Gingival overgrowth induced by anticonvulsant drugs: A cross-sectional study on epileptic patients.

OBJECTIVE: Our aim was to estimate the prevalence of gingival overgrowth (hyperplasia) and to determine whether active molecules affect the severity of overgrowth in a group of epileptic patients. BACKGROUND: The effects of phenytoin on oral health have been explored in different studies, yet little information is available on other antiepileptic drugs. METHODS: Data were collected from 213 subjects of both sexes, from 5 to 80 years. Patients taking the same antiepileptic therapy for at least 1 year and meeting the inclusion criteria of the study (n = 162) were subjected to measurement of gingival overgrowth according to the modified Harris and Ewalt classification and O'Leary's plaque control record (OLR). Descriptive statistics were calculated. Data were analyzed using Pearson's r correlation coefficient and chi-square test. Significance level was set at 5%. RESULTS: The active drugs lamotrigine, oxcarbazepine, and phenobarbital were significantly associated with gingival overgrowth in 61%, 71%, and 53% of cases, respectively, and phenytoin, valproic acid, and carbamazepine in 50%, 44%, and 32% of cases, respectively. CONCLUSION: Different antiepileptic molecules may be related to gingival overgrowth. In addition to phenytoin, also lamotrigine, oxcarbazepine, and phenobarbital were associated with increased prevalence of gingival overgrowth. In the management of epileptic patients, dentists should take into account different drugs as possible causes for gingival overgrowth and warn for possible alternatives.

Influence of different anti-hypertensive drugs on gingival overgrowth: A cross-sectional study in a Turkish population.

OBJECTIVE: The purpose of this study was to evaluate the occurrence rate of drug-induced gingival overgrowth (DIGO) in patients treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) such as amlodipine, lercanidipine, and benidipine, as well as to assess the relationship of those mentioned above with medication variables and oral hygiene. METHODS: Sociodemographic details, DIGO, and clinical periodontal parameters were obtained from one hundred and thirty-one patients receiving ACE inhibitors, ARBs, and CCBs for a period of at least 2 years. RESULTS: The occurrence rate of DIGO was 19.6% in patients using CCB, 12.5% in the ARB group, and 7.5% in the ACE inhibitor group. In a subgroup analysis of CCBs, DIGO was found to be 31.8% in the amlodipine group, 13.3% in the lercanidipine group, and 7.1% in the benidipine group. While there was a significant relationship between amlodipine drug dosage and DIGO, no association was found between the duration of therapy and DIGO in all CCB subgroups. CONCLUSION: There was no difference between the groups in terms of DIGO. Duration of therapy and drug dosage did not affect the severity of DIGO in both ACE inhibitors and ARB groups.

Oral health of pediatric liver transplant recipients.

To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P<.001) and primary diagnosis of cholestatic disease (P=.04). Gingival inflammation was associated with plaque (P<.001), use of immunosuppressive medication (P=.04), and was more pronounced in children with cholestatic disease (P=.007). Children and young adults with liver transplants presented a rather poor oral health status. Liver transplant physicians should counsel patients for regular dental follow-up in order to avoid serious dental infections.

Gingival overgrowth in renal transplant subjects: a 44-month follow-up study.

BACKGROUND: To assess changes in gingival status of renal transplant subjects under immunosuppressive regimens based on cyclosporine (CsA), tacrolimus (Tcr), and sirolimus (Sir). METHODS: From a sample of 135 subjects (baseline examination [BE]), 89 without periodontal treatment, who maintained the immunosuppressive regimen based on the same main agent (CsA=23, Tcr=31, and Sir=35), were reexamined after 44 months (follow-up examination [FE]). Demographic, pharmacologic, and periodontal variables were collected and gingival overgrowth (GO) was assessed by visual examination. RESULTS: In Tcr and CsA groups, although not significant, occurrence of GO decreased (CsA [BE=56.5% and FE=34.8%; P=0.063] and Tcr [BE=19.4% and FE=12.9%; P=0.500]). In addition, the severity of GO decreased significantly in CsA group (mean score BE=10.29 ± 7.70 and mean score FE=0.78 ± 1.38; P=0.003). In Sir group, GO decreased from 17.1% (BE) to 0.0% (FE) (P=not applicable). In total sample, GO was associated with papillary bleeding index (P=0.001) and concomitant use of calcium channel blockers (P=0.029); in CsA and Tcr groups, GO was associated with papillary bleeding index (P=0.029 and 0.033, respectively). CONCLUSIONS: There was no incidence of GO, and a decrease in the occurrence and severity of GO was significant in total sample. This decrease can be attributed to changes in pharmacologic and periodontal variables over this period of time.

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. (AU)

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.

Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital.

OBJECTIVES: To determine the prevalence of amlodipine-induced gingival overgrowth (GO) among elderly subjects attending an Indian teaching hospital and find any association with demographic factors, drug variables, oral hygiene status and gingival inflammation. METHODS: A cross-sectional pilot study included 157 dentate patients aged 60 years or more, taking Amlodipine for at least 3 months. Data were collected from past medical records and oral examination. Clinical assessment of GO was correlated with patient's age, gender, drug dosage (2.5, 5 or 10 mg/day), duration of drug therapy (3-4, 4-6, 6-12, 12-24 and >24 months) and also with subjects' plaque index and gingival index scores. RESULTS: Eight patients (5.09%) had GO. No statistically significant relation was observed between age (p = 0.79), gender (p = 0.56), drug dosage (p = 0.25) and duration of drug intake (p = 0.62) and prevalence of GO. GO prevalence related highly significantly (p < 0.001) with plaque and gingival index scores. CONCLUSIONS: Prevalence of amlodipine-associated GO in the sample of elderly Indian patients was noted higher than that previously reported. Plaque and gingival inflammation were highly correlated with this condition, while demographic characteristics and drug dosage did not relate significantly.

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 versus 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 versus 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.

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.

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.(AU)

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.

Gingival enlargement in pediatric organ transplant recipients in relation to tacrolimus-based immunosuppressive regimens.

PURPOSE: Tacrolimus, in contrast to cyclosporine, has not been found to be associated with gingival enlargement (GE) among adult transplant recipients. The purpose of this study was to explore the prevalence of GE in relation to tacrolimus and cyclosporine-based immunosuppressive regimens among pediatric solid-organ transplant recipients, controlling for the use of calcium channel blockers (CCB) and the presence of supragingival plaque. METHODS: A standardized questionnaire was administered and a comprehensive oral examination was performed among pediatric renal and liver transplant recipients who were at least 6 months post-transplant. RESULTS: The prevalence of GE among 133 participants was 26%, with the highest incidence among subjects receiving cyclosporine and CCB (60%) and the lowest among those receiving tacrolimus without CCB (13%). A multivariate model showed that the odds of having GE were 5 times higher among children receiving cyclosporine than in those not receiving this medication, and 4 times higher among boys than girls. Supragingival plaque and the use of CCB, however, were not found to be associated with GE. CONCLUSION: This study revealed that tacrolimus was not associated with gingival enlargement while cyclosporine remains a risk factor for the development of this condition in pediatric renal and liver transplant recipients.

[Analysis of risk indicator for nifedipine-induced gingival hyperplasia].

OBJECTIVE: To investigate the prevalence and risk indicator of nifedipine-induced gingival overgrowth in a community population in Beijing. METHODS: A cross-sectional survey was conducted in 616 community subjects with hypertension or coronary vascular disease in Beijing, China. Among them 205 individuals took nifedipine for at least half year and 411 individuals who had never received calcium channel blocker (CCB) were recruited as controls. Smoking, oral hygienic habit, systemic health, pharmacological and demographic data for each subject were recorded by questionnaire. Sulcus bleeding index (SBI) was assessed in 12 anterior teeth per subject. Turesky modified Quigley-Hein plaque index (PI) and gingival overgrowth index in anterior teeth were scored on photograph. 38.6% was defined as threshold to identify individual with significant gingival overgrowth. RESULTS: 7.3% of the subjects taking nifedipine were found to have significant gingival overgrowth in this population. The prevalence of gingival overgrowth in nifedipine group was statistically higher than that in the control group. By logistic regression analysis, SBI was found to be the only risk indicator (odds ratio = 5.92, P = 0.001). CONCLUSIONS: The presence of gingival inflammation was an important cofactor for the occurrence of gingival overgrowth.

Prevalence, severity, and risk variables associated with gingival overgrowth in renal transplant subjects treated under tacrolimus or cyclosporin regimens.

BACKGROUND: Some reports suggest that the prevalence and severity of gingival overgrowth (GO) is lower in patients taking tacrolimus (Tcr) than in those taking cyclosporin A (CsA). The present study was conducted to determine the prevalence and severity of GO in a group of renal transplant recipients treated with Tcr in comparison to those treated with CsA and to evaluate the risk variables associated with the development of GO in these two drug regimens. METHODS: A cross-sectional study was conducted in a public hospital in Belo Horizonte City, Brazil. Demographic, pharmacological, and periodontal data were recorded for each subject. Variables from 134 subjects taking Tcr were compared to 451 subjects taking CsA using independent sample t, chi(2) statistic, or Mann-Whitney tests. The effects of potential risk factors on GO severity were determined using forward and backward stepwise regression analysis. RESULTS: Subjects taking CsA showed a higher mean GO score (29.03% +/- 22.9%) compared to subjects taking Tcr (16.9% +/- 3.4%) (P = 0.0038). In the Tcr group, 17.9% of the subjects had clinically significant GO compared to 38.1% in the CsA group (P = 0.045). In the multivariate final model, papillary bleeding index, azathioprine dosage, and concomitant use of calcium channel blockers (CCB) were significant variables associated with severity of GO in Tcr and CsA groups. In addition, previous CsA use also remained significant for GO in subjects under a Tcr regimen. CONCLUSIONS: The prevalence and severity of GO is lower in transplant subjects taking Tcr compared to CsA. GO severity in both groups was strongly associated with the papillary bleeding index, highlighting the role of inflammation in this condition. Concomitant CCB use, azathioprine dosage, and previous CsA use in the Tcr group reinforces the possible synergistic effects of these pharmacological variables on GO severity.

Expresión MMP-13 en enfermedad periodontal / MMP-13 expression in periodontal disease

Objetivo: determinar si existe diferencia en la expresión y localización de MMP-13 en periodonto sano, agrandamiento gingival inducido por placa bacteriana, periodontitis crónica moderada/avanzada y periodontitis agresiva, mediante inmunohistoquímica para evidenciar un posible papel de esta colagenasa en la progresión del daño tisular en patologías infecciosas del periodonto. Métodos: el tipo de diseño seguido en este estudio fue observacional comparativo. Se tomaron biopsias de 22 pacientes que fueron diagnosticados como 5 sanos (S), 6 periodontitis crónica (PC), 6 periodontitis agresia (PA) y 5 agrandamiento gingival inducido por placa bacteriana (AGIPB), analizándose 4 estratos tisulares en cada biopsia: epitelio oral (EO), epitelio de unión (EU), conectivo adyacente al epitelio de unión (CAEU) y conectivo profundo (CP). El tipo de muestreo fue intencional, ya que los investigadores conocían las características de los sujetos que se escogieron para el estudio. Las muestras se colocaron en formalina al 10 por ciento y se incluyeron en bloques de parafina, para posteriormente realizar la técnica de inmunohistoquímica. Se hizo valoración semicuantitativa determinada por conteo celular al microscopio de luz (40X). Resultados: la mayor expresión de MMP-13 se da en la periodontitis crónica (PC) seguida por el agrandamiento gingival inducido por placada bacteriana (AGIPB), periodontitis agresiva (PA) y finalmente los pacientes sanos que no mostraron expresión alguna de esta colagenasa. El estrato tisular que más expresión mostró fue el epitelio oral a nivel del estrato granuloso. Conclusión: la MMP-13 no se expresa en biopsias de tejido sano. La expresión se presenta en tejidos que se encuentran en procesos de destrucción o de remodelación (AU)

Expresión MMP-13 en enfermedad periodontal / MMP-13 expression in periodontal disease

Objetivo: determinar si existe diferencia en la expresión y localización de MMP-13 en periodonto sano, agrandamiento gingival inducido por placa bacteriana, periodontitis crónica moderada/avanzada y periodontitis agresiva, mediatne inmunohistoquímica para evidenciar un posible papel de esta colagenaa en la progresión del daño tisular en patologías infecciosas del periodonto. Métodos: el tipo de diseño seguido en este estudio fue observacional comparativo. Se tomaron biopsias de 22 pacientes que fueron diagnosticados como 5 sanos (S), 6 periodontitis crónica (PC), 6 periodontitis agresia (PA) y 5 agrandamiento gingival inducido por placa bacteriana (AGIPB), analizándose 4 estratos tisulares en cada biopsia: epitelio oral (EO), epitelio de unión (EU), conectivo adyacente al epitelio de unión (CAEU) y conectivo profundo (CP). El tipo de muestreo fue intencional, ya que los investigadores conocían las características de los sujetos que se escogieron para el estudio. Las muestras se colocaron en formalina al 10 por ciento y se incluyeron en bloques de parafina, para posteriormente realizar la técnica de inmunohistoquímica. Se hizo valoración semicuantitativa determinada por conteo celular al microscopio de luz (40X). Resultados: la mayor expresión de MMP-13 se da en la periodontitis crónica (PC) seguida por el agrandamiento gingival inducido por placada bacteriana (AGIPB), periodontitis agresiva (PA) y finalmente los pacientes sanos que no mostraron expresión alguna de esta colagenasa. El estrato tisular que más expresión mostró fue el epitelio oral a nivel del estrato granuloso. Conclusión: la MMP-13 no se expresa en biopsias de tejido sano. La expresión se presenta en tejidos que se encuentran en procesos de destrucción o de remodelación (AU)

Gingival overgrowth in children: epidemiology, pathogenesis, and complications. A literature review.

Gingival overgrowth is the enlargement of the attached gingiva due to an increased number of cells. The most prevalent types of gingival overgrowth in children are drug-induced gingival overgrowth, hereditary gingival fibromatosis (HGF), and neurofibromatosis I (von Recklinghausen disease). Gingival overgrowth induced by drugs such as phenytoin, nifedipine, and cyclosporin develops due to an increase in the connective tissue extracellular matrix. According to epidemiologic studies, it is more prevalent in male children and adolescents. There is an additive effect of those drugs on the degree of gingival overgrowth. Genetic heterogeneity seems to play an important role in the development of the disease. Functional difficulties, disfigurement, increased caries, and delayed eruption of permanent teeth are the main complications of drug-induced gingival overgrowth. HGF is the most common syndromic gingival enlargement in children. This autosomal dominant disease usually appears at the time of eruption of permanent dentition. Histologically, it is characterized by highly collagenized connective tissue. The most important complications are drifting of teeth, prolonged retention of primary dentition, diastemata, and poor plaque control. Neurofibromatosis I is an autosomal dominant disease more common in mentally handicapped individuals. Gingival overgrowth is caused by the formation of plexiform neurofibromas in the connective tissue of the gingiva. Plexiform neurofibromas are pathognomonic of the disease and consist of hypertrophic nerves arranged as lobules in the connective tissue. Complications of the disease are multiple and severe due to neurofibromas and their occasional malignant transformation.

Oral health in children with renal disease.

Thirty-eight children (aged 2-16 years) attending a regional kidney unit had a full clinical and radiological dental examination. Twenty had previously undergone a renal transplant, 11 had chronic renal failure and 7 had other renal diseases. Periodontal disease was uncommon The presence of gingival hyperplasia (gum overgrowth), as recorded in 22 of the children, did not show any relationship with the use of immunosuppressant therapy. However, gingival overgrowth was so excessive in 2 patients that surgical removal was required. The prevalence of dental caries was low. Enamel defects were common, and of an unusual pattern, with a much higher prevalence of diffuse opacities and enamel hypoplasia than in the normal child population, 83% and 22%, respectively. This increased prevalence is probably due to disordered calcium and phosphate metabolism. The prevalence of these defects may reflect an early onset of renal disease, since there were a number of very young children in the programme. Dental and medical care should be closely integrated for children with renal disease to avoid the undesirable dental sequelae of, in particular, gingival overgrowth, carcinoma and enamel hypoplasia.