Abstract
İlaca bağlı dişeti büyümeleri antikonvülzan, immünsüpresan ve kalsiyum kanal blokörleri gibi önemli ilaç gruplarının kullanımına bağlı olarak karşılaşılmaktadır. Bu ilaç gruplarının reçete edildiği hastalar için ilacın kullanımı genel sağlık durumları için elzemdir ve bu da sürecin yönetilmesini zorlaştırmaktadır. Amlodipin, hipertansiyon tedavisinde sıklıkla kullanılan üçüncü kuşak dihidropiridin kalsiyum kanal blokeridir. Nifedipin'den daha uzun etkili ve daha az yan etkiye sahip dihidropiridin türevidir. Amlodipin kaynaklı dişeti büyümesi, kalsiyum kanal blokerleri arasında nispeten daha az görülmektedir. İlaca bağlı dişeti büyümelerinde tedavi yaklaşımı ağız hijyeninin iyileştirilmesi, plak retansiyonuna sebep olan faktörlerin eliminasyonu ve başlangıç periodontal tedavi sonrası rezidüel büyümelerin cerrahi olarak uzaklaştırılması şeklindedir.
Bu olgu sunumunda 54 yaşındaki kadın hasta dişetlerinde zamanla artan büyümeler ve dişeti kanaması şikayetleri ile başvurmuştur. 5 yıldır hipertansiyon tanısı ile amlodipin türevi ilaç kullanım öyküsü olduğu öğrenilen hastanın intraoral muayenesinde anterior bölgede yaygın dişeti büyümeleri, yoğun plak ve diştaşı birikimi gözlenmiştir. Ayrıca etkilenen dişlerde Miller III mobilite mevcuttur.
Başlangıç periodontal tedavisine başlanan hastanın kardiyoloji hekimi ile yapılan konsültasyonu sonucu iki kez ilaç değişikliği yapılmış, periodontal tedavi ve ümitsiz dişlerin çekimi sonrası rezidüel büyümelere cerrahi işlem planlanmış ancak randevu günü büyümelerin tamamen gerilediği gözlenmiştir. Restoratif tedavileri de biten hastanın yapılan 6. Ay kontrolünde nükse rastlanmamıştır.
İlaca bağlı dişeti büyümelerinde çoğunlukla cerrahi müdahale gerekse de, ilaç değişimi ve uygun plak kontrolü sonrası cerrahisiz iyileşme mümkün olabilmektedir. Hekimlere cerrahi öncesi fazı dikkatle takip etmelerini ve dokuya gereken zamanı tanımalarını önermekteyiz.
References
- Agrawal, A. A. (2015). Gingival enlargements: Differential diagnosis and review of literature. World Journal of Clinical Cases, 3(9), 779. doi:10.12998/wjcc.v3.i9.779
- Bajkovec, L., Mrzljak, A., Likic, R. ve Alajbeg, I. (2021). Drug-induced gingival overgrowth in cardiovascular patients. World Journal of Cardiology, 13(4), 68–75. doi:10.4330/wjc.v13.i4.68
- Casetta, I., Granierí, E., Desideròa, M., Monetti, V. C., Tola, M. R., Paolino, E., … Caluraa, G. (1997). Phenytoin-induced gingival overgrowth: A community-based cross-sectional study in ferrara, italy. Neuroepidemiology, 16(6), 296–303. doi:10.1159/000109700
- Crăiţoiu, Ş., Bobic, A. G., Manolea, H. O., Mehedinţi, M. C., Pascu, R. M., Florescu, A. M., … Iacov-Crăiţoiu, M. M. (2019). Immunohistochemical study of experimentally drug-induced gingival overgrowth. Romanian Journal of Morphology and Embryology, 60(1), 95–102.
- Fardal, Ø ve Lygre, H. (2015). Management of periodontal disease in patients using calcium channel blockers - Gingival overgrowth, prescribed medications, treatment responses and added treatment costs. Journal of Clinical Periodontology, 42(7), 640–646. doi:10.1111/jcpe.12426
- Kimball, O. P. (1939). The treatment of epilepsy with sodium diphenylhydantoinate. JAMA, 112, 1244–1245. Lindhe, Jan; Lang, N. P. (2022). Clinical Periodontology and Implant Dentistry. WILEY Blackwell (Seventh Ed., C. 53).
- Livada, R. ve Shiloah, J. (2014). Calcium channel blocker-induced gingival enlargement. Journal of Human Hypertension, 28(1), 10–14. doi:10.1038/jhh.2013.47
- Mavrogiannis, M., Ellis, J. S., Thomason, J. M. ve Seymour, R. A. (2006). The management of drug‐induced gingival overgrowth. Journal of clinical periodontology, 33(6), 434–439.
- Mawardi, H., Alsubhi, A., Salem, N., Alhadlaq, E., Dakhil, S., Zahran, M. ve Elbadawi, L. (2021). Management of medication-induced gingival hyperplasia: a systematic review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 131(1), 62–72. doi:10.1016/j.oooo.2020.10.020
- Moffitt, M. (2020). Drug-induced gingival enlargement: an overview, (May 2013).
- Newman, M. G., Takwi, H. H., Klokkevold, P. R. ve Carranza, F. A. (2016). Newman and Carranza’s Clinical Periodontology Thirteenth Edition. Angewandte Chemie International Edition, 6(11), 951–952.
- Nishikawa, S., Nagata, T., Morisaki, I., Oka, T. ve Ishida, H. (1996). Pathogenesis of Drug-Induced Gingival Overgrowth. A Review of Studies in the Rat Model. Journal of Periodontology, 67(5), 463–471. doi:10.1902/jop.1996.67.5.463
- Rosalin Hongsathavij1 , Yosvimol Kuphasuk1, K. R. (2017). Effectiveness of platelet-rich fibrin in the management of pain and delayed wound healing. European Journal of Dentistry, 11(4), 192–195. doi:10.4103/ejd.ejd
- Teshome, A., Girma, B. ve Aniley, Z. (2020). The efficacy of azithromycin on cyclosporine-induced gingival enlargement: Systematic review and meta-analysis. Journal of Oral Biology and Craniofacial Research, 10(2), 214–219. doi:10.1016/j.jobcr.2019.12.005
- Thomason, J. M., Seymour, R. A. ve Rice, N. (1993). The prevalence and severity of cyclosporin and nifedipine‐induced gingival overgrowth. Journal of Clinical Periodontology, 20(1), 37–40. doi:10.1111/j.1600-051X.1993.tb01757.x
Abstract
Drug-induced gingival overgrowth, which is linked to anticonvulsants, immunosuppressants, and calcium channel blockers, can be challenging to manage due to the need for these medications. Amlodipine is a third generation dihydropyridine calcium channel blocker commonly used in the treatment of hypertension. It is a dihydropyridine derivative that is longer acting and has fewer side effects than nifedipine. Amlodipine-induced gingival enlargement is relatively rare among calcium channel blockers. The treatment for drug-induced gingival overgrowth involves improving oral hygiene, eliminating factors that cause plaque accumulation, and surgically removing residual growths after initial periodontal treatment. A 54-year-old woman with a history of hypertension and amlodipine use presented with complaints of gingival overgrowth and bleeding. Examination showed extensive overgrowths, plaque buildup, and tooth mobility. The patient received initial periodontal treatment and had two medication changes after consultation with a cardiologist. Surgical removal of growths was planned, but on the day of the appointment, the growths had completely regressed. No recurrence was found during a 6-month follow-up, and the patient's restorative treatments were completed. While surgery is often necessary for drug-induced gingival overgrowths, non-surgical recovery can occur with drug changes and proper plaque control. Physicians should carefully monitor patients preoperatively and allow sufficient time for tissue healing.
References
- Agrawal, A. A. (2015). Gingival enlargements: Differential diagnosis and review of literature. World Journal of Clinical Cases, 3(9), 779. doi:10.12998/wjcc.v3.i9.779
- Bajkovec, L., Mrzljak, A., Likic, R. ve Alajbeg, I. (2021). Drug-induced gingival overgrowth in cardiovascular patients. World Journal of Cardiology, 13(4), 68–75. doi:10.4330/wjc.v13.i4.68
- Casetta, I., Granierí, E., Desideròa, M., Monetti, V. C., Tola, M. R., Paolino, E., … Caluraa, G. (1997). Phenytoin-induced gingival overgrowth: A community-based cross-sectional study in ferrara, italy. Neuroepidemiology, 16(6), 296–303. doi:10.1159/000109700
- Crăiţoiu, Ş., Bobic, A. G., Manolea, H. O., Mehedinţi, M. C., Pascu, R. M., Florescu, A. M., … Iacov-Crăiţoiu, M. M. (2019). Immunohistochemical study of experimentally drug-induced gingival overgrowth. Romanian Journal of Morphology and Embryology, 60(1), 95–102.
- Fardal, Ø ve Lygre, H. (2015). Management of periodontal disease in patients using calcium channel blockers - Gingival overgrowth, prescribed medications, treatment responses and added treatment costs. Journal of Clinical Periodontology, 42(7), 640–646. doi:10.1111/jcpe.12426
- Kimball, O. P. (1939). The treatment of epilepsy with sodium diphenylhydantoinate. JAMA, 112, 1244–1245. Lindhe, Jan; Lang, N. P. (2022). Clinical Periodontology and Implant Dentistry. WILEY Blackwell (Seventh Ed., C. 53).
- Livada, R. ve Shiloah, J. (2014). Calcium channel blocker-induced gingival enlargement. Journal of Human Hypertension, 28(1), 10–14. doi:10.1038/jhh.2013.47
- Mavrogiannis, M., Ellis, J. S., Thomason, J. M. ve Seymour, R. A. (2006). The management of drug‐induced gingival overgrowth. Journal of clinical periodontology, 33(6), 434–439.
- Mawardi, H., Alsubhi, A., Salem, N., Alhadlaq, E., Dakhil, S., Zahran, M. ve Elbadawi, L. (2021). Management of medication-induced gingival hyperplasia: a systematic review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 131(1), 62–72. doi:10.1016/j.oooo.2020.10.020
- Moffitt, M. (2020). Drug-induced gingival enlargement: an overview, (May 2013).
- Newman, M. G., Takwi, H. H., Klokkevold, P. R. ve Carranza, F. A. (2016). Newman and Carranza’s Clinical Periodontology Thirteenth Edition. Angewandte Chemie International Edition, 6(11), 951–952.
- Nishikawa, S., Nagata, T., Morisaki, I., Oka, T. ve Ishida, H. (1996). Pathogenesis of Drug-Induced Gingival Overgrowth. A Review of Studies in the Rat Model. Journal of Periodontology, 67(5), 463–471. doi:10.1902/jop.1996.67.5.463
- Rosalin Hongsathavij1 , Yosvimol Kuphasuk1, K. R. (2017). Effectiveness of platelet-rich fibrin in the management of pain and delayed wound healing. European Journal of Dentistry, 11(4), 192–195. doi:10.4103/ejd.ejd
- Teshome, A., Girma, B. ve Aniley, Z. (2020). The efficacy of azithromycin on cyclosporine-induced gingival enlargement: Systematic review and meta-analysis. Journal of Oral Biology and Craniofacial Research, 10(2), 214–219. doi:10.1016/j.jobcr.2019.12.005
- Thomason, J. M., Seymour, R. A. ve Rice, N. (1993). The prevalence and severity of cyclosporin and nifedipine‐induced gingival overgrowth. Journal of Clinical Periodontology, 20(1), 37–40. doi:10.1111/j.1600-051X.1993.tb01757.x
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Periodontics |
| Journal Section | Case Report |
| Authors | |
| Publication Date | August 31, 2023 |
| Published in Issue | Year 2023Volume: 8 Issue: 2 |
