Amlodipine induced gingival enlargement

Correspondence to Professor Neeta Mohanty; neetamohanty@soa.ac.in Description Gingival enlargement be it generalised or localised, with its aesthetic implications and potential to provide a niche for multiplication of microbial flora, presents as a diagnostic dilemma to the clinician.1 A plethora of causes including heredity, inflammation, drugs or systemic disease can be linked to it (figure 1). The accumulation of the drug in the gingival crevicular fluid in the presence of bacteria can lead to upregulation of proinflammatory cytokines leading to gingival enlargement.3 Even decreased folic acid uptake leads to defective collagenase activity, increased adrenocorticotrophic hormone due to feedback from adrenal cortex following blockage of aldosterone synthesis and upregulation of keratinocyte growth factor contribute to the non-inflammatory mechanisms.2 3 The management involves oral prophylaxis, meticulous oral self-care and substitution of the antihypertensive drug which is enough for resolution of the enlargement. The pedunculated mass in the midline of the palate extending from the gingiva was excised under local anaesthesia and histologically evaluated, revealing dense fibro-collagenous stroma having chronic inflammatory cell infiltration at places with many small blood vessels, suggestive of fibrous hyperplasia (figure 3).