Management of periodontal disease in patients using calcium channel blockers – gingival overgrowth, prescribed medications, treatment responses and added treatment costs

Abstract Objectives Gingival overgrowth ( GO ) is an adverse drug reaction in patients using calcium channel blockers ( CCB s). Little is known about the effects of CCB s on the management of periodontal diseases. The aim of this study was to assess how the use of CCB s affects the long‐term supportive treatment and outcomes in patients undergoing periodontal therapy. Methods All patients using CCB s during the initial treatment and/or the supportive periodontal therapy ( SPT ) were selected from a periodontal practice. Patients were scored using a Gingival Overgrowth Index ( GOI ). The effects of CCB types and dosages were assessed in terms of the frequency and the severity of GO , treatment responses, substitutions and extra treatment costs. Mean values, Standard Deviation ( SD ) and range were calculated. The Mann–Whitney test was used to assess statistically significant differences ( p < 0.05) for GO between patients with good and poor oral hygiene, differences between before and after terminating or replacing the CCB s, possible differences between drug dosages (Dihydropyridine 5 mg and 10 mg) and differences between three drug combinations ( CCB and inhibitors of the renin–angiotensin system ( IRAS ), CCB and non‐ IRAS , CCB and statins). Results One hundred and twenty‐four patients (58 females, 66 males, 4.6% of the patient population) were using CCB s. 103 patients were assessed. Average age was 66.53 years ( SD . 9.89, range 42–88) and the observation time was 11.30 years ( SD 8.06, range 1–27). Eighty‐nine patients had GO , 75 of these required treatment for GO . Terminating or replacing with alternatives to CCB s resulted in significant decreases in GO ( p = 0.00016, p = 0.00068) respectively. No differences were found between good and poor oral hygiene ( p = 0.074), drug dosages or the various drug combinations. Surgical treatment was more effective than non‐surgical treatment in controlling the GO . Long‐term tooth loss was 0.11 teeth per patient per year. Forty‐two patients needed re‐treatments for GO , resulting in an extra life cost per patient of €13471 (discounted €4177). Conclusion The majority of patients (86.4%) using CCB s experienced GO . 47.2% of these experienced recurrence(s) of GO during the SPT and needed re‐treatments with resulting added costs. The long‐term tooth loss was considerably higher for patients using CCB s than for other patients groups from the same practice setting.