Gingival overgrowth (GO) or enlargement is an unwanted effect occurring on the gingiva that commonly associated with medications. Hypertension is a global burden systemic conditions and showed high prevalent and more patients are taking antihypertensive drugs. Objective: This study aimed to assess the prevalence of drug-induced gingival overgrowth (DIGO) and its associated risk factors among hypertensive patients attending Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Methods: A total of 42 patients with the mean age of 57.1 (SD=9.3) years had participated in this cross-sectional study. They were recruited if they had consumed anti-hypertensive agents for at least 6 months. Demographic data and oral hygiene status were recorded and the presence of DIGO was assessed based on clinical index for gingival overgrowth. Data were analyzed using SPSS version 24.0 with p < 0.05 is considered statistically significant. Results: Majority of patients were taking calcium channel blockers (CCB) (81.0%) with amlodipine reported as the most common antihypertensive prescribed (47.6%). About 52% presented with DIGO and among them 55.9% were in those on CCB by which 9.5% presented with clinically significant enlargement. Except for gingivitis, oral hygiene status and demographic data were not significant risk factors for DIGO (p > 0.05). Conclusion: We found that DIGO is prevalent among hypertensive patients on CCB and its occurrence is coexists with gingivitis. Therefore, periodontal assessment is recommended among these patients for early detection and management of drug-induced gingival overgrowth.


1. Andrew W, Evelyn W, Francis M, Mark J, Mark C. Pattern of gingival overgrowth among patients on antihypertensive pharmacotherapy at a Nairobi hospital in Kenya. Open J Stomatol. 2014;4:169-173.

2. Hassell TM, Hefti AF. Drug-induced gingival overgrowth: old problem, new problem. Crit Rev Oral Biol Med 1991;2:103-137.

3. Taib H, Ali TBT, Kamin S. Amlodipine-induced gingival overgrowth: a case report. Arch Orofac Sci. 2007;2:61-64.

4. Amit B, Shalu B. Gingival enlargement induced by anticonvulsants, calcium channel blockers and immunosuppressants: a review. IRJP. 2012;3:116-119.

5. Brown RS, Arany PR. Mechanism of drug-induced gingival overgrowth revisited: a unifying hypothesis. Oral Dis. 2015;21:e51-61.

6. Ellis J, Seymour R, Monkman S, Idle J. Disposition of nifedipine in plasma and gingival crevicular fluid in relation to drug‐induced gingival overgrowth. J Periodont Res. 1993;28:373-378.

7. Kataoka M, Kido J-i, Shinohara Y, Nagata T. Drug-induced gingival overgrowth—a review. Biol Pharm Bull. 2005;28:1817-1821.

8. Trackman PC, Kantarci A. Molecular and clinical aspects of drug-induced gingival overgrowth. J Dent Res. 2015;94:540-546.

9. Chia YC, Kario K. Asian management of hypertension: Current status, home blood pressure, and specific concerns in Malaysia. J Clin Hypertens. 2020;22:497-500.

10. Seymour RA, Thomason JM, Ellis JS. The pathogenesis of drug‐induced gingival overgrowth. J Clin Periodontol. 1996;23:165-175.

11. Seymour RA. Effects of medications on the periodontal tissues in health and disease. Periodontol 2000. 2006;40:120-129.

12. MOH. Clinical Practice Guidelines Management of Hypertension. 2018; http://www.acadmed.org.my/view_file.cfm?fileid=894. Accessed 27 April 2020.

13. Hughes A. Calcium Channel Blockers. Hypertension: A Companion to Braunwald's Heart Disease E-Book. 2017:242.

14. Beaumont J, Chesterman J, Kellett M, Durey K. Gingival overgrowth: Part 1: aetiology and clinical diagnosis. Br Dent J. 2017;222:85-91.

15. Ellis JS, Seymour RA, Steele JG, Robertson P, Butler TJ, Thomason JM. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. J Periodontol. 1999;70:63-67.

16. Golob Deeb J, Lyons DJ, Laskin DM, Deeb GR. Severe drug-induced gingival enlargement and periodontitis: A case series with clinical presentation and management. Oral Maxillofac Surg Cases. 2020;6:100143.

17. Gopal S, Joseph R, Santhosh VC, Kumar VVH, Joseph S, Shete AR. Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study. J Indian Soc Periodontol. 2015;19:308.

18. Asari ASM. The expert says. Current concept in gingival overgrowth. Malays Dent J. 2007;28:107-111.

19. Mason YKS, Rath A, Hesarghatta PR, Sidhu P, Fernandes B, Halasagundi V. Non-surgical management of amlodipine induced gingival overgrowth: A short review and a case report. Asia Pac J Health Sci Res. 2017;2:9.

20. O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43:38-38.

21. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25:229-235.

22. Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque‐induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontol. 2018;45:S44-S67.

23. Ingles E, Rossmann JA, Caffesse RG. New clinical index for drug-induced gingival overgrowth. Quintessence Int. 1999;30:467-473.

24. Jarari N, Rao N, Peela JR, Ellafi KA, Shakila S, Said AR, et al. A review on prescribing patterns of antihypertensive drugs. Clin Hypertens. 2016;22:7-7.

25. Karnik R, Bhat KM, Subraya Bhat G. Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital. Gerodontology. 2012;29:209-213.

26. Bharti V, Bansal C. Drug-induced gingival overgrowth: The nemesis of gingiva unravelled. J Indian Soc Periodontol. 2013;17(2):182-187.

27. Jorgensen MG. Prevalence of amlodipine‐related gingival hyperplasia. J Periodontol. 1997;68:676-678.

28. Ono M, Tanaka S, Takeuchi R, Matsumoto H, Okada H, Yamamoto H, et al. Prevalence of amlodipine-induced gingival overgrowth. Int J Oral-Med Sci. 2010;9:96-100.

29. Rawisandran B, Arjunkumar R. Management of Phenytoin Induced Gingival Overgrowth: A Case Report. J Dental Medic Sci. 2013;11(6):19-26.

30. Mavrogiannis M, Ellis JS, Thomason JM, Seymour RA. The management of drug-induced gingival overgrowth. J Clin Periodontol. 2006;33(6):434-439.

31. Chesterman J, Beaumont J, Kellett M, Durey K. Gingival overgrowth: Part 2: management strategies. Br Dent J. 2017;222(3):159-165.

32. Matsumoto H, Takeuchi R, Ono M, Akimoto Y, Kobayashi N, Fujii A. Drug-induced gingival overgrowth and its tentative pharmacotherapy. Jpn Dent Sci Rev. 2010;46:11-16.

33. Seymour RA, Ellis JS, Thomason JM. Risk factors for drug‐induced gingival overgrowth. J Clin Periodontol. 2000;27(4):217-223.

34. Marshall RI, Bartold PM. A clinical review of drug‐induced gingival overgrowths. Aust Dent J. 1999;44(4):219-232.

35. Nery EB, Edson RG, Lee KK, Pruthi VK, Watson J. Prevalence of nifedipine‐induced gingival hyperplasia. J Periodontol. 1995;66:572-578.

36. Peñarrocha‐Diago M, Bagan‐Sebastian J, Vera‐Sempere F. Diphenylhydantoin‐induced gingival overgrowth in man: a clinico‐pathological study. J Periodontol. 1990;61:571-574.

37. Barak S, Engelberg IS, Hiss J. Gingival hyperplasia caused by nifedipine: Histopathologic findings. J Periodontol. 1987;58:639-642.

38. Morisaki I, Kato K, Loyola-Rodriguez J, Nagata T, Ishida H. Nifedipine‐induced gingival overgrowth in the presence or absence of gingival inflammation in rats. J Periodontal Res. 1993;28:396-403.

39. Thomason JM, Seymour RA, Ellis JS, Kelly PJ, Parry G, Dark J, et al. Iatrogenic gingival overgrowth in cardiac transplantation. J Periodontol. 1995;66:742-746.

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