The subgingival microflora in phenytoin-induced gingival hyperplasia

Nonsurgical Management of Phenytoin-induced Gingival Hyperplasia

INTRODUCTION

The aim of this report is to present a severe case of phenytoin (PHT)-induced gingival hyperplasia in a Saudi patient.

MATERIALS AND METHODS

A 12-year-old male epileptic patient, undergoing PHT therapy, was diagnosed clinically with severe gingival hyperplasia. His treatment consisted meticulous oral care and weekly professional prophylaxis. The patient was advised oral folic acid supplementation (0.5 mg/day) and was also recommended 0.2% chlorhexidine gluconate mouthwash twice daily.

RESULTS

There was significant reduction in the hyperplastic tissue within 4 weeks of treatment.

CONCLUSION

It is possible to treat PHT-induced gingival hyperplasia non-surgically with intensive dental care, correct oral hygiene and oral folic acid supplements.

Phenytoin-induced severe gingival overgrowth in a child

Gingival enlargement or overgrowth (GO) is a common complication of the anticonvulsant drug phenytoin (PHT). GO is evident in almost half of the patients receiving PHT therapy. PHT-induced gingival overgrowth (PGO) is more common in children than in adults and affects both males and females equally. PGO may vary from mild to severe and does not seem to be dose dependant. It is supposed that PHT and its metabolites cause a direct effect on the periodontal tissues; however, poor oral hygiene may contribute to the severity of gingival inflammation in patients with PGO. Management of PGO includes meticulous oral hygiene practice to reduce inflammation and surgical excision of the overgrown tissue, known as gingivectomy. We present a case of PHT-induced severe GO in a 10-year-old boy and discuss the clinical features, aetiology, pathogenesis and management of PGO.

Unilateral pathology associated with bilateral etiologies

Hormonal fluctutaions affect not only a woman's reproductive system but surprisingly they have a strong influence on the oral cavity also. These changes are not necessarily the result of direct hormonal action on the tissue, but are perhaps best explained as the effects of the local factors (e.g. plaque on tissues exacerbated by hormonal activity). One such case of pubertal induced gingival enlargement associated with chronic generalized periodontitis caused by the combined influence of hormones and the habit of unilateral mastication is presented here. A 14-year-old girl reported with a complaint of swollen gums in the right maxillary and mandibular arches of the mouth since 2 years. The patient also had the habit of unilateral mastication (left side) since childhood which was revealed upon history. Amelioration of the gingival inflammation and the periodontal attachment loss was obtained through conventional periodontal therapy, including plaque control, scaling, root planing, and surgical removal of the soft tissue using Modified Widman Flap and bone grafting. Postoperative follow-up did not show any signs of recurrence. Pubertal induced gingival enlargement with unilateral masticatory habit needs early removal of enlargement to prevent further bone loss.

Phenytoin-induced gingival overgrowth: a review of the molecular, immune, and inflammatory features

Gingival overgrowth (GO) is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. GO is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. One of the main drugs associated with GO is the antiepileptic phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. Nevertheless, the pathogenesis of such drug-induced GO remains fulfilled by some contradictory findings. This paper aims to present the most relevant studies regarding the molecular, immune, and inflammatory aspects of phenytoin-induced gingival overgrowth.

Drug-induced gingival enlargement - Part II. Antiepileptic drugs: not only phenytoin is involved

INTRODUCTION: Gingival enlargement is the term now used to describe medication-related gingival overgrowth or gingival hyperplasia, a common reactionary phenomenon that occurs with the use of several types of therapeutic agents, including antiepileptic drugs. This disorder has been recognized since 1939, shortly after the introduction of phenytoin. METHODS: Review of literature concerning etiology, pathogenesis and management of antiepileptic drug induced gingival enlargement. CONCLUSIONS: It is important that neurologists become aware of the potential etiologic agents of antiepileptic drug induced gingival enlargement and its characteristic features in order to be able to prevent, diagnose and successfully manage it.

Relationship of periodontal bacteria and Porphyromonas gingivalis fimA variations with phenytoin-induced gingival overgrowth

OBJECTIVES

We investigated the relationship between phenytoin-induced gingival overgrowth (GO) and the harboring of periodontal bacteria.

MATERIALS AND METHODS

Periodontal conditions and subgingival bacterial profiles were examined in 450 sites of 75 subjects. A polymerase chain reaction method was used to detect six bacterial species; Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), Tannerella forsythia, Treponema denticola (Td), Prevotella intermedia (Pi), and Prevotella nigrescens (Pn). Genetic variations of the Pg fimA gene were also examined. Bacterial occurrence was compared with the severity of GO, and alterations in the bacterial occurrence rate and quantities were monitored following periodontal treatment.

RESULTS

The occurrences of Aa, Td, Pi, Pn, and Pg with type II fimA (type II Pg) were significantly associated with the severity of GO. Td occurrence was reduced in association with gingival improvement following ultrasonic scaling, however, no such relationship was observed with Aa, Pi, Pn, and Pg. In addition, Pg and Pi markedly persisted after treatment. Clinical improvement of the sites, following an Er:YAG laser treatment, significantly associated with quantitative reduction of Pg in improved sites, however, not that of Pi.

CONCLUSION

Type II Pg and Td were each found to have a significant relationship with the development and deterioration of GO.

New Rapid Polymerase Chain Reaction-Immunochromatographic Assay forPorphyromonas gingivalis

BACKGROUND

A simple and rapid method for Porphyromonas gingivalis detection in clinical samples has been developed using polymerase chain reaction (PCR) and an immunochromatographic assay (ICA) with a lateral-flow device (strip) to detect species-specific 16S rRNA genes.

METHODS

The PCR used a pair of primer sets labeled with fluorescein isothiocyanate (FITC) or biotin at each 5' terminus. The strip used a nitrocellulose membrane containing streptavidin conjugated to gold particles and anti-FITC line.

RESULTS

PCR and ICA detected as few as 1 and 10 cells of P. gingivalis, respectively. ICA required 5 to 10 minutes more than the initial PCR. The amplifications were not observed in other oral black-pigmented bacteria at concentrations of 10(6) colony forming unit (CFU). The ICA strips showed bands at more than 10(4) CFU/ml equivalents in clinical samples from periodontitis.

CONCLUSIONS

A diagnostic assay based on PCR-ICA was developed for the detection of P. gingivalis, and results were obtained visually in 3 hours. PCR-ICA will be a valuable tool for the rapid detection of target bacteria by chair side.