title: Management of periodontal disease in patients using calcium channel blockers - gingival overgrowth, prescribed medications, treatment responses and added treatment costs.
abstract: OBJECTIVE
  Gingival overgrowth (GO) is an adverse drug reaction in patients using calcium channel blockers (CCBs). Little is known about the effects of CCBs on the management of periodontal diseases. The aim of this study was to assess how the use of CCBs affects the long-term supportive treatment and outcomes in patients undergoing periodontal therapy.
  
  
  METHODS
  All patients using CCBs during the initial treatment and/or the supportive periodontal therapy (SPT) were selected from a periodontal practice. Patients were scored using a Gingival Overgrowth Index (GOI). The effects of CCB types and dosages were assessed in terms of the frequency and the severity of GO, treatment responses, substitutions and extra treatment costs. Mean values, Standard Deviation (SD) and range were calculated. The Mann-Whitney test was used to assess statistically significant differences (p < 0.05) for GO between patients with good and poor oral hygiene, differences between before and after terminating or replacing the CCBs, possible differences between drug dosages (Dihydropyridine 5 mg and 10 mg) and differences between three drug combinations (CCB and inhibitors of the renin-angiotensin system (IRAS), CCB and non-IRAS, CCB and statins).
  
  
  RESULTS
  One hundred and twenty-four patients (58 females, 66 males, 4.6% of the patient population) were using CCBs. 103 patients were assessed. Average age was 66.53 years (SD. 9.89, range 42-88) and the observation time was 11.30 years (SD 8.06, range 1-27). Eighty-nine patients had GO, 75 of these required treatment for GO. Terminating or replacing with alternatives to CCBs resulted in significant decreases in GO (p = 0.00016, p = 0.00068) respectively. No differences were found between good and poor oral hygiene (p = 0.074), drug dosages or the various drug combinations. Surgical treatment was more effective than non-surgical treatment in controlling the GO. Long-term tooth loss was 0.11 teeth per patient per year. Forty-two patients needed re-treatments for GO, resulting in an extra life cost per patient of €13471 (discounted €4177).
  
  
  CONCLUSIONS
  The majority of patients (86.4%) using CCBs experienced GO. 47.2% of these experienced recurrence(s) of GO during the SPT and needed re-treatments with resulting added costs. The long-term tooth loss was considerably higher for patients using CCBs than for other patients groups from the same practice setting.
authors.affiliation: Private Practice, Egersund, Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Fardal
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Henning
authors.initials: H
authors.lastname: Lygre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055113:Chronic Periodontitis / Q000191:economics / Q000628:therapy*; D004095:Dihydropyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D019214:Gingival Overgrowth / Q000139:chemically induced* / Q000191:economics / Q000601:surgery; D017048:Health Care Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000187:drug effects; D019233:Retreatment; D016388:Tooth Loss / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; C038806:1,4-dihydropyridine
keywords: calcium channel blockers; gingival overgrowth; maintenance therapy; periodontal disease; treatment costs