A minimally verbal 60-year-old man was found to have marked gingival hyperplasia. His medical history included hypertension and seizure disorders following a prior stroke. The prescribed medications included amlodipine, nifedipine, bisoprolol fumarate, and levetiracetam. An oral examination revealed generalized papillary proliferation of the gingiva with bead-like enlargement of the interdental gingiva (Picture 1) and poor oral hygiene. A biopsy revealed gingival overgrowth without evidence of vasculitis, granuloma, or malignancy, suggesting drug-induced gingival hyperplasia. The two calcium channel blockers were discontinued, and the hyperplasia resolved over the next four months (Picture 2). Drug-induced gingival hyperplasia is most frequently associated with phenytoin, cyclosporine, and nifedipine (1). Presumed mechanisms include inhibition of the intracellular calcium uptake causing activation of gingival fibroblasts, impaired collagenase activity, upregulation of keratinocyte growth factor, and elevated inflammatory cytokines (2). Gingival enlargement may be complicated by difficulty with chewing, poor oral hygiene, and cosmetic issues.
Picture 1.
Picture 2.
The authors state that they have no Conflict of Interest (COI).
Acknowledgement
We thank Dr. Rita L. McGill (Department of Medicine, University of Chicago) for assisting with the editing.
References
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