Evaluation of gingival and periodontal conditions following causal periodontal treatment in patients treated with nifedipine and diltiazem^*

Abstract

It is established that phenytoin, cyclosporin and some calcium antagonists produce gingival overgrowth, but it is not known how this condition may respond to causal periodontal treatment. In order to find out, a longitudinal study was carried out, over a year, comparing a group of patients who were given nifedipine (NG, n = 18) and another group who were given diltiazem (DG, n = 13) with 2 others: one comprised cardiopathic patients who took no calcium antagonists (CG, n = 12) and the other contained patients who were medically healthy, with moderate periodontitis (HG, n = 12). On their basal visit, they were examined and instructed in oral hygiene, and then given causal periodontal treatment, being seen again at 4 and 8 months, when hygiene instructions were reinforced. They were seen for the last time at 12 months, when they were again examined. Groups NG and DG, on their basal visit, showed larger gum size than groups HG and CG, which was statistically significant; on their final visit, these differences remained only at the interproximal level. The number of patients with gingival overgrowth-taking the average of group HG as a minimal value-was much higher in groups CG (92%), DG (100%) and NG (89%) on the basal visit; on the final visit, the differences remained only in groups DG (85%) and NG (83%). The probing pocket depth reduction was much greater in groups HG and CG than in DG and NG, basically due to a greater gaining on clinical attachment level. The % of sites in which the pocket depth improved by more than 2 mm was 39.8% in HG, 54.5% in CG, 23.7% in DG and 28.7% in NG. The % of sites where the attachment gain by more than 2 mm was 46.2% in HG, 55.5% in CG, 22.8% in DG and 21.4% in NG. The amount of plaque and bleeding on probing, which was similar in all groups on the basal visit, decreased throughout the study, especially between the basal and 2nd visit in groups HG and CG. We have demonstrated that patients that take nifedipine and diltiazem show a larger gum size and their response to causal periodontal treatment is poorer than in the healthy and the cardiac groups.

Conservative management of amlodipine influenced gingival enlargement

“…The nature of the relationship between plaque and the expression of gingival enlargement is unclear. [6–9] In the present report, a marked reduction of the enlargement occurred following scaling and root planning. This goes in accordance with the findings of Hancock R.[10]…”

A clinical review of drug‐induced gingival overgrowths

“…90 The role of plaque in nifedipine-induced gingival overgrowth is uncertain as no convincing longitudinal studies have investigated its role. Some role can be inferred from a case study 9 1 where improvement in oral hygiene together with thorough scaling resulted in significant reduction in gi n gi val ove r gr ow t h without substitution of the drug (Fig.…”

Agrandamiento gingival por bloqueantes de canales de calcio

“…Además encontramos agrandamiento de la encía solo en las papilas interproximales, Fig. 1 lo cual es concordante con algunos estudios 16,17 que realizaron estudios longitudinales en pacientes consumidores de nifedipina y diltiazem, observaron que el AG apareció primero en las papilas, por ello son un lugar de especial evaluación que nos puede proporcionar un diagnóstico temprano de dicha alteración.…”