Periodontal condition of epileptic adults treated long-term with phenytoin or carbamazepine

The periodontal condition of 40 adult epileptic subjects (mean age 51 years) receiving long-term therapy (mean 18 years) with phenytoin (PHT) or carbamazepine (CBZ) was studied. The subjects completed a questionnaire and underwent clinical and radiologic examination. Patients receiving PHT exhibited the same level of alveolar bone loss as those receiving CBZ. Patients receiving PHT exhibited more units with gingival overgrowth, reflected by the significantly higher number of gingival units with increased probing depth (p < 0.05). The results indicate that long-term PHT does not result in increased risk for alveolar bone loss as compared with CBZ.

Documented clinical side-effects to dental amalgam

Since all dental restorative materials are foreign substances, their potential for producing adverse health effects is determined by their relative toxicity and bioavailability, as well as by host susceptibility. Adverse health effects to dental restoratives may be local in the oral cavity or systemic, depending on the ability of released components to enter the body and, if so, on their rate of absorption. The medical scientific community is now in general agreement that patients with dental amalgam fillings are chronically exposed to mercury, that the average daily absorption of mercury from dental amalgam is from 3 to 17 micrograms per day, and that the amalgam mercury absorption averages 1.25-6.5 times the average mercury absorption from dietary sources (World Health Organization, 1991). The health significance of this chronic mercury exposure is now being investigated by several medical research groups.

Steroid-induced mandibular bone loss in relation to marginal periodontal changes

Long-term high-dose glucocorticosteroid treatment may be suspected as causing profound marginal periodontal bone loss due to the immunosuppressive/antiinflammatory effects and due to the osteoporotic side-effects. This study comprised an analysis of the loss of the mandibular and forearm bone mineral content (BMC), measured in vivo by dual-photon scanner, in relation to the concomitant changes of the periodontal indices (visible plaque, gingival bleeding, loss of attachment) in 17 acute nephrotic dentate patients undergoing intensive steroid treatment for 12 months. The measurements were performed at start of treatment, when all patients were considered healthy as regards the skeleton, and at the 6-month and 12-month follow-up. The mean BMC loss at the standard sites of the mandible and the forearm bones was 5.6%/year at both sites. No significant changes could be demonstrated in the periodontal indices (P greater than 0.10), and no relation was found between the mandibular BMC loss and the periodontal condition (R = 0.06, P greater than 0.10). In conclusion, profound marginal periodontal bone loss does not seem to be a prominent side-effect of long-term glucocorticosteroid treatment, although the degree of induced osteopenia in the mandible corresponds to that in other cortical bones of the skeleton.

[Behaviour of gingival elastic constituents in periodontal disease]

Disorganization of gingival elastic constituents, including oxytalan fibers, elaunin fibers, and mature elastic fibers, is a feature of periodontal disease. In early stages where inflammation is moderate, this disorganization involves only oxytalan fibers. As the disease progresses, fragmentation and lamination of elaunin fibers and mature elastic fibers is seen. In cyclosporin A-induced gingival hyperplasia, there is a substantial increase in the amount of elastic fibers as compared with healthy gingiva. In gingival fragments from edentulous elderly individuals the elastic constituents form dense granules.

Medication side effects of dental interest

Many dental patients require continuing medication. With some, the medications will have side effects that have an oral or perioral manifestation. Commonly prescribed medications and their dental side effects are listed. This information may aid patients who have oral symptoms unrelated to the needed dental care.

Prepubertal periodontitis: a review of diagnostic criteria, pathogenesis, and differential diagnosis

This paper reviews the literature on prepubertal periodontitis (PP) according to the definition and the classification of PP by Page. The generalized form of PP (G-PP) defined by Page was identified as the oral manifestation of a systemic disease called leukocyte adhesion deficiency (LAD) and thus the pathogenesis is known at the molecular level. On the other hand, the localized form of PP (L-PP) is a disease defined by clinical criteria and its pathogenesis is not known at the molecular level. The reported prevalence of L-PP differs widely in reports, according to the methodology and population studied. However, it seems to be at least 0.84% or greater. Potential periodontal pathogens that have been associated with L-PP include the following bacteria: Actinobacillus actinomycetemcomitans (A.a.), Bacteroides intermedius, Bacteroides gingivalis, Capnocytophaga sputigena, and Eikenella corrodens. Suggested contributing factors have included PMN or monocyte chemotactic defects and cementum defects. There is no unique pattern of bone loss in L-PP; however, there may be a type of periodontitis that affects all deciduous teeth, in the absence of LAD. L-PP may lead to localized juvenile periodontitis (LJP) or generalized juvenile periodontitis (GJP). Histiocytosis X, hypophosphatasia and mild forms of blood dyscrasias may have minimal or no clinical signs and symptoms except for alveolar bone loss. Therefore diseases known to be associated with alveolar bone loss must be definitively excluded in prepubertal children until the pathogenesis of L-PP at the cellular and molecular levels is understood and L-PP can be definitively diagnosed either as a distinct disease entity or entities.

[Odontostomatological problems in patients with neoplastic pathology treated by chemotherapy. A bibliographic review]

A careful examination of the mouth should be a routine check in patients affected by neoplasms before commencing chemotherapy. This allows an appropriate programme of odontostomatologic treatment to be drawn up and put into practice before, during and after the administration of anti-blastic drugs. Together with instructions for the maintenance of oral hygiene which should be given to the patient, this treatment will reduce the morbidity and mortality which is induced, either directly or indirectly by chemotherapy.

Drugs and the periodontium

The periodontium and periodontal disease activity can be affected by systemic drug therapy. Many drugs can have an adverse effect on the periodontium, i.e., gingival hyperplasia. Alternatively, some drugs can modify the inflammatory and immunological responses of the periodontal tissues to bacterial plaque. The aim of this review is to evaluate the effects of drug therapy on the periodontium and periodontal disease activity, and where possible, to relate such changes to the pharmacodynamics of the drugs considered. Drugs which have been reported to affect the periodontium can be categorised as follows: anti-epileptics, immunosuppressants, corticosteroids, non-steroidal anti-inflammatory drugs and hormones. Those drugs whose pharmacodynamics are clearly established and which affect the rate of periodontal disease activity, may provide information on the mechanisms of periodontal destruction. Finally, the mechanisms of drug-induced gingival hyperplasia (overgrowth) are discussed in relationship to the drugs' pharmacodynamics and pharmacokinetics.

Periodontium destruction associated with oncology therapy. Five case reports

Radiation treatment to the head and neck and cytotoxic chemotherapy can produce deleterious side effects to the periodontium that are generally transient in nature, reversible, and do not result in permanently visible defects. However, combinations of the malignant disease itself, the direct and indirect effects of medical therapy and associated oral infections, along with local trauma can lead to periodontal tissue destruction with resulting permanent architectural defects. Five case reports illustrate destructive alterations of the periodontium that were associated with oncology therapy. Proposed guidelines for periodontal treatment of compromised individuals undergoing oncology therapies are suggested.

Rapid loss of alveolar bone associated with nonprecious alloy crowns in two patients with nickel hypersensitivity

In recent years there has been a dramatic increase in the use of nonprecious alloy and porcelain crowns in clinical dentistry. The alloy in these restorations frequently contains a high percentage (greater than 70%) of nickel. Most cases of metal hypersensitivity are related to nickel, and clinical manifestations of the hypersensitivity are the result of a cellular (T lymphocyte) immune response. In this report, we review the cases of two women who demonstrated significant loss of alveolar bone about nickel-rich nonprecious alloy and porcelain crowns. The loss of alveolar bone occurred within 18 months after placement of the restorations. Both individuals displayed a positive patch test to a nickel preparation. These findings suggest that a Type IV hypersensitivity reaction may have accounted for the rapid loss of alveolar bone. Though the majority of individuals treated with nonprecious alloy and porcelain crowns apparently tolerate these restorations quite well, greater care is urged in case selection.

Cemento-fibrous dysplasia of the periodontal membrane (studies of the European hamster maxillary incisor)

The periodontal membrane of European hamster maxillary incisors showed histologic changes consisting of an irregularly orientated, less vascularized connective tissue which included abundant cementicle-like structures. The changes were multifocal and bilateral, growing towards the alveolar bone (Grade 1), causing atrophy of the alveolar bone due to compression (Grade 2) and reaching the periosteal membranes (Grade 3). In a few animals, the lesions were seen after one year. They were seen in 80% of hamsters more than 2 years old. Carcinogenic exposure did not alter the latency and incidence of the alterations. The lesions were thought to be a spontaneously occurring disease representing a nodular cemento-fibrous dysplasia of the periodontium. As, morphologically, no exact attribution to other odontogenic or mesenchymal growth could be made, the entity of this periodontal lesion was considered. Although the changes observed in the periodontal membrane of the maxillary incisors of the European hamster were not exactly comparable to odontogenic cemental lesions in man, they may serve as a model to further clarify the nature of fibro-osseous lesions.

The effects of phenytoin and sodium valproate on the periodontal health of adult epileptic patients

The periodontal health of 30 adult epileptic patients treated with either sodium valproate or phenytoin was compared with a control group (n = 15) of otherwise healthy patients. The 3 groups were matched for age and sex. Patients on phenytoin therapy showed significantly higher plaque scores (P less than 0.05), gingival index (P less than 0.05) and pocketing (P less than 0.05) than patients in the control group. The % of gingival hyperplasia was significantly higher (P less than 0.05) in the phenytoin-treated patients than those on sodium valproate or in the control group. However, patients on phenytoin therapy had significantly less bone loss than those on sodium valproate (P less than 0.05) or in the control group (P less than 0.01). No significant differences were observed between the sodium valproate group and the control group on any of the parameters assessed. The results from this study would suggest that sodium valproate has no unwanted effects on periodontal health and may be considered a safe alternative, regarding the periodontal aspects, to phenytoin for the treatment of adult onset epilepsy.

Cyclosporine therapy. Its significance to the periodontist

Cyclosporine is a relatively new immunosuppressive agent which has been used successfully to prevent organ transplant rejection, to treat type-I diabetes mellitus as well as several other autoimmune disorders. It is anticipated that the therapeutic use of cyclosporine will progressively increase in the future to include the treatment of numerous other disorders. As its clinical use broadens, more health professionals will need to become familiar with the beneficial effects as well as some of the undesirable side-effects of cyclosporine therapy. Two side-effects of the drug which are of interest to the periodontist are gingival hyperplasia and transient perioral hyperaesthesia. It is anticipated that the dental profession, particularly periodontists, will be called upon to help prevent, control or treat these side effects. The purpose of this paper is to familiarize the periodontist with cyclosporine and to discuss its anticipated impact on the practice of periodontics.

The effect of chronic beta-aminoproprionitrile intoxication on the periodontium of the rat. A light microscopic and histochemical study with review of the literature

This histologic study of the periodontium of male white rats with chronic lathyrism demonstrates the appearance, progression, and persistence of certain pathologic changes caused by disordered collagen synthesis and maturation. Typical lesions were seen after 6 weeks. These include increased vascularity, especially in the periapical region, hyalinization and calcification of the transseptal fibers, alveolar bone and cementum resorption, interruption of the periodontal fibers with formation of typical hyaline zones surrounded by palisades of atypical fibroblasts, known as "lathyritic bodies," and an increase in mast cells.