Periodontics · patient case question
Which of this patient's medications is most likely responsible for the gingival enlargement?
Patient case: Elevated blood pressure and swollen gums
Patient: Male, 62 years old
Chief Complaint: “My gums have grown over my teeth.”
Background: Hypertension for eight years and angina. Current medications: nifedipine, atorvastatin, low-dose aspirin. Non-smoker. He reports brushing twice daily.
Vital Signs: BP 145/92 mmHg (repeated, seated, correct cuff) · HR 76 bpm · RR 16
Findings: Firm, fibrotic, nodular enlargement of the interdental papillae, most pronounced anteriorly and facially. Moderate plaque. No spontaneous bleeding.
Show answer and explanation
Correct answer: A. Nifedipine
- A. CORRECT. NIFEDIPINE is a dihydropyridine calcium channel blocker and the classic drug cause of gingival enlargement in a cardiac patient. The three drug classes to know are calcium channel blockers (nifedipine, amlodipine, verapamil), the anticonvulsant PHENYTOIN, and the immunosuppressant CICLOSPORIN. The mechanism involves altered calcium flux in gingival fibroblasts leading to excess collagen accumulation; plaque is a necessary co-factor, which is why the enlargement is worst where hygiene is poorest.
- B. Statins have no association with gingival overgrowth. Their adverse effects are myopathy and transaminase elevation.
- C. Aspirin causes prolonged bleeding, not tissue overgrowth.
- D. Plaque alone produces oedematous, red, bleeding tissue. The firm, fibrotic, nodular quality described here points to a drug-influenced enlargement superimposed on plaque.