95 among ccbs nifedipine is the most frequently

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[95] Among CCBs, nifedipine is the most frequently implicated drug, inducing gingival overgrowth. [95] However, in the last two decades, more cases of gingival overgrowth have been reported after amlodipine use than nifedipine (25 cases of amlodipine as against 13 cases of nifedipine). Low doses and short‑term administration of CCBs might also induce gingival hyperplasia as suggested by Lafzi et al . in 2006 [21] and Joshi and Bansal in 2013. [10] Furthermore, a case report by Sunil et al . in 2012 [29] suggests that severity of the enlargement is dose dependent. Changes of drug and meticulous oral hygiene are important aspects in the management of CCB‑associated gingival overgrowth. Aldemir et al . in 2012 [12] reported a case of gingival overgrowth in a hypertensive patient under amlodipine therapy, in which, change of medication resulted in regression of the overgrowth within 3 months without any need for surgical intervention. Joshi and Bansal in 2013 [10] reported that gingival overgrowth in a hypertensive patient under amlodipine therapy showed drastic improvement within 1.5 months after change of drug. Similarly, Ramsdale et al . in 1995 [36] reported gingival hyperplasia in a patient with heart disease under long‑term nifedipine therapy, which disappeared completely within 6 months after cessation of nifedipine use. On the contrary, D’Errico and Albanese in 2013 [8] reported a case of gingival overgrowth in a hypertensive patient under amlodipine therapy, where changing drug and execution of a professional oral hygiene treatment did not allow resolution of the hyperplasia. Only surgical excision of the overgrowth permitted resolution of the case. Leaving the two extremities apart, majority of cases were managed by change of drug and meticulous plaque control, which resulted in moderate regression of the lesion. This was followed by surgical correction of gingival tissues for optimal gingival health and maintenance. Phenytoin is the most commonly prescribed anticonvulsant agent in the management of epilepsy. Phenytoin‑induced gingival overgrowth is the earliest known DIGO; first case of which was reported in 1939 by Kimball. [96] Phenytoin affects metabolism of certain fibroblast subpopulations, intracellular calcium metabolism, reduces folic acid uptake and metabolism, leading to production of inactive collagenase; thus, leading to gingival overgrowth. [6] Although rare, besides gingival hyperplasia, phenytoin is also known to induce mucosal hyperplasia in denture wearers. [97] Dhingra and Prakash in 2012 [89] reported a rare case of enlargement of mucosa in partially edentulous alveolar ridges despite not using any denture, after combination therapy of phenytoin and phenobarbital for epilepsy. Chee and Jansen in 1994 [57] reported a case of peri‑implant tissue hyperplasia after phenytoin therapy for epilepsy.
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