Bajkovec L, Mrzljak A, Likic R, Alajbeg I. Drug-induced gingival overgrowth in cardiovascular patients. World J Cardiol 2021; 13(4): 68-75 [PMID: 33968305 DOI: 10.4330/wjc.v13.i4.68]
Corresponding Author of This Article
Anna Mrzljak, FEBG, PhD, Associate Professor, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb 10000, Croatia. anna.mrzljak@gmail.com
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2021; 13(4): 68-75 Published online Apr 26, 2021. doi: 10.4330/wjc.v13.i4.68
Drug-induced gingival overgrowth in cardiovascular patients
Lucija Bajkovec, Anna Mrzljak, Robert Likic, Ivan Alajbeg
Lucija Bajkovec, Institute of Emergency Medicine of Medimurje County, Institute of Emergency Medicine of Međimurje County, Cakovec 40000, Croatia
Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
Anna Mrzljak, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Robert Likic, Unit for Clinical Pharmacology and TherapeuticsDepartment of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Ivan Alajbeg, Department of Oral Medicine, University of Zagreb School of Dental Medicine and University Hospital Centre Zagreb, Zagreb 10000, Croatia
Author contributions: Bajkovec L made contributions to the conception and design of the study, drafted and revised the manuscript critically; Mrzljak A, Alajbeg I and Likic R collected data, drafted and wrote the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Mrzljak, FEBG, PhD, Associate Professor, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb 10000, Croatia. anna.mrzljak@gmail.com
Received: February 7, 2021 Peer-review started: February 7, 2021 First decision: February 28, 2021 Revised: March 1, 2021 Accepted: March 29, 2021 Article in press: March 29, 2021 Published online: April 26, 2021 Processing time: 72 Days and 17.3 Hours
Abstract
Drug-induced gingival overgrowth (DIGO) is a pathological growth of gingival tissue, primarily associated with calcium channel blockers and immunosuppressants. Consequently, it is mainly seen in cardiovascular and transplanted patients. Nifedipine remains the main calcium channel blocker related to the development of this unpleasant side-effect. As for immunosuppressants, cyclosporin is the leading causative agent, whereas other drugs from this drug-group, including tacrolimus, have better safety profiles. Accumulated collagen with inflammatory infiltrates is the histological hallmark of this condition. Several factors are involved in the pathogenesis and can increase the risk, such as male gender, younger age, pre-existing periodontal inflammation, and concomitant use of other DIGO-inducing medications. Patients with DIGO may experience severe discomfort, trouble with speech and mastication, pain, and teeth loss, aside from cosmetic implications. Furthermore, these patients also have an increased risk for cardiovascular diseases. The interdisciplinary approach and cooperation with dental care experts are necessary for patient management. Treatment includes discontinuing the drug and switching to one with a better profile, improving oral hygiene, and surgical removal of enlarged tissue. Recognizing the potential of commonly used medications to cause DIGO and its effect on patients' health is necessary for early detection and adequate management of this complication.
Core Tip: Drug-induced gingival overgrowth is a side-effect of the drugs such as calcium channel blockers and immunosuppressants, commonly used in cardiovascular and transplanted patients. The condition is multifactorial and mainly depends on the potential of the used drug to cause gingival changes and the state of oral hygiene. Patients who develop drug-induced gingival overgrowth may experience severe discomfort and pain in addition to troubles with mastication, speech, and maintaining oral hygiene. Since it significantly reduces the quality of life, preventive and curative measures should be implemented as part of a care plan for patients at risk.
