a 65-year - old male reported to the clinic with a complaint of enlarged gums in relation to the right side upper and lower jaw for the past 2 years . nifedipine 30 mg bid for the past 3 years , as prescribed by his physician . history of the presenting illness revealed that the patient noticed the swelling which started before 2 years and progressed to the present stage . on intraoral examination , there was bulbous enlargement of the gingival mucosa in relation to 13 , 14 , 44 , and 45 ; surface was lobulated and reddish pink in color [ figure 1 ] . assessment of plaque accumulation was done using silness and loe plaque index ( 1964 ) which gave in a score of 3 ( marking abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin ) . assessment of gingival inflammation was made using gingival index of silness and loe ( 1963 ) , which gave a score of 1 ( which includes mild inflammation , slight change in color , slight edema , and no bleeding on palpation ) . the gingival hyperplasia was graded by using angelopoulos and goaz ( 1972 ) criteria , which was graded as grade i ( which presents with hyperplastic gingiva extending to the cervical third or less of the anatomic crown ) . intra oral picture showing the bulbous enlargement of the gingival mucosa in relation to 13 , 14 , 44,and 45 there are various theories postulated in the pathogenesis of gingival enlargement due to nifedipine . among the antihypertensives , nifedipine showed higher prevalence of gingival enlargement . it starts as an enlargement of interdental papilla and later turns into a lobulated mass or nodules . it may also extend over the crown and reach occlusal heights , thereby interfering with mastication . these growths may aggravate the plaque accumulation and an increase in pocket depth formation , which adds to the problem . factors like age , genetic predisposition , pharmacological actions , dose , plaque , and oral hygiene have been attributed for gingival enlargement in nifedipine - induced gingival enlargement . younger age people show more enlargement because they have greater fibroblastic metabolism and hormonal change than the elderly . other factors like increased production of heparin sulfate glycosaminoglycan ( hspg ) , basic fibroblast growth factor ( bfgf ) , and transforming growth factor - beta ( tgf- ) were found to be increased in nifedipine- and phenytoin - induced gingival hyperplasia . calcium antagonists like nifedipine block the influx of calcium ions , thereby affecting homeostasis of collagen . the synthesis and degradation of the collagen being altered lead to the abnormal growth . with these factors , an ambiguity exists among different researchers in the pathogenesis and progression of gingival enlargement in nifedipine . our case showed gingival enlargement where teeth were present . obviously , the teeth with high plaque index were a key factor in the pathogenesis and progression of the disease in our case . in correlation with this , the edentulous areas did not show any enlargement , which proves that plaque is an essential factor in gingival enlargement due to nifedipine . the same observation was reported by eslami et al . that edentulous areas did not show signs of enlargement . the histopathology of our patient showed increased plasma cells and the other chronic inflammatory cells , proving plaque to have an inflammatory effect on gingiva resulting in gingival enlargement [ figure 2 ] . eslami et al . , in their study on 200 patients taking nifedipine , found gingival enlargement in patients with poor oral hygiene and high plaque index . 10 histopathology showing hyperplastic epithelium with dense collagen fibres and chronic inflammatory cells in the connective tissue the dose of the drug also has an impact on gingival oral growth . they also found that the higher concentration of nifedipine in the gingival crevicular fluid could increase the severity of gingival enlargement . from earlier studies , it was obvious that good oral hygiene and drug dose were the main factors in gingival enlargement . gingival hyperplasia was substantially reduced by applying proper prophylactic method accompanied by plaque control measures . concluded that nifedipine - induced gingival enlargement can be prevented by periodontal treatment along with anti - inflammatory drugs like anti  il - i  ( interleukin - i beta ) . it was obvious from our case that poor oral hygiene along with drug dose can increase the gingival growth . . it should be mandatory that a physician should have a dental opinion before prescribing nifedipine to the patients . patients with nifedipine therapy need prophylaxis at least once in 3 months and also should have meticulous plaque control measures . it was also proved that increased drug dosage showed increased gingival enlargement , so the physician can consider altering the dose of nifedipine or combine it with other antihypertensives or substitute with other drugs .
gingival enlargement is a common finding in a routine dental practice . 
 though it has many etiological factors , enlargement due to drugs which are administered to treat the systemic problems is of major concern which needs attention . here , 
 we present a case of nifedipine - induced gingival enlargement and discuss the reason for the enlargement .