Management of Phenytoin-Induced Gingival Enlargement: A Case Report.

Gingival enlargement is frequently observed in patients taking certain drugs such as anticonvulsants, immune suppressants, and calcium channel blockers. The effects of these drugs are not only directed at the primary target tissues, but also on secondary target tissues, such as gingival connective tissue, causing clinical, and histopathological aberrations. These aberrations can adversely affect speech, mastication, tooth eruption, and esthetics. Disfiguring gingival overgrowth triggered by these medications often impairs the nutrition and provides access to oral infection, caries, and periodontal disease. The present case report describes the treatment of a patient with a phenytoin induced gingival enlargement.

Gingival Enlargement: Revisited: A Case Series.

Gingival enlargement can be hereditary or acquired. More than 20 prescription medications are associated with gingival overgrowth. A detailed review on the risk factors and pathogenesis from various peer reviewed journals has been discussed in this article. The aim was to discuss the role of drugs causing gingival enlargement, the hereditary gingival fibromatosis (HGF) and its possible pathogenesis. The following case series highlights four cases of gingival enlargement, one being a case of HGF and the other three being drug-induced gingival enlargement. Variable etiopathogenesis such as age, genetic predisposition, pharmacokinetic variables, tissue homeostasis, inflammation and growth factors have been associated with this disease. Inflammatory changes that occur within the gingival tissues appear to orchestrate the interaction between the “modified fibroblast” and the drug. Alternatively, these drugs influence directly the inflammatory response in the form of enlargement. This information is valuable for the clinician as it will have implication to treat the patient effectively.

Agrandamientos gingivales inducidos por fármacos / Drug-induced gingival enlargements

El término agrandamiento gingival por fármacos se refiere a un crecimiento anormal de la encía, secundario al uso de una medicación sistémica. Si bien se reporta una larga lista de medicamentos relacionados, se encontró una fuerte asociación sólo con la Fenitoína , la Nifedipina y la Ciclosporina A. La prevalencia del Agrandamiento Gingival varía ampliamente, sin embargo la prevalencia relacionada con el uso de la Fenitoína es aproximadamente del 50 por ciento. La Nifedipina y la ciclosporina producen cambios en el 25 por ciento de los pacientes tratados. Existe controversia entre la dosis y el riesgo o severidad del Agrandamiento.El grado de Agrandamiento gingival parece estar relacionado con la susceptibilidad del paciente y el grado dehigiene bucal de éste. Después de 1 a 3 meses de iniciada la medicación del fármaco los agrandamientos originadosen la papila interdental, se expande afectando otras áreas de la encía llegando a cubrir en casos extremosuna porción importante de los dientes principalmente en los segmentos anteriores por vestibular. El uso discontinuo de la medicación por el médico de cabecera y más aún la sustitución del fármaco por otroresulta en la regresión y el cese del Agrandamiento.

Low prevalence of gingival overgrowth associated to new imunossupressive protocols with cyclosporin

Gingival overgrowth (GO) is a frequent finding in patients treated with cyclosporine (CsA). This study investigated the prevalence and severity of GO in patients who received kidney transplant and CsA therapy, as well as associations with pharmacological and clinical factors. This cross-sectional study included 63 kidney transplant recipients who were treated with CsA in a university hospital. Demographic, pharmacological, and periodontal data were collected. The primary variable was GO. Independent sample t- and chi-square tests were used to compare means in groups with versusl without GO. The response rate was 86.3%. Overall, 40% of patients had some degree of GO. Eleven individuals presented GO scores > 10%, and 5 individuals reached 30%. The mean GO percentage was low (6.79 ± 15.83). Patients that were concurrently under nifedipine treatment showed a non-significant trend toward a greater prevalence of GO. Mean CsA dosage and serum levels were 3.20 ± 0.94 mg/kg/d and 156.12 ± 162.75 ng/mL, respectively. There were no statistically significant differences between patients with versusl without GO nor between the groups receiving nifedipine, no drug, or verapamil. The GO prevalence and severity rates were lower than those reported in previous studies and seemed to be independent of drug interactions.

Gingival overgrowth and drug association: A review.

Drugs used locally or systemically induce several alterations in micro and macroscopic tissues. However, nearly 20 drugs have been reported so far in the literature associated with gingival enlargement. Many systemic diseases have limited therapeutic options and such drugs or their metabolites have an adverse influence on different systems/organs, and one of these is that they initiate or accelerate the overgrowth of gingival tissue. The increase in size may be to the extent that teeth may be partially or completely covered, and the resultant 'gummy smile' may result in aesthetic concern for the patient.In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. It is apparent that there is a subpopulation of fibroblasts which is sensitive to these drugs. The exuberant growth of gingival tissue is of great aesthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention, and/or substitution of the drug with analogs. A relatively healthy oral environment provided by the dentist will reduce local microflora that will help in eliminating the major focus of infection. Physicians, general practitioners, and dentists need to make a coordinated and concise treatment plan that will be beneficial for the patients. This article will facilitate full information to physicians to involve dentists in the multidisciplinary treatment plan.

Oral lesions in kidney transplant patients

Oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. These patients have the potential to be involved with lesions developed as a result of the administration of immunosuppressive drugs. The aim of this study was to investigate oral lesions in a group of kidney transplant recipients. The present study was a cross-sectional research on 100 patients with a kidney transplant for at least 3 months. Oral mucosa was assessed clinically for any lesion. Additional data on systemic diseases, transplant duration, and medications were recorded. Twenty-four percent of the patients had at least 1 oral lesion. The most common lesion was oral candidiasis in 16% of the participants [13 cases of acute pseudomembranous and 3 cases of chronic oral candidiasis]. Gingival enlargement was seen in 7% of the kidney transplant recipients, and 2% had a coated tongue. Elimination of oral fungal lesions in kidney transplant recipients is highly recommended. We hope this study can shed light on this particular aspect of healthcare in kidney transplant recipients

Agrandamientos gingivales en niños y adolescentes transplantados renales / Gingival overgrowths in renal transplant children and adolescents

El receptor de transplante renal requiere terapia medicamentosa compleja con agentes inmunosupresores, corticoides, antimicrobianos, hipotensores y estimuladores de la regeneración ósea para prevenir el posible rechazo del órgano transplantado, controlar las infecciones secundarias a la inmunosupresión, las alteraciones de crecimiento y las variaciones de tensión arterial causadas por la insuficiencia renal. El objetivo de este trabajo fue analizar relación entre agrandamiento gingival y medicaciones recibidas. Fueron evaluados 47 niños y adolescentes transplatados renales, con edades entre 4 y 19 años (media 12.10 +- años) sin tratamiento preventivo bucal durante los 2 años previos a la iniciación del estudio, atendidos en el servicio de Nefrología del Hospital Nacional de Pediatría Juan P. Garrahan, de la Ciudad Autónoma de Buenos Aires, Argentina. Se analizó tipo de donante, tiempo de transplante y medicaciones inmunosupresoras (ciclosporina, micofenolato, azatioprina); corticoides (meprednisona), antimicrobianos (sulfametoxazol + trimetropina furantoína), hipotensores (enalapril, nifedipina); y estimuladores de la regeneración ósea (carbonato de calcio, 1 alfa 25-dihidroxicolecalciferol). Los resultados mostraron un agrandamiento gingival en el 69,6 por ciento de los niños y adolescentes, con un 31,9 por ciento de agrandamiento grado 3 y 4. Se observó correlación entre agrandamiento gingival y tiempo de trasplante P<0.05. No se observó asociación y correlación entre agrandamiento gingival y medicaciones.