Introduction: Gingival hyperplasia is considered an abnormal overgrowth of gingival tissues1. Gingival hyperplasia can be caused by a variety of factors such as inflammation, medication side effects, systemic diseases, or even neoplasms 2. The main classes of drugs typically associated with gingival hyperplasia include anticonvulsants (phenytoin), immunosuppressive agents (cyclosporine), and antihypertensive drugs. Amlodipine induced gingival hyperplasia is one of the rare side effects of dihydropyridine calcium channel blockers. Of the dihydropyridines, nifedipine has been most frequently associated with gingival hyperplasia3.

Case Presentation: In this paper, we present a 60-year-old male with hypertension, multiple sclerosis, and syphilis who presented to the clinic for management of his stage I hypertension. Patient had been consistent with a daily dose of Amlodipine 5 mg without significant side effects. During the clinic visit, the patient’s amlodipine was increased from 5mg to 10mg. Most common adverse effects of amlodipine include peripheral edema, heart failure, pulmonary edema, hypotension, and more severely massive vasodilation with reflex tachycardia. However, this patient returned to the clinic with persistent and worsening gingival hyperplasia after increasing his dose of amlodipine. Physical examination of the patient revealed marked swelling of the gingiva with enlargement of interdental papilla.

Final/Working Diagnosis: Amlodipine Induced Gingival Hyperplasia

Management/Outcome: Three weeks following discontinuation of amlodipine, the patient had spontaneous regression of the gingiva with marked decrease in swelling. The rare incidence of gingival hyperplasia in the subset of patients using amlodipine has raised the question of its pathophysiology. Inflammatory and non-inflammatory mechanisms have been proposed on the pathogenesis of the amlodipine induced gingival hyperplasia. Amlodipine is thought to increase the interaction between gingival fibroblasts through inflammatory mediators such as IL1A, IL1B, IL5, and IL7, eventually leading to gingival hyperplasia. However, poor oral hygiene is also considered an important risk factor for the expression of amlodipine induced gingival hyperplasia. Using this unique case, we will review the interaction between amlodipine, gingival fibroblasts, and associated inflammatory mediators4.