Non-surgical management of a severe drug related gingival enlargement: 3 years follow-up clinical case

ABSTRACT

Background: Nifedipine is a calcium channel-blocking drug, common antihypertensive medication. Gingival tissue enlargement is a frequent periodontal side effect, associated to the presence of dental plaque. Description of the procedure In January 2018, a male 62-year-old patient was evaluated at the Dentistry Department of Coimbra University Hospital. His main complaint was gingival “swelling” and masticatory difficulty. Anamnesis revealed hypertension medicated with Nifedipine for 8 years. Besides partial edentulism and tooth migration, oral observation highlighted severe bimaxillary gingival enlargement, not restricted to the papillae, pronounced inflammation and periodontal attachment loss. Periodontal screening revealed 10 mm probing depth (PD) at several interdental sites, maximum clinical attachment loss (CAL) of 5 mm, bleeding on probing (BOP) of 61% and plaque index (PI) of 100%. The patient was diagnosed Nifedipine Gingival Enlargement with a Generalized Stage IV, Grade B Periodontitis. Non-surgical periodontal treatment was initiated with oral hygiene instructions, supra and subgingival instrumentation. Simultaneously, his assistant physician replaced nifedipine with enalapril. The patient attended regular periodontal appointments for 12 months. A decrease in gingival enlargement was noted in the subsequent months. Due to COVID-19 restrictions, patient was only reevaluated in May 2021. Outcomes: Three years after replacement of nifedipine and nonsurgical periodontal treatment, gingival enlargement was resolved. Periodontitis was stabilized, as periodontogram revealed a mean reduction PD of 6 mm at the deepest sites, grade II furcation involvements, BOP of 10% and PI of 34%. Step 3 periodontal therapy could be initiated. Due to economic restrictions, oral rehabilitation could not be fulfilled. Conclusions: Severe gingival tissue enlargement related to nifedipine in a periodontitis IVB patient was resolved by non-surgical periodontal treatment. Meticulous plaque control is mandatory. Communication with the Physician is important to alter the medication and restore patient's quality of life.