Title	Patients On Calcium Channel Blockers Should Be Monitored For Enamel Demineralization
Clinical Question	In patients taking calcium channel blockers [for the treatment of hypertension, angina, tachycardia, etc], has demineralization of the enamel been seen to a degree that a remineralization regimen would be indicated?
Clinical Bottom Line	Yes, in the cited study, a significantly increased number of patients who underwent calcium antagonist therapy exhibited signs of “decalcination” and and dental caries, but this is not yet grounds for prophylactic remineralization. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 10989674 Ivanova/1999 100 taking calcium channel blocker vs. 60 not taking them. Cohort Key results 100 patients between the ages of 22 and 50 years who had undergone calcium channel blocker for greater than one year were examined for decalcination of enamel and dental caries and compared to a control group of 60 patients. 87.5% of persons in the experimental group had caries and decalicnation, compared to 65% of the healthy control group (p < 0.001).
Evidence Search	"Calcium Channel Blockers"[Mesh] AND "Tooth Demineralization"[Mesh]
Comments on The Evidence	It is a small group, which is less than ideal. Also, without having examined all subjects prior to start of therapy, it’s impossible to tie this therapy to the resultant dental disease, especially considering the lack of controlled conditions in oral hygiene and diet. Realistically, the dental decay could have been adjunct to other disease processes or a result of the sugar mixed into the drug and had little or nothing to do with the MOA of calcium channel blocker therapy. Nonetheless, the percentage spread from those treated is significant and should not be ignored. It also is not a double blind study, groups were treated far from identically, and compliance, adequate follow up, and competing interests are impossible to evaluate. At best, these results are grounds for additional study, but hardly establish a clear clinical implication at this time.
Applicability	Patients newly placed on Calcium Channel Blocking therapy at most should be encouraged to maintain or improve oral hygiene and if caries are detected, then scheduled on a shorter-term recall regimen for more frequent evaluation of new caries or demineralization.
Specialty	(General Dentistry)
Keywords	Calcium Channel Blocker, Calcium Antagonist, Demineralization,
ID#	845
Date of submission	03/31/2011
E-mail	knudsona@livemail.uthscsa.edu
Author	Andrew Knudson
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Michaell Huber, DDS
Faculty mentor e-mail	HuberM@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Jordan Felkner and Kevin Farnsworth (San Antonio, TX) on 10/03/2014 A PubMed and Trip Database search in Oct 2014 revealed no new research on this topic. This CAT addresses patients taking calcium channel blockers and their effect on enamel demineralization. Patients on calcium channel blockers should be encouraged to maintain proper oral hygiene to help prevent caries and placed on shorter-term recall basis if caries are detected.