Case Report Nonsurgical Management of Nifedipine Induced Gingival Overgrowth George Sam 1 and Staly Chakkalakkal Sebastian 2 1 Department of Periodontics, Government Dental College, Kottayam, Kerala, India 2 Obstetrics and Gynaecology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India Correspondence should be addressed to George Sam; 007georgy@gmail.com Received 11 May 2014; Revised 8 July 2014; Accepted 16 July 2014; Published 3 August 2014 Academic Editor: Pablo I. Varela-Centelles Copyright © 2014 G. Sam and S. C. Sebastian. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Drug-induced gingival overgrowth is frequently associated with three particular drugs: phenytoin, cyclosporin, and nifedipine. As gingival enlargement develops, it afects the normal oral hygiene practice and may interfere with masticatory functions. Te awareness in the medical community about this possible side efect of nifedipine is less when compared to the efects of phenytoin and cyclosporin. Te frequency of gingival enlargement associated with chronic nifedipine therapy remains controversial. Within the group of patients that develop this unwanted efect, there appears to be variability in the extent and severity of the gingival changes. Although gingival infammation is considered a primary requisite in their development, few cases with minimal or no plaque induced gingival infammation have also been reported. A case report of gingival overgrowth induced by nifedipine in a patient with good oral hygiene and its nonsurgical management with drug substitution is discussed in this case report. 1. Introduction Gingival enlargement is a well-known consequence of the administration of some anticonvulsants, immunosuppres- sants, and calcium channel blockers and may create speech, mastication, tooth eruption, and aesthetic problems. Not all the patients using these agents are afected by gingival overgrowth, and the extent and severity are variable in such patients. Phenytoin-induced overgrowth may be present in 50 to 100% of patients treated with such drug, whereas cyclosporin and calcium channel blocker-induced overgrowths seem to be less common, with a prevalence of 30% and 20%, respectively [1–3]. Although there are previous reports of nifedipine induced gingival enlargement man- aged with nonsurgical therapy, there are no comprehensive description of cases managed efectively with drug substitu- tion. Tis may partly be explained due to the enlargement in most cases having a predominant infammatory component that ofen requires only an improvement in plaque control. In other cases, the present medical condition may prevent the ofending drug from being discontinued. In the present case, the patient presented with minimal plaque and calculus suggesting a minor role of infammation in the overall development of the enlargement. Since scaling and root planning did not show improvement in the condition, drug substitution was done with losartan potassium and the two months followup showed signifcant reduction in gingival enlargement. 2. Case Report A 53-year-old male patient reported to the Department of Periodontology, with a complaint of swollen gums. On exam- ination, generalized gingival enlargement was noticed in the lower arch, whereas an isolated nodular growth was observed in the right side of upper arch. Te enlarged gingiva was frm, pale pink, and resilient with a minutely lobulated surface and displayed no tendency to bleed (Figure 1). Te teeth displayed generalized cervical abrasion, probably attributed to the vigorous tooth brushing habit of the patient. Tere were little amounts of calculus present, and no deep periodontal pockets were detected. Te medical history of the patient revealed that the patient was hypertensive and that he was under medication for a period of 4 years for the same. Hindawi Publishing Corporation Case Reports in Dentistry Volume 2014, Article ID 741402, 4 pages http://dx.doi.org/10.1155/2014/741402