Amlodipine-Induced Mandibular Fibrous Overgrowth in Hypertension Patients with Chronic Kidney Disease

Introduction: Amlodipine is a CCB that is often used to treat hypertension. One of the long-term effects of Amlodipine is excessive growth of gingiva. The clinical manifestation can be fibrous overgrowth in the mandibular arch. Case Illustration: A 46 year old woman was treated for swelling in her right lower jaw for 1 year and become bigger in the last 6 months. The patient had hypertension since 2011, kidney failure since 9 years ago and has undergone routine dialysis twice a week. For hypertension, the patient received Amlodipine 2x10 mg, Clonidine 3x150 mcg, Bisoprolol 1x5 mg, Candesartan 2x16 mg. On physical examination, blood pressure was 169/95, right mandibular mass 8x6 cm. Histopathological examination showed fibrous dysplasia without signs of malignancy. Discussion: The type of CCB drug that most frequently prescribed is amlodipine at 37%. Changes in the gingiva began to occur after 3 months of Amlodipine administration. The prevalence of gingival overgrowth was 31.4% of patients receiving treatment with Amlodipine. The pathophysiology goes through inflammatory and non-inflammatory pathways. Management of this condition is by discontinuing or replacing CCB drugs, periodontal treatment and surgery. With combined management of these 3 modalities, patients who were followed for up to 18 months did not experience recurrence. Conclusion: This case report presents an incident of excessive fibrous tissue growth in the mandible of a patient who received amlodipine therapy for 11 years for hypertension. With surgical and non-surgical treatment, it is hoped that the patient will experience improvement and not recur.