A case of chronic periodontitis with drug-induced gingival hyperplasia who improved with non-surgical periodontal treatment

Abstract

: Gingival hyperplasia is one of the well-known side effects of calcium channel blockers, which are often used for the treatment of hypertension. Gingival hyperplasia may induce malalignment of the teeth and aesthetic problems. Although the mechanisms of gingival hyperplasia are not yet clearly un-derstood, inflammatory conditions of the periodontal tissue caused by dental plaques are known to be in-volved in the pathogenesis of gingival hyperplasia. In general, a change of the antihypertensive drug to one without the side effect of gingival hyperplasia by the patientʼs attending physician, and thorough in-itial treatment, including plaque control and scaling and root planing are effective for the treatment of calcium channel blockers-induced gingival hyperplasia. Periodontal surgery may be performed, if neces-sary. Herein, we report the case of a 41-year-old male patient, a hypertensive under treatment with the calcium channel blocker amlodipine besilate Ⓡ , who was diagnosed as having gingival hyperplasia and chronic periodontitis (Stage III, Grade C). He presented with marked gingival enlargement and bleeding, mobility of the anterior maxillary teeth, and disordered teeth. We attempted periodontal infection control, including instructions on oral hygiene, and professional care, including scaling and root planing and professional mechanical tooth cleaning. After re-evaluation, persistence of deep pockets with a pocket depth of more than 4 mm at multiple sites was observed, although the gingival hyperplasia had almost completely resolved. We planned a flap operation, but we could not do it, because the patient was very busy with his career and did not provide informed consent. So, we repeated scaling and root planing, and used a local drug delivery system in order to eliminate periodontopathic microorganisms. Furthermore, we motivated the patient by repeatedly explaining the importance of plaque control, professional care, as well as blood pressure control. As a result, the periodontal tissue and dentition improved with non-surgical therapy.