Pattern of Gingival Overgrowth among Patients on Antihypertensive Pharmacotherapy at a Nairobi Hospital in Kenya

Wetende Andrew, Wagaiyu Evelyn, Macigo Francis, Joshi Mark, Chindia Mark

Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
Department of Oral and Maxillofacial Surgery, School of Dental Sciences, University of Nairobi, Nairobi, Kenya.
Department of Periodontology and Community dentistry, School of Dental Sciences, University of Nairobi, Nairobi, Kenya.

DOI: 10.4236/ojst.2014.44025                

Abstract

The objective of the study was to describe the prevalence and severity of gingival overgrowth (GO) among patients on anti-hypertensive pharmacotherapy at a Nairobi hospital in Kenya and to evaluate the relationship between GO and associated risk factors among these patients. The study design was a cross-sectional survey using a consecutive convenient sampling method. All the patients were examined for gingival enlargement by the method described by Seymour, et al. and modified by the authors to allow for measurement in millimetres. Gingival inflammatory status and plaque scores were also evaluated. The results showed that of the 164 hypertensive patients recruited, 20.7% had gingival overgrowth. Slightly over half (56.1%) of these patients were on calcium channel blockers (CCB). Patients on CCB had a higher prevalence (31.5%) of GO compared to those on non-CCB (7%). This difference was statistically significant (Yates χ2 = 13.39: 1 df: P = 0.000) with an odds ratio of 6.17 (95% CI 0.21 - 19.45). There was no statistically significant association between gender, drug dosage, plaque levels and gingivitis with GO. In conclusion, usage of CCB pharmacotherapy showed a significant association with GO.

Keywords

Gingival Overgrowth; Hypertension; Calcium Channel Blockers

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Seymour, R.A., Ellis, J.S. and Thomason, J.M. (2000) Risk Factors for Drug-Induced Gingival Overgrowth. Journal of Clinical Periodontology, 27, 217-223. http://dx.doi.org/10.1034/j.1600-051x.2000.027004217.x
[2]	Kearney, P.M., Whelton, M., Reynold, K., Munther, P., Whelton, P.K. and He, J. (2005) Global Burden of Hypertension; Analysis of World Wide Data. Lancet, 365, 217-223. http://dx.doi.org/10.1016/S0140-6736(05)17741-1
[3]	Seymour, R., Thomason, J. and Ellis, J. (1996) The Pathogenesis of Drug-Induced Gingival Overgrowth. Journal of Clinical Periodontology, 23, 165-175. http://dx.doi.org/10.1111/j.1600-051X.1996.tb02072.x
[4]	Hassell, T.M. and Hefti, A.F. (1991) Drug Induced Gingival Overgrowth: Old Problem, New Problem. Critical Reviews in Oral Biology & Medicine, 2, 103-137.
[5]	Barclay, S., Thomason, J.M., Idle, J.R. and Seymour, R.A. (1992) The Incidence and Severity of Nifedipine-Induced Gingival Overgrowth. Journal of Clinical Periodontology, 19, 311-314. http://dx.doi.org/10.1111/j.1600-051X.1992.tb00650.x
[6]	Steele, R., Schuna, A. and Schreiber, R. (1994) Calcium Antagonist-Induced Gingival Hyperplasia. Annals of Internal Medicine, 120, 663-664. http://dx.doi.org/10.7326/0003-4819-120-8-199404150-00006
[7]	Fattore, L., Stablein, M., Bredfeldt, G., Semla, T., Moran, M. and Doherty-Greenberg, J.M. (1991) Gingival Hyperplasia: A Side Effect of Nifedipine and Diltiazem. Special Care Dentistry, 11, 107-109. http://dx.doi.org/10.1111/j.1754-4505.1991.tb00828.x
[8]	Ellis, J., Seymour, R., Steele, J., Robertson, P., Butler, T. and Thomason, J. (1999) Prevalence of Gingival Overgrowth Induced by Calcium Channel Blockers: A Community Based Study. Journal of Periodontology, 70, 63-67. http://dx.doi.org/10.1902/jop.1999.70.1.63
[9]	Majola, M., McFayden, M., Connolly, C., Nair, Y., Govender, M. and Laher, M. (2000) Factors Influencing Penytoin-Induced Gingival Enlargement. Journal of Clinical Periodontology, 27, 506-517. http://dx.doi.org/10.1034/j.1600-051x.2000.027007506.x
[10]	Seymour, R.A., Smith, D.G. and Turnbull, D.N. (1985) The Effects of Phenytoin and Sodium Valproate on the Periodontal Health of Adult Epileptic Patients. Journal of Clinical Periodontology, 12, 413-419. http://dx.doi.org/10.1111/j.1600-051X.1985.tb01377.x
[11]	Thomason, J.M. and Seymour, R.A. (1990) Phenytoin-Induced Gingival Overgrowth in General Medical Practice. Journal of Dental Research, 69, 969.
[12]	Saunders, E., Weir, M., Kong, B., Hollifield, J., Gray, J. and Vertes, V. (1990) A Comparison of the Efficacy and Safety of a β-Blocker, a Calcium Channel Blocker and a Converting Enzyme Inhibitor in Hypertensive Blacks. Archives of Internal Medicine, 150, 1707-1713. http://dx.doi.org/10.1001/archinte.1990.00040031707020
[13]	Hancock, R. and Swan, R. (1992) Nifedipine Induced Gingival Overgrowth (Report of a Case Treated by Controlling Plaque). Journal of Periodontology, 19, 12-14. http://dx.doi.org/10.1111/j.1600-051X.1992.tb01141.x