Drug induced gingivitis There are 3 kind of drugs that can induced gingival enlargement, they are 1.

Anti convulsant drugs 2. Anti hypertensive drugs 3. Immunosuppressant drugs All these drugs are related to patient which has systemic complication. Anticonvulsant drugs This drugs are used to prevent rapid and excessive firing of neurons that can lead to seizures and epilepsy. The example for this drug are Phenytonin (C15H12N2O2), this drug also decrease the concentration of folic acid in human body thus could increase the risk of gingival enlargement Antihypertensive drug There are many type of of this drugs such as : Thiazide deuretic ACE inhibitor Calcium channel blockers Alpha adregenic blocking agent Centrally acting adregenic drugs Vasodilators

Above all types of drugs, only thus include as calcium channel blockers could induced gingival enlargement, here is some example of non-calcium channel blockers action.

Thiazide Deuretics This drugs is the most commonly used as first line drug for hypertensive medication due to its compability and low adverse effect on human systemic condition. Below are the schematic for the pharmacokinetic of this drug.

As we can see there is no effect that can act as a predisposing factors for gingival enlargement. Research also shows that there is no correlation between this drugs to other gingival disease/abnormalities. ACE Inhibitors ( Angiotensin Converting Enzyme )

Like the thiazide deuretics, this drug also used as first line drug and also does not change systemic condition that can lead to gingival disease Calcium channel blockers There are 2 types of groups that include as calcium blockers, they are: 1. Dehydropyridine 2. Non-dehydropyridine The relationship of these 2 will explain later Pharmacokinetic The overall pharmacokinetic of CCB are by blocking tha L-calcium channel at the smooth muscle of cardiac and at pheriperal arterioles including the plexus located in gums.

The picture above represent the action of amlodipine, type of CCB that belong to dehydropyridine group. When the flow of calcium was blocked into the cell plasma membrane, the smooth muscle wont undergo contraction thus the muscle cell will relax and stretched causing some plasma blood leakage causing local tissue enlargement , as already indicated by research studies, the prevalence of gingival enlargement increase with patient who under the drug treatment of CCB.

Treatment As a dentist, the choice of treatment must be as best as possible and effect long term success. Gingivoplasty or other periodontal surgery may be done but with this kind of treatment the etiology of disease is not eliminated, so before initiating any surgical approach the dentist should refer to the patient physicist to switch drug into isradipine (dehydropyridine). A survey have conducted and result shows that the prevalence of gingival enlargement is not affected with isradipine intake. The reason is still unclear why this drug does not induced gingival enlargement. Hipotesis 1. The calcium channel blocker act directly to the L-calcium channel and prevent any contraction at the smooth muscle of both cardiac myocyte (located in sinotrial) and pheriperal arterioles, the relaxed smooth muscle of the plexus ( arterioles in gingiva) will cause leakage of the vessels causing local blood plasma accumulation that appear as bumps/enlargement on gingival tissues. 2. Yantis susceptible condition shows that she has low immune system and low oxygen supply which causes her body more prawn to bacterial infection, so it will be easier for her to suffer from gingivitis.