Drug-Induced Gingival Overgrowth — ORE Part 1 MCQ

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HardPeriodontologyDrug-Induced Gingival OvergrowthORE Part 1

A patient who has received a kidney transplant takes ciclosporin and nifedipine. They present with drug-induced gingival overgrowth. How does concomitant nifedipine affect the gingival effect of ciclosporin?

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Correct answer: A — It potentiates ciclosporin-associated gingival overgrowth

Explanation lettering: E = shown as C · C = shown as E

A is correct. Both ciclosporin and nifedipine are recognised causes of drug-induced gingival overgrowth, and clinical studies in kidney-transplant recipients show that nifedipine potentiates the adverse gingival effect of ciclosporin. Thus, a patient receiving both agents is at greater risk of more extensive or severe overgrowth than one receiving ciclosporin alone. Plaque and gingival inflammation can further worsen the clinical expression, but they do not alter the direction of this drug interaction. Options B, C and E incorrectly imply an antagonistic or protective effect. Option D is incorrect because the combination has been associated with significantly greater gingival overgrowth than ciclosporin alone.

Reference: Seymour RA, Smith DG, Turnbull DN. Gingival overgrowth induced by nifedipine and cyclosporin A. Clinical and morphometric study with image analysis. Journal of Clinical Periodontology. 1995. https://pubmed.ncbi.nlm.nih.gov/8583014/