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Appala

Gum Enlargement

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My dentist says I have overgrowth of gum tissue & he suspects it is a side effect of one of my meds, possibly Isradipine or Metformin (for diabetes). Isradipine was prescribed for HBP, but really my blood pressure isn't very high and I requested that one because of its possibly beneficial effects on PD. Other drugs I take: Levothyroxine, modafinil, and very small doses of Sinemet & Requip. I had DBS 2 years ago & need only small amounts of these last 2 now. What do you think it might be & what should I do about it? Switch drugs or discontinue? I'm still hoping the Isradipine will be beneficial for PD, so I hate to give it up. Also, since DBS I've gained weight (a known issue for DBS) & my A1C has increased, so I need the Metformin now more than ever to help control it. Any advice greatly appreciated.

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Appala,

When looking at your medication profile it appears that the Metformin is probably causing the gum enlargement, also known as gingival hyperplasia. There are several studies to indicate that this issue is directly associated with Metformin and at any dose.

I understand your concern with Israpidil, but it appears that the Calcium Channel Blockers Nifedipine and Verapamil are the most prevalent blood pressure medications that cause gingival hyperplasia.

Before changing any medication, did the Dentist suggest any enhanced oral care? Patients with Parkinson's do have a more difficult time with their fine motor skills. These are the skills used when we brush and floss. There were 3 changes that my Dentist recommended due to my diagnosis and they have been successful. (1) Change to an electronic toothbrush with a round head. This most mimics a dental tool and greatly increases food and plaque removal. (2) The use of flossers instead of dental floss. The plastic flossers are much easier to use for a patient with Parkinson's. (3) A good antibacterial mouth wash like Listerine. It is most effective when it is gargled and swished around the mouth and through the teeth. I would making these 3 changes for a month and see if these are beneficial changes.

If the above does not help the situation then a medication change might be in order. I completely understand that you need the Metformin, my suggestion would be to ask your Doctor to replace it with an alternative. There are a variety of different options available and since your Doctor knows your medical history they should be able to give you a good alternative. 

I would also recommend that you continue the Isradipine  because of it's possible benefit to Parkinson's patients.

I hope this helps and please keep me posted

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This doesnt really relate t0 gums but I have a ? about teeth.

It seems that over the past fews years the  4 bottom front teeth have shifted back so now my two eye teeth look like fangs

is that due to PD or just old age 

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Noah,

This is a good question. Many patients with Parkinson's and their caregivers know little about the effects the disease has on the mouth.

In your case, it may be 2 fold. Yes, it could be age. As we all get older our teeth may shift, causing overcrowding in one area and separation in other areas.

Parkinson's patients also have a tendency to clinch, clamp down, or grind their teeth. This can cause chipped teeth, ground down teeth, movement of teeth, and even muscle issues of the jaw or head. This can result in headaches, difficulty opening the mouth, and muscle spasms in the jaw, face, and neck.

I know I gave a few examples of what Parkinson patients should do that can help maintain good oral hygiene. It should also be stressed the importance of having a yearly dental check-up. With the advancements in dentistry, they can now find other health issues at the time of the check-up.

I hope this helps and please keep me posted.

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Thank you for your response. I'll talk it over with my doctor & dentist. I do use the electronic toothbrush & the plastic flossers.

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Appala,

I would also recommend using Listerine. It may taste bad, but it works well at removing plaque and promotes good teeth and gum health.

I forgot to mention the use of a bite guard. Since Parkinson patients have a tendency to grind their teeth, this is a good way to stop and damage to the teeth.

I hope this helps and please keep me posted.

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Thanks again. I'll try the Listerine. I believe my dentist says I don't have  a plaque problem (my husband does, both teeth & arterial!). I apparently have the other type of dental issue, problems with many cavities, lost teeth, implants, toothaches, etc., all my life. Dentist says you tend tohave one or the other type based on mouth chemistry, perhaps inherited. I do have a nightguard & wear it every night.

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