Drug-induced gingival enlargement.

OBJECTIVES Side effect of medicamentous treatment in hypertension therapy and angina pectoris with calcium channel blockers related to fibrotic gingival enlargement were examined. METHODS In our study we deal with clinico-histopathological and microbiological knowledge from this field underpinned by two case reports treated with antihypertensive therapy using calcium channel blockers. In the first case report we were largely concerned with microbiological findings from the area of periodontal pseudopockets diagnosed through a DNA analysis and appropriate antibiotic therapy. In a patient treated with a preparation from amlodipine group we proceeded to a complex treatment involving the change of hypertension therapy, introduction of professional and home oral hygiene and also following surgical and prosthetico-aesthetic rehabilitation. RESULTS Case Report 1 who was for a long term medicated with a preparation from the nifedipine group of antihypertensives we detected the presence of periodontal pseudopockets with probing depth of 4 to 7 mm with positive BOP and with marked rigid fibrotic gingival enlargement accompanied with considerable foetor ex ore. In a patient from the Case Report 2 who was for a long term medicated with a preparation from the amlodipine group of antihypertensives with large gingival overgrowth angiogenesis was characterized by cuboidal endothelial cell lining. In the samples under a layer of stratified epithelium there was present dense fibrous connective tissue comprising largely of collagen fiber bundles. CONCLUSION Bacterial composition in the patient with a high degree of gingival enlargement and periodontal pseudopockets 4 to 7 mm deep represented a typical spectrum of bacteria occuring in chronic forms of periodontitis. However, we cannot determine, if such distribution of bacteria was primary before the application of nifedipine antihypertensives, or it originated later after the formation of typical anaerobic setting of false periodontal pockets.