Felodipine-influenced gingival enlargement in an uncontrolled type 2 diabetic patient.
BACKGROUND
The potential of calcium channel blockers (CCBs) to induce gingival enlargement (GE) as well as the influence of diabetes mellitus on periodontal tissues has been well documented. This case report documents a conservative clinical approach to the management of felodipine-influenced gingival enlargement and displays a clinical and histologic case of felodipine-influenced GE in an undiagnosed type 2 diabetic patient.


METHODS
At the initial examination, a medical consultation was requested and two incisional biopsies were taken for pathological evaluation. The patient was diagnosed with uncontrolled type 2 diabetes. Felodipine was withdrawn and the diabetes was controlled before dental treatment was initiated. The patient then underwent selective extractions and full-mouth scaling and root planing as well as oral hygiene instructions. No surgical therapy was indicated.


RESULTS
The histological results demonstrated the presence of elongated rete pegs; fibrous hyperplasia; a low-grade chronic inflammatory infiltrate, predominantly consisting of lymphocytes; and collagen bundle groups randomly distributed. These features were similar to those present in other drug-influenced GE. Clinical results have demonstrated almost complete resolution of GE after the withdrawal of felodipine and the control of diabetes. Further improvements were seen after scaling and root planing and oral hygiene instructions. No recurrences were noted 12 months after initial therapy.


CONCLUSIONS
This report demonstrated that the control of systemic factors seemed to have the most influence on success for this particular case. Since the control of diabetes was managed at the same time as the felodipine withdrawal, it remains difficult to speculate how these two factors impacted both the severity of the GE and the therapeutic results. More importantly, the conservative treatment rendered demonstrated the stability of periodontal status during maintenance phase and the avoidance of surgical interventions.
Fay
Ann Adams
AA
Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, 650 East 25th Street, Kansas City, MO 64108, USA.
Satheesh
Keerthana
K
Gapski
Ricardo
R
D016301:Alveolar Bone Loss / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D017742:Dental Care for Chronically Ill; D012534:Dental Scaling; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D015736:Felodipine / Q000009:adverse effects*; D005885:Gingival Hyperplasia / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D000924:Anticholesteremic Agents; D002121:Calcium Channel Blockers; D007004:Hypoglycemic Agents; D008687:Metformin; D015736:Felodipine