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.

Drug-influenced gingival enlargement (DIGE) or overgrowth manifests as abnormal enlargement of the gingiva due to an adverse effect of certain drug reactions in patients treated with anticonvulsants, immunosuppressants, or calcium channel blockers (CCBs). As the gingival enlargement became significant, it may interfere with the normal oral hygiene measures, aesthetics, as well as masticatory functions of the patients. The exact mechanism of how this undesirable condition develops is yet unknown, and complicated, with non-inflammatory and inflammatory pathways involved. This review illuminates these putative pathways of DIGE and highlights various treatment approaches based on existing research and current observations.

Associationsbetween periodontal disease (PD) and other diseases, including rheumatoid arthritis (RA), respiratory disease, and chronic kidney disease, have been reported. Patients with moderate to severe periodontitis have a high risk of suffering from RA and vice versa. This bidirectional relationship could be due to genetic (HLA-DR), dysregulation of the inflammatory response, and the role of Porphyromonas gingivalis(P. gingivalis), which stimulates anti-cyclic citrullinated peptide antibodiesvia citrullination. This review aims to identify associated factors that contribute to RA and PD relationship and to explore the effects of disease-modifying anti-rheumatic drugs (DMARDs) on PD. A literature search was performed using PubMed and Google Scholar to identify related articles published from the year 1990 to 2020 within the research interest using keyword combinations. Thirty-one articles thatfit the research interest and address the research questions for both objectives were selected. As a result, the associated factors for RA and PD relationship, including genetic predisposition, immunoregulatory imbalance, and the role of P. gingivalisin the citrullination process as a risk factor of RA. Significant improvement was found in periodontal parameters in RA patients treated with biologic and synthetic DMARDs. This review reported common factors contributing to the RA and PD relationship and the benefits of DMARDs on periodontitis.

Drug-influenced gingival enlargement (DIGE) among hypertensive patients is commonly associated with antihypertensive drugs such as calcium channel blockers (CCBs). Immune response alteration is one of the proposed mechanisms for DIGE. Immunoglobulin A (IgA) in saliva which involves in defense mechanism was shown to be affected in patients with DIGE. Objective: This study aimed to determine the association of salivary IgA level with DIGE. Methods: This cross-sectional study comprised 47 hypertensive patients who had consumed antihypertensive drugs for at least 3 months. Twenty-one (44.7%) males and 26 (55.3%) females had participated in this study. Data was analyzed using SPSS version 26.0. The p-value of less than 0.05 at a 95% confidence interval is considered statistically significant. Results: Eighty-three percent and 17.0% of hypertensive patients were on CCBs and non- CCBs respectively. Amlodipine was found to be the most common (55.3%) antihypertensive drug consumed. Twenty- one (44.7%) patients presented with DIGE. The salivary IgA level was significantly decreased (p=0.03) among hypertensive patients with DIGE [Median 4.9 ng/mL (IQR 5.268)] compared to those without DIGE [median 15.03 ng/mL (IQR 32.246)]. Conclusion: This data indicates the level of salivary IgA was significantly affected in patients with DIGE which may compromise the defense mechanism of saliva.