Last Updated on January 13, 2022 by Dr Gustavo Assatourians DDS
Nifedipine and dental health
What is Gingival Hyperplasia?
Gingival Hyperplasia (GH) or Gingival Enlargement (GA) is defined as excessive gum growth due to an increase in the size of the constituent cells or gingival hypertrophy, or by an increase in the number of cells or gingival hyperplasia. This occurs due to treatment with some medications. Antiepileptic drugs (phenytoin), immunosuppressants (cyclosporine (Cs)), calcium channel blockers (nifedipine), and high doses of oral contraceptives are associated with gingival enlargement, among others (1).
The overgrown tissue creates pockets that harbor pathogenic bacteria that cannot be reached by toothbrush or dental floss. These unfavorable changes impair optimal oral hygiene and can lead to increased host susceptibility to oral infections, cavities, and periodontal disease (2).
Clinically, gum overgrowths are characterized by an increase in the volume of the interdental papillae; they manifest with a fibrous consistency and progressively invade the base of the tooth until it is partially or totally covered. Although they can affect the entire mouth, they usually appear in the front gum (the gum of the teeth in front). It can significantly affect the upper jaw as opposed to the lower jaw. Gingival hyperplasia causes pain in chewing, impaired swallowing, speech disorders, gingival bleeding, periodontal abnormalities, dental occlusion, and a possible cosmetic damage (3,4).
What is Nifedipine?
Nifedipine is commonly used in the treatment of some cardiovascular pathologies. They are part of the evaluation and monitoring done by public health and, likewise, the drug represents the preferred treatment for the vast majority of the population. Nifedipine is generally indicated in the management of hypertension (high blood pressure) or angina (chest pain). It acts mainly through calcium channels, inhibiting the entry of this calcium ion to smooth and cardiac muscle cells selectively, affecting the stimulation mechanisms in the muscle, resulting in vascular relaxation (5).
This medication may be indicated by your treating physician or cardiologist depending upon the diagnosis presented; also, the doses may vary according to some pharmaceutical presentations such that the product cannot be crushed or split to be administered (6). Its use occurs in both adults and children, but its effectiveness or safety has not been established. Of note, in elderly patients with hepatic or renal insufficiency, the dose should be adjusted and handled with caution due to its adverse effects (5,6).
Could Nifedipine affect my oral health?
In studies since 2007, several cases of patients who received oral treatment with nifedipine for different cardiovascular conditions have been identified along with the time of appearance of an adverse event between the start of treatment (ranging from five months to one year), depending upon the response and control of the pathology of each patient. In these patients, gingival enlargement was identified; it was more evident in those who had been on the drug for a longer time. In examinations, it was observed that at the cellular level, there was an enlargement of the epithelium cells in the gums, for which it was necessary to withdraw the medication and replace it with another despite the fact that blood pressure and/or arrhythmias were controlled. This has been named an adverse event associated with this drug (3.7).
Age, genetic predisposition, pharmacological actions, dose, plaque, and oral hygiene can predispose a person to different factors. The incidence in the occurrence of this adverse event is approximately 6%, and it can generally be resolved after the suspension of the drug with adequate oral hygiene since when this is not carried out, it is one of the major aggravating factors of this diagnosis. (4.8).
Currently, the mechanism by which it is possible has not been identified; however, the increase in production corresponding to cell growth factors and also the blocking of the entry of calcium ions into the cell have been identified. A derivative of nifedipine affects the synthesis and degradation of collagen, leading to abnormal growth. When these mechanisms are associated with the factors mentioned above and in addition early detection is not carried out, the plaque accumulates and the body responds through an inflammatory response. This can become more and more serious (the snowball effect) and the expulsion of the tooth may occur due to poor oral hygiene (8).
Prevention and treatment of Nifedipine and dental health
Different studies have concluded that gingival enlargement can be prevented through good oral hygiene and proper dose management; therefore, it is important that when you present these symptoms, you immediately notify your doctor or cardiologist so they can adjust the drug doses (pharmacological management) since uncontrolled arterial hypertension could cause xerostomia and increases the risk of plaque accumulation as indicated above. Also, it can be prevented with periodontal treatment and management with some anti-inflammatory drugs (8).
In the first phase, your dentist will carry out a complete review of your clinical history and pharmacological treatments, as well as your oral hygiene to establish a dental treatment plan (2):
- Nonsurgical periodontal treatment: Nonsurgical treatment is generally the choice for patients with mild to moderate gingival overgrowth. The mechanical removal of plaque and dental calculus performed by a professional has shown positive effects in reducing gingival enlargement by eliminating its inflammatory component. Good oral hygiene and home care are essential to prevent further inflammation and thus maintain the positive results of the treatment. Some dentists recommend chlorhexidine mouthwashes to control overgrowth; however, it is important to consult with your dentist.
- Surgical periodontal treatment: In the case of patients with mild gingival enlargement, this type of management may not be required; however, in the case of moderate gingival enlargement, non-surgical treatment improves surgical conditions and reduces the risk of postoperative infection. When the management is surgical, excess tissue is removed or the pockets that cover the teeth are removed, restoring the appearance, contour, and function of the gum.
In light of the above, it is important to notify your dentist if you are diagnosed with a cardiovascular disease and are consuming nifedipine or any medication associated with treatment. If you require a dental procedure or surgery, you may need to suspend or analyze the associated risks.
In conclusion, it is important to always carry out adequate dental cleaning and schedule a quarterly review with your dentist, or earlier, as required by your condition.
If you have any questions about this or other topics, you can contact us at Channel Island Family Dental as well as our Facebook page. We look forward to your visit and will make a timely diagnosis. Our dentists in Oxnard, Santa Paula, Ventura, Newbury Park, and Port Hueneme will be able to guide you towards the best treatment to take care of your health and return your best smile.
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