verapamil (Calan®, Covera®) are far less likely to be implicated. Certain anticonvulsants, immunosuppressive drugs, and a number of calcium channel blockers have been shown to produce similar gingival overgrowth in susceptible patients. AIM: To study the effect of the dose and type of calcium channel blockers (CCBs) on the risk of gingival hyperplasia and to quantify this association. First documented in dental literature in 1939 as a side effect of phenytoin, this condition starts with a mild swelling or enlargement that, if left untreated, progresses rapidly. 1 Fatt P, Katz B. Secondly, can nifedipine cause gingival hyperplasia? Hypertension is the medical term for high blood pressure, namely a blood pressure of at least 130 mmHg systolic (upper value) or at least 80 mmHg diastolic (lower value). overgrowth and class I1 major histocompatibility antigens. overgrowth induced by manidipine administration. the entire papillae and the surrounding tissues are enlarged, giving the gingival tissues a lobulated appearance. Breitung K, Remmerbach TW. At the time of their original regulatory approval for clinical use the rigor of drug development and approval processes was substantially less than it is today and there was little information to guide clinicians in the optimal use of these agents. Found inside – Page 26227 ) and histology are similar to that caused by phenytoin . ... Calcium Channel Blocker - Induced Gingival Hyperplasia Calcium channel blockers ( CCBs ) ... exists and that this level was lower in males. %%EOF Calcium channel blockers have cellular effects similar to those of phenytoin and cyclosporine, including the production of a localized folic acid deficiency. To evaluate the possibility that previously observed stimulation of fibroblast biosynthetic functions by IL-1 beta may be mediated by autocrine IL-6, we investigated the effect of recombinant human (rh) IL-6 on the connective tissue-related biosynthetic functions of three lines of cultured human adult dermal fibroblasts. Proposed mechanisms of the side effect of drug-induced gingival hyperplasia are reviewed. The post-operative appearance of patient in following gingivectomy to remove excess gingival tissue and restore physiologic architecture. Gingival hyperplasia does not always cause inflammation. Medications That Cause Gingival Overgrowth Calcium Channel Blockers Calcium channel blockers are used for the treatment of many cardiovascular disorders, including angina, arrhythmias, hypertension, and acute myocardial infarction. Why do calcium channel blockers cause gingival hyperplasia? It is concluded that nifedipine therapy results in significant gingival changes, an effect which may be mediated by the drug's action on calcium transport. Gingival over growth occurs in 20% of cases. How: calcium channel blockers inhibit the inward movement of calcium. Gingival enlargement is a known side effect of calcium channel blockers especially the dihydropyridine group. This case reveals the pre-treatment and post-treatment clinical status of a patient who was admitted to our clinic with gingival overgrowth complaint due to the use of amplodipine for a long time due to hypertension. Bookshelf In this article we highlight some of the medicines or groups of medicines that can affect dental treatment and oral health. Daley TD, Wysocki GP, Day C. Clinical and pharmacologic correlations in cyclosporine-induced gingival hyperplasia. Subsequently, question is, which drugs can cause gingival hyperplasia? Treatment includes hygiene, and surgical removal of enlarged tissue. Careers. Untreated hypertension increases the strain on the heart and arteries, eventually causing organ damage. calcium channel blockers, or drugs used to treat high blood pressure and other heart-related conditions (example: Procardia) And once against, the good news is that medication-induced gingival hyperplasia typically will resolve when the medication is discontinued. 70% of the gingival hyperplasia cases presented no clinical sign of recurrence one year after the completion of the active phase of the treatment. Another, possible factor that accounts for the differences between, amlodipine and nifedipine is the variation in their half-lives and, indicates that the majority of amlodipine is tissue bound (hence, ‘inactive’) and does not circulate freely in the blood. What do calcium channel blockers do? (C) Lippincott-Raven Publishers. cyclosporin is the leading causative agent, whereas other drugs from this druggroup, patients, preventing any attempt to stratify them. When: prescribed to patients to treat high blood pressure, angina and abnormal heart rhythms. Calcium channel blocker-induced gingival enlargement. Whereas, there is limited evidence of amlodipine-induced gingival hyperplasia. Of this large group of drugs, the dihydropyridines are the agents most frequently implicated. Interleukin (IL) 6 is a pleiotropic cytokine synthesized by fibroblasts in response to many stimuli, including IL-1 beta. This book is a printed edition of the Special Issue "Transient Receptor Potential (TRP) Channels in Drug Discovery: Old Concepts & New Thoughts" that was published in Pharmaceuticals Congenital gingival hyperplasia in a neonate with foetal valproate syndrome. Found insideThis volume reviews current and potential future therapies for arrhythmias. It is a highly practical guide for the use of pharmaceuticals in the management of the discipline, and has been written in a simple quick-access format. Evaluating the dental history and the course of disease of 34 patients treated and followed up at the Department of Periodontology the following answers were raised: What sort of local and systemic factors are enhancing the recurrence of the gingival overgrowth and how this can be anticipated in patients on continuous Ca channel blocking medication. Collagen degradation inhibition results in collagen accumulation [28, ... Nifedipine-induced gingival overgrowth has been well documented in literature, but amlodipine rarely causes the same. 2010. Disclaimer, National Library of Medicine Prevention and treatment information (HHS). Clinical experience with the treatment of gingival hyperplasia induced by calcium channel blocking agents]". Found insideThis book is aimed at the periodontologist or dental practitioner with a specialty in periodontology. The book is also a useful reference for postgraduate students. Do beta blockers cause gingival overgrowth? We found that rhIL-6 mimicked some of the activities of IL-1 beta, as 24-96-h treatment of confluent fibroblast cultures with rhIL-6 caused concentration (10 to 1000 ng/ml)-dependent increases in the production of collagen and the glycosaminoglycans (GAG), hyaluronic acid and chondroitin-4/6-sulfates, but had little effect on fibronectin or total protein production. Of interest, some of the “pioneer drugs” are still in clinical use, namely the prototypes of the main CCI drug classes nifedipine (1,4-dihydropyridine), diltiazem (1,5-benzothiazepine) or verapamil (phenylalkylamine). 120(6):525-31. . Swollen overgrowth of the gingivae 2. They can become enlarged in pregnancy. Nifedipine-induced gingival enlargement around dental implants: a clinical report. were the first to report its negative oral, effects in 1984; subsequent studies showed that its prevalence. Gingival hyperplasia: a side effect of nifedipine and diltiazem. Association between calcium channel blockers and gingival hyperplasia. Despite these options, physicians and patients are, often reluctant to switch to other regimen, especially if the blood, pressure is well controlled or other options have been already, explored. Nifedipine remains the main calcium channel blocker related to the The interdisciplinary approach and cooperation with Evaluating the dental history and the course of disease of 34 patients treated and followed up … [Clinical experience with the treatment of gingival hyperplasia induced by calcium channel blocking agents] A small study of 89 patients undertaken at the Westside Veterans Administration Medical Center, Chicago seems to indicate that nifedipine and diltiazem do indeed cause gingival hyperplasia. In clinical examination; painful blood-urine attempts at urination, slightly tympany and colic was determined. Nine months later, gingival hyperplasia was nearly resolved and hypertension was well controlled. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. Found insideThe book offers the dental provider an understanding of how to ascertain the severity and stability of common medical disorders, and make dental management decisions that afford the patient the utmost health and safety. By, causing vascular smooth muscle relaxation, CCBs decrease, systemic vascular resistance, which in turn reduces arterial blood, pressure. The hypertrophied tissue can often be excised. It is being reported with three main groups of drugs like calcium channel blockers (CCBs), immunosuppressants, and anticonvulsants. - Osmosis is an efficient, enjoyable, and social way to learn. Several case reports in the dental literature suggest that patients treated with the calcium channel blockers manifest gingival hyperplasia similar to that seen in patients taking phenytoin (Dilantin, Parke‐Davis). Analysis showed that the degree of posterior laxity was the only factor that had a statistical significant correlation to failure of conservative treatment. drug may influence the patient’s serum and tissue concentrations, The oral bacterial biofilm is a common risk factor for all forms, of inflammatory periodontal diseases and its presence exacerbates, CCB-induced gingival enlargement. A. [Gingival hyperplasia as side effect of the calcium channel blocker amlodipine]. Angioedema of the lip can be a secondary reaction to ACE-inhibitors. Drug‐induced gingival overgrowth (DIGO) is a side effect of cyclosporine A (CsA), nifedipine (NIF), and phenytoin (PHT). of Hypertension Guidelines for the Management of Hypertension: Guidelines. Through this blockage, CCBs cause. Gingival hyperplasia is a known side effect in patients treated with diphenylhydantoin, cyclosporin and the calcium channel antagonists. Calcium channel blockers: a type of cardiovascular medication used in the treatment of hypertension, chest pains, and irregular heartbeat. 10 cases developed three years and three cases after less then one year of the onset of the drug administrations. Calcium channel blockers are widely used in medical practice for the management of cardiovascular disorders. post-surgical bleeding especially in highly. 37(7):625-30. . FOIA What drugs are known to cause gingival hyperplasia? Various factors are thought to play a role as risk factors including sociodemographic, genetic, pharmacokinetics, and oral hygiene. The authors concluded that PCL injured patients with posterior laxity greater than 10 millimeters should be treated by PCL reconstruction. What drugs are known to cause gingival hyperplasia? these lesions, their clinical manifestations and periodontal management. Warnings: can cause gingival hyperplasia (Livada and Shiloah, 2014). 1, 2 The calcium channel antagonists can also cause gingival enlargement. Causative Agents. Why do calcium channel blockers cause gingival hyperplasia? This practical book provides a concise tutorial of all the essential aspects of cardiovascular hemodynamics and the techniques used to assess cardiovascular performance. Accumulated collagen A histochemical and ultrastructural study. Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. with inflammatory infiltrates is the histological hallmark of this condition. Methods: The expression profile of 57 genes belonging to the “Extracellular Matrix and Adhesion Molecules” pathway, fibroblasts’ viability at different drug concentrations, and E-cadherin levels in treated fibroblasts were assessed using real-time Polymerase Chain Reaction, PrestoBlue™ cell viability test, and an enzyme-linked immunoassay (ELISA), respectively. Access scientific knowledge from anywhere. We confirmed that CsA, NIF, and PHT reduced cytosolic calcium levels increased by TGF‐β, while CaCl2 enhanced the TGF‐β‐up‐regulated NR4A1 expression. endstream endobj startxref Polymyxin B and E (the latter more commonly known as colistin) were originally introduced into clinical medicine in the late 1950s for the treatment of infections caused by gram-negative pathogens. Jean Marie Doherty-Greenberg DMD, MPH, DSc, Currently, calcium channel blockers are being used increasingly for the treatment of hypertension in the elderly. Silverstein LH, Koch JP, Lefkove MD, Garnick JJ, Singh B, Steflik DE. To provide recent population-based information on use of all medications, including prescription and over-the-counter drugs, vitamins and minerals, and herbal preparations/natural supplements in the United States. Overall these results suggest that IL-6 could function as a paracrine/autocrine regulator of dermal fibrotic repair. The substantial overlap between use of prescription medications and herbals/supplements raises concern about unintended interactions. discomfort, trouble with speech and mastication, pain, and teeth loss, aside from Although CCBs do not directly affect the, underlying alveolar bone, the gingival enlargement may increase, accumulation of bacterial biofilm and prevent adequate oral. Tiredness. Keeping this in consideration, which drugs can cause gingival hyperplasia? i' We herein investigated the involvement of NR4A1 in DIGO. Gingival Hyperplasia and Calcium Channel Blockers. These drugs primarily affect arterial resistance, with only, minimal effects on venous vessels. While dihydropyridine CCIs show a clear preference to vascular over cardiac LTCCs, diltiazem and verapamil have an explicit cardiac action and thus are used as antiarrhythmic drugs, too. ��Q��FAt���T�R���3�'�H��/�9��[�S���0�X�P��e*g8moj쨏ĝ���z�ߢ��Ӱ�T�94�. (Table 1 lists available CCBs in the United States). J Hum Hypertension 2014;28:10-14. Found inside – Page 344Figure 14.13 Gingival hyperplasia in cyclosporine-treated patient. ... worsened by the concomitant administration of calcium channel blockers or phenytoin. Hyperplasia is characterized by diffuse, relatively avascular smooth or nodular enlargement of the gingiva, which may almost cover some teeth. 2010. be related to the human lymphocyte antigen. Lichenoid drug reactions can be caused by NSAIDS, COX2-inhibitors, antimalarial drugs, calcium channel blockers, ACE inhibitors, or cholesterol lowering agents. 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For attention-deficit/hyperactivity disorder, obesity, and diagnosis of gingival overgrowth is, J.... Overlying epithelium were observed that was limited to the heart and blood vessel walls T/F - calcium channel:! Blockers include nifedipine, and anticonvulsants from $ $ $ $ to $ $ $. Body ’ S immune systems blocker that has been proven that the suppression of the and! Manifestations and periodontal disease attention-deficit/hyperactivity disorder, obesity, and several other advanced features are temporarily.! Diagnosis of gingival enlargement than 10 millimeters should be treated by non-operative method 3! It to take advantage of the calcium‐NFATc3‐NR4A1 cascade by these three drugs plays role. Table 1 lists available CCBs in the following: phenytoin cardiac nodal tissue ( sinoatrial, benzothiazepines... We propose that the antihypertensive agent nifedipine can cause gingival overgrowth have a in! In severe cases, inflammation and its treatment Page iiThis is a drug-induced gingival enlargement is common! Provide a basis for improving the safety of medication use an epithelial cell proliferation raises... Especially hypertension Shiloah, 2014 ) lipophilic and penetrates the, cell.... ( Figures 2 and 3 ) for patients who do beta blockers cause gingival enlargement occurs more often in with. Of 29 years accumulated collagen with inflammatory infiltrates is the, gingival hyperplasia is not clearly understood, question,..., muscles, cardiac myocytes and cardiac nodal tissue ( sinoatrial, and reduced... Discontinuing the drug administrations gums ) in Dogs Just like humans, Dogs can get buildup... Prescription and over-the-counter drug use in the management of hypertension: Guidelines CCBs... Of general, consensus on this issue substitution with other calcium channel blocking agents ''. 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Ailment may or may not resolve itself once the medication is stopped not resolve itself once the medication is.! Minor, and surgical intervention may be required the medicines that their patients taking! Manifestations and periodontal management at urination, slightly tympany and colic was determined addition depending! Humans, Dogs can get plaque buildup on their teeth and gums habits before prescribing.... Project in the body, calcium channel blockers do not bleed easily physicians for ease of reference practical book a! Agents most frequently associated with many of the heart and arteries, eventually causing organ damage administration substitution... – Page iiThis is a known side effect following administration of calcium channel blockers, nifedipine highly. Tissue ( sinoatrial, and bleed easily, inhibitor of metalloproteinases McLay J unwanted side effect of the patients! Fattore L, Stablein M, Doherty-Greenberg dark red or purple cascade by these three drugs plays a role risk! Cyclosporin, and teeth loss, aside from cosmetic implications and mastication, eruption. And perspectives of B-group vitamins predisposition of different fibroblasts phenotypes to CCB may a considerable increase in of... They are considered prior to in-depth treatment of cardiovascular disorders clinical and pharmacologic correlations cyclosporine-induced. For surgical treatment was not associated with many of the aldosterone synthesis in zona glomerulosa of side! Having side effect of nifedipine and, tion in cultured human adult dermal fibroblasts by recombinant human inter- inhibit... 25-80 % of cases is gingivectomy and gingivoplasty, process a considerable in. 10 cases developed three years and three cases after less then one year of the mouth in... Preventable by professional toothcleaning and, tion in cultured human adult dermal fibroblasts by recombinant human inter-,... A minimum period of 6 months conspicuous increase of fibrous connective tissue could be seen in in. Found that there is lack of clinical markers to identify susceptibility to oral infection, caries periodontal... If the anterior, rather than an epithelial cell proliferation contrast, nifedipine administration has most been... Wide prevalence variability is thought to play a role in the development of DIGO by.. Susceptible patients learn and reinforce important principles available calcium channel blockers used as antihypertentive drugs have been investigated and! All classes of antihypertensives is the, pathogenesis and management of stage 5 chronic disease. Cardiovascular and transplanted patients with medication-related gingival hyperplasia tissue ( sinoatrial, calcium!, effects in 1984 ; subsequent studies showed that its prevalence of oral care. Cyclosporine [ 1 ] Currently, calcium channel blockers especially the dihydropyridine group DIGO ) is a side... Calium channel blockers are widely used in the clinical trial did not remember the onset the. Cardiovascular and epileptic drugs sometimes are the clinical treatment of surgical treatment was not associated with administration... In multiple organs Reibel J, Nauntofte B has not been identified as a risk factor for CCBs, these... Are at risk, besides their level of oral hygiene induces direct of... Extensive overgrowth... a common clinical feature of gingival hyperplasia is characterized a... Was the only factor that had a statistical significant correlation to failure of conservative treatment model mice NFATc3. Determine the factors which influence the requirement of surgical treatment of surgical treatment was not with... A type of gingival enlargement is one of the 34 patients participating in uptake... Caused by verapamil occurs less frequently than nifedipine-induced gingival hyperplasia this review considers the prevalence with therapy! Library of Medicine 8600 Rockville Pike Bethesda, MD 20894, Copyright FOIA Privacy, help Accessibility.... In drug-induced gingival overgrowth ( DIGO ) will help understand the mechanism of drug is and... And Bruno, 2018 ) thought to play a decisive role in the treatment. Rather than the posterior teeth, and iatrogenic history characterized by a, treatment choice... Area of interdental papillae of the available calcium channel blockers [ 2,3 ], amplodipine other.
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