A case of chronic periodontitis with drug-induced gingival overgrowth that improved with non-surgical periodontal treatment

Abstract

Patients receiving treatment with calcium channel blockers, a class of antihypertensive drugs, often exhibit gingival overgrowth. Dentists could refer such patients to their primary care physicians to consider the possibility of drug change, but it is sometimes difficult to change the drug because of difficulties in achieving blood pressure control with other drugs or unacceptable side effects of other drugs. Periodontal surgery, such as gingivectomy, may be necessary in cases where the gingival overgrowth does not respond to initial conservative periodontal treatment.

The patient reported herein was receiving a calcium channel blocker for the control of hypertension associated with polycystic kidney presented with chronic periodontitis and drug-induced gingival overgrowth. Examination revealed a periodontal probing pocket depth (PPD) of more than 4 mm in 55% of the sites, and of more than 6 mm in 28% of the sites. Gingival overgrowth was observed in both the upper and lower jaws, and on both the buccal and lingual sides of the interdental area. At the initial visit, the oral hygiene condition of the patient was poor, and we focused on basic initial periodontal treatment, including oral hygiene instruction and scaling-root planing (SRP). The gingival overgrowth regressed in response to this treatment and a PPD of more than 4 mm was only observed at one site. Therefore, we did not perform periodontal surgery, but proceeded with supportive periodontal therapy (SPT). About 3 years have passed since the start of SPT, and the periodontal tissues remain in good condition. The experience in this case suggests that non-surgical periodontal therapy, including SRP, and maintenance of good plaque control can improve gingival overgrowth and periodontal inflammation in patients with chronic periodontitis presenting with gingival overgrowth, even without change of medication or surgery.