Gingival overgrowth: Part 1: aetiology and clinical diagnosis

Dentistry and Sturge-Weber syndrome: Case report and narrative review

Sturge-Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a rare congenital disorder that affects the skin, brain, and eye. It is characterized by facial port-wine stains, leptomeningeal angiomas, and glaucoma. SWS can also cause neurological complications, such as seizures, headaches, cognitive impairment, and stroke. Antiepileptic drugs that are used to treat seizures associated with SWS lead to the development of gingival hyperplasia which requires non-surgical and/or surgical dental treatment. The purpose of this case report and narrative review is to provide an overview of the etiology, pathophysiology, clinical features, diagnosis, and treatment of SWS. This paper will also discuss the oral manifestations and dental considerations of SWS.

Fibrocyte: A missing piece in the pathogenesis of fibrous epulis

OBJECTIVES

To explore the role of fibrocytes in the recurrence and calcification of fibrous epulides.

METHODS

Different subtypes of fibrous epulides and normal gingival tissue specimens were first collected for histological and immunofluorescence analyses to see if fibrocytes were present and whether they differentiated into myofibroblasts and osteoblasts upon stimulated by transforming growth factor-β1 (TGF-β1). Electron microscopy and elemental analysis were used to characterize the extracellular microenvironment in different subtypes of fibrous epulides. Human peripheral blood mononuclear cells (PBMCs) were subsequently isolated from in vitro models to mimic the microenvironment in fibrous epulides to identify whether TGF-β1 as well as the calcium and phosphorus ion concentration in the extracellular matrix (ECM) of a fibrous epulis trigger fibrocyte differentiation.

RESULTS

Fibrous epulides contain fibrocytes that accumulate in the local inflammatory environment and have the ability to differentiate into myofibroblasts or osteoblasts. TGF-β1 promotes fibrocytes differentiation into myofibroblasts in a concentration-dependent manner, while TGF-β1 stimulates the fibrocytes to differentiate into osteoblasts when combined with a high calcium and phosphorus environment.

CONCLUSIONS

Our study revealed fibrocytes play an important role in the fibrogenesis and osteogenesis in fibrous epulis, and might serve as a therapeutic target for the inhibition of recurrence of fibrous epulides.

Successful Management of an Emerging Distinct Gingival Lesion With a New Histopathological Identity

Gingival fibroma is a pathological condition that can manifest in pediatric and adult patients, often presenting diagnostic challenges due to shared histopathological characteristics among various lesions. It has been reported as a novel category with distinct histopathological features with new diagnostic criteria. A 40-year-old Saudi female patient with no significant medical history reported a 4×3 cm pedunculated, non-tender, firm, red gingival growth adjacent to the remaining root of tooth number 27 in the maxillary left side. Radiographic assessment yielded remarkable findings. An excisional biopsy was performed, and histopathology analysis confirmed the lesion to be a gingival fibroma. This case marks the first reported instance of gingival fibroma in Saudi Arabia. The recognition of such distinctive histopathological features contributes to improved diagnostic accuracy and highlights the need for vigilance in identifying emerging pathological entities within the gingival overgrowths. The recognition of gingival fibroma as a unique pathological entity is clinically significant, resolving diagnostic challenges in gingival growth cases. Specific diagnostic criteria enable accurate differentiation from similar lesions. The advancement improves patient care and refines the understanding of gingival overgrowth pathogenesis.

Targeting SRD5A1 and MMP-2/NLRP3/TGF-β1 axis alleviates the amlodipine-induced gingival hyperplasia in rats: Emerging role of saw palmetto and folic acid

Saw palmetto (SAW), the herbal drug used to treat prostatic hyperplasia, exerts its antiproliferative effects by blocking steroid 5 alpha-reductase (SRD5A1) activity, that has also been involved in gingival hyperplasia (GH) pathogenesis. Concurrently, folic acid (FA) could reduce GH prevalence via its antioxidant and anti-inflammatory effects. Thus, this study tended to assess the potential therapeutic efficacy of SAW, alone and along with FA, against amlodipine-induced gingival inflammation and overgrowth in rats. Rats were grouped into (CONT, AIGH, SAW, SAW-treated, FA-treated, and SAW + FA-treated). SAW and FA were administered once daily for 4 weeks. Gingival SRD5A1, CTGF, GSK-3β, and NLRP3 expressions, as well as T, DHT, MDA, TAC, ET-1, and MMP2 levels were determined. In addition, histopathological and immunohistochemical analyses of TNF-α, IL-6, TGF-β1, and α-SMA were documented. Results declared that SAW and FA administration markedly ameliorated amlodipine-associated GH and may be presenting a novel therapeutic avenue in the future.

Management of Orthodontic Therapy-Associated Gingival Overgrowth for Esthetic Consideration in Anterior Maxillary Region: A Case Report

Gingival inflammation and fibrous type of overgrowth, or a combination of both can lead to gingival enlargement (GE), and this negatively affects mainly masticatory function and esthetics, and sometimes causes psychological issues in patients. A typical characteristic of gingival diseases is gingival overgrowth, which can be brought on by fibrous overgrowth, gingival inflammation, or a combination of the two. It is a complex ailment arising from interactions between the environment and the host or different stimuli. Patients frequently have misaligned teeth, which encourages the buildup of bacterial plaque and unintentionally fuels gingival inflammation. Fixed orthodontic equipment can rectify this misalignment but they may also promote plaque buildup and the ensuing development of GE, gingival invaginations, and generalized hyperplastic gingivitis. The attachment of application and the rise in the amount of discernible supra- and subgingival plaque cause changes in microbial growth. Moreover, the force used in the treatment tends to activate the gingival soft tissue response. Clinical consequences such as persistent infection, inflammatory hyperplasia, gingival recession, attachment loss, or gingival overgrowth may arise after the device is placed. 'Plaque-induced' and 'non-plaque-induced' gingival disorders, such as gingival overgrowth, can be distinguished; however, a more precise fundamental etiology is frequently discernible. Several hereditary, systemic, or infectious diseases do not depend on plaque induction. Accompanying plaque accumulation in certain circumstances may make the clinical appearance worse. The case described here is of a 21-year-old female patient presenting with anterior maxillary GE associated with lateral incisors with orthodontic therapy. Surgical therapy was carried out to provide an excellent esthetic outcome for the patient.

The yes-associated protein-1 (YAP1) inhibitor celastrol suppresses the ability of transforming growth factor β to activate human gingival fibroblasts

OBJECTIVE

To determine whether celastrol, an inhibitor of the mechanosensitive transcriptional cofactor yes-associated protein-1 (YAP1), impairs the ability of TGFβ1 to stimulate fibrogenic activity in human gingival fibroblast cell line.

DESIGN

Human gingival fibroblasts were pre-treated with celastrol or DMSO followed by stimulation with or without TGFβ1 (4 ng/ml). We then utilized bulk RNA sequencing (RNAseq), real-time polymerase chain reaction (RT-PCR), Western blot, immunofluorescence, cell proliferation assays to determine if celastrol impaired TGFβ1-induced responses in a human gingival fibroblast cell line.

RESULTS

Celastrol impaired the ability of TGFβ1 to induce expression of the profibrotic marker and mediator CCN2. Bulk RNAseq analysis of gingival fibroblasts treated with TGFβ1, in the presence or absence of celastrol, revealed that celastrol impaired the ability of TGFβ1 to induce mRNA expression of genes within extracellular matrix, wound healing, focal adhesion and cytokine/Wnt signaling clusters. RT-PCR analysis of extracted RNAs confirmed that celastrol antagonized the ability of TGFβ1 to induce expression of genes anticipated to contribute to fibrotic responses. Celastrol also reduced gingival fibroblast proliferation, and YAP1 nuclear localization in response to TGFβ1.

CONCLUSION

YAP1 inhibitors such as celastrol could be used to impair pro-fibrotic responses to TGFβ1 in human gingival fibroblasts.

Assessment of Negative Gingival Recession: A Critical Component of Periodontal Diagnosis

Accurate measurement of negative gingival recession (GR) is essential to accurately determine the clinical attachment loss, which leads to an accurate diagnosis and optimal therapy of periodontal disease. However, the accuracy of measuring the negative GR has been shown to be low and highly variable between examiners. The position of the gingiva margin in relation to the cemento-enamel junction (CEJ) varies among different stages of passive eruption. The amount of negative GR is about 2 mm on average at the mid-facial sites and ranges from 2 to 3.5 mm at interproximal sites in periodontally healthy patients. Some other clinical conditions may change the gingival dimension coronal to the CEJ, such as altered passive eruption and gingival enlargement. In addition to the traditional approach using a periodontal probe to assess the negative GR, nowadays dental ultrasound imaging may be able to assist in accurately measuring the amount of negative GR. This narrative review will discuss the existing evidence of the dimension of dentogingival tissue and the clinical assessment of negative GR using different clinical tools.

Impact of Immunosuppressive Drugs on Fibroblasts: An In Vitro Study

Background: The aim of this study was to compare the direct impact of different agents for immunosuppressive therapy on mouse fibroblasts as a possible cause of drug-induced gingival overgrowth (DIGO). Methods: 3T3 mouse fibroblasts were cultivated in cell-specific media (2 × 104 cells/mL) and treated for 6, 24, 48 and 72 h with one of three immunosuppressive drugs (IsDs): cyclosporin a (CsA), tacrolimus (TaC) and sirolimus (SiR). Different concentrations (10−750 ng/mL) were used to mimic serum levels under active immunosuppressive therapy conditions. Cell population characteristics (cell number, viability and morphology) were assessed using computer-assisted cell analysis. Expression of pro-collagen type I carboxy-terminal propeptide (PICP) was identified using an ELISA assay. Results: The influence of IsDs on the biological status of 3T3 fibroblasts was time- and dose-dependent. Comparing CsA and TaC, the total cell amount was enhanced using concentrations in the range of 10−150 ng/mL (p > 0.05). In contrast, treatment with SiR resulted in a decrease in the average cell number (p < 0.01). PICP and cell diameter of fibroblasts were not susceptible to IsD treatment (p > 0.05). Conclusions: Our results revealed time-dependent effects of IsDs, with distinct influences on cell number. The cell morphology and the PICP balance of the investigated fibroblast cell line remained unaffected. Hence, the potential role of IsDs is not a unilateral mechanism of action but rather a multifactorial process.

Non-Plaque Induced Diffuse Gingival Overgrowth: An Overview

Non-plaque induced diffuse gingival overgrowth represents a broad class of conditions caused by several etiological factors. The aim of this review is to highlight the most recent updates and classifications of all the existent gingival overgrowths. In addition, we highlighted the diagnostic pathway that should be employed in patients affected by gingival overgrowth. Gingival overgrowth can be related to syndromic diseases including a wide spectrum of genetic and chromosomal alterations. However, thanks to scientific sharing and the availability of genetic panels it is possible to obtain an accurate phenotypic identification of well-known syndromes and also to identify new ones. This narrative review shows that through rigid, strict diagnostic protocols, the work of the clinician is greatly facilitated, despite the wide variety of pathologies considered. In conclusion, the exchange of specialists’ competencies and the multidisciplinary management of these patients, are crucial to reach diagnosis and the correct clinical-therapeutic management.

Comprehensive evaluation of factors that induce gingival enlargement during orthodontic treatment: A cross-sectional comparative study

Background

Gingival enlargement (GE) is one of the most common soft tissue problems encountered during fixed orthodontic treatment. Aims: This study aimed to evaluate the factors affecting GE in adolescents and young adults, compared with their normal peers.

Subjects and Methods

This is a cross-sectional comparative study. The sample consisted of 329 subjects (ages 10-30 years) of both genders, which was divided into four main groups: The control group (G0) with no orthodontic treatment; subjects who underwent orthodontic treatment were divided according to treatment duration into G1 (4-12 months), G2 (13-24 months), and G3 (>24 months). The clinical examinations included the level of debris, calculus (simplified oral hygiene), and GE indices. Regression analyses were used to assess the GE association in all the studied groups.

Results

The mean GE score increased significantly with increased treatment duration (0.42 ± 0.29 for G0 and 1.03 ± 0.52 for G3). GE scores of the lower arch were significantly higher in the anterior segment than in the posterior segment among all treatment groups. Regression analysis revealed that gender, age, oral hygiene, and treatment duration had a significant effect on GE (P < 0.05), while angle classification, overjet, overbite, treatment stage, bracket type, and therapeutic extraction did not show significant associations (P > 0.05).

Conclusion

Gender, age, oral hygiene, and treatment duration were the most important risk factors for GE during fixed orthodontic treatment.

Systemic medicines taken by adult special care dental patients and implications for the management of their care

Introduction Significant changes have taken place in the profile of prescription medicines being taken by the adult UK population over the last decade. The aims of this article are to review the literature to understand the overall trends and underlying factors, and then to compare this with the medication profile of a cohort of adult special care dental (SCD) patients. Materials and method Five hundred patient records were examined and retrospective data on systemic medicines being taken were obtained and classified according to the index used in the British National Formulary (BNF).Results The results revealed a high level of polypharmacy with 57% of SCD patients taking three or more medicines compared to 24% of the population in England. Antiepileptic drugs were the most frequently taken group of medicines (42%), followed by antidepressants (39.7%) and antipsychotics (37.6%). Conclusions Our results demonstrate the medical complexity of patients in this cohort and enable clinicians to increase their familiarity with the most commonly taken medicines and the tools available to manage the implications for dental care.

High expression of aryl hydrocarbon receptor (AhR) plays an important role in the formation of fibrous epulis

OBJECTIVES

Epulis is considered to be a massive reactive lesion rather than a true neoplasia. AhR is thought to be associated with inflammation and development of neoplasms. Here, we aimed to observe the expression of AhR in fibrous epulis and explore its role and possible mechanism in the pathogenesis of epulis.

MATERIALS AND METHODS

Epulis and normal gingival tissues were collected, and AhR expression was detected at the mRNA and protein levels by quantitative polymerase chain reaction (qPCR) and immunohistochemistry, respectively. The expression levels of proinflammatory cytokines and apoptosis-related factor genes in human periodontal ligament cells (hPDLCs) and human gingival fibroblasts (hGFs) transfected with AhR short interfering RNA (siRNA) or negative control siRNA, upon stimulation with lipopolysaccharide of Porphyromonas gingivalis (Pg-LPS), were then examined. Finally, the expression levels of the proinflammatory cytokines and apoptosis-related factor genes in the epulis tissues were observed by qPCR.

RESULTS

AhR expression in fibrous epulis was significantly increased at both the mRNA and protein levels. The expression of proinflammatory cytokines and apoptosis-related factor genes in hPDLCs transfected with AhR siRNA was significantly decreased when stimulated with Pg-LPS. The same trends were observed for hGFs. The opposite trend was detected in the epulis tissues.

CONCLUSION

AhR may be a key factor in fibrous epulis pathogenesis that acts by regulating the expression of BCL2 family genes and inflammatory factor-related genes.

Symptom-orientated oral hygiene for children after heart transplantation: Effectiveness of a standardized prophylactic program

Children with CHD, especially heart-transplanted patients, are predisposed to have caries lesions, gingivitis and other oral findings like gingival hyperplasia. The aim of the study was the implementation of a specific oral hygiene program in these patients and its effect on the improvement of oral health, especially gingival overgrowth. For this, we used a newly developed systematic GHI to evaluate and describe this gingival alteration. Thirty-three children, aged 6 to 15 years with cardiac transplants (9 girls, 24 boys), were examined and introduced into a specific oral hygiene program. Each child showed evidence of gingival hyperplasia. They were randomly divided into three groups with the following oral care measurements: Group ZZ tooth brushing, Group ZZS tooth brushing and mouth rinsing, Group ZZSS tooth brushing, mouth rinsing and the use of an additional single and sulcus toothbrush. A significant decline of all oral health parameters could be proven in all groups. Gingival hyperplasia (GHI) improved as well as plaque accumulation (QHI). The children who used in addition to toothbrushing rinsing solutions and/or additional miniature toothbrushes showed better parameters of the gingival hygiene indexes from the baseline examination until the end of the study. The results show that any infant with cardiac transplant has to be introduced into an individualized oral hygiene program underlining the need of comprehensive dental care in cooperation with pediatric cardiology.

Quantification of matrix metalloproteinases MMP-8 and MMP-9 in gingival overgrowth

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Protein dot-blot method is suitable to compare expression levels of MMP-8 and MMP-9 in gums.

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The relative levels of MMP-8 and MMP-9 in mild and moderate gingival overgrowth were measured.

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Biological variability among individuals did not affect assay development.

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The protein dot blot was fast, highly sensitive, repeatable and economic.

Background

Matrix metalloproteinases (MMPs) are proteolytic enzymes involved in extracellular matrix remodeling of all body tissues, including oral tissues such as gingival tissue. Expression levels of MMPs are widely studied as important biomarkers for explaining the biochemical mechanisms and evolution of many oral diseases.

Objective

Demonstrate the sensitivity, reproducibility, repeatability, and robustness of the dot blot assay for the relative quantification of MMP-8 and MMP-9 expression levels in patients with GO associated with orthodontic treatment.

Methods

A validated dot blot assay was used to compare the relative expression levels of MMP-8 and MMP-9 in gingival samples. Methodological variability, reproducibility, sensitivity and robustness were determined with the use of control samples from healthy donors (G1). Next, expression levels were measured in gingival tissue from patients with mild and moderate gingival overgrowth associated with orthodontic treatment (G3 and G4) and patients without gingival overgrowth but with a history of using orthodontic appliances (G2).

Results

Dot blot assay demonstrated that MMP-8 and MMP-9 expression levels were higher in patients with gingival overgrowth and distinguished those with moderate clinical grade (G4) from those with mild overgrowth (G3). In addition, patients with a history of orthodontic treatment showed similar expression levels to the control group two years after removing orthodontic appliances.

Conclusions

With the assay used, we were able to detect differences in MMP-8 and MMP-9 expression in patients with different levels of severity of gingival overgrowth. Dot blot could be used to measure MMPs during the onset and progression of gingival overgrowth.

Clinical periodontal, bacterial, and immunological outcomes of antimicrobial photodynamic therapy in orthodontic treatment-induced gingival enlargement

AIM

The aim of the present clinical trial is to evaluate the clinical, bacterial, and immunological outcomes of photodynamic therapy (PDT) in adolescent patients with orthodontic treatment-induced gingival enlargement (OTGE).

MATERIALS AND METHODS

A total of 26 adolescent patients, 16 girls and 10 boys, of mean age 16.8 years, undergoing fixed orthodontic treatment for at least 6 months (mean duration in months, 8.3 ± 1.9) and presenting with GE were included in the clinical trial. All patients undergoing fixed orthodontic treatment with clinical diagnosis of OTGE were divided into two groups: Patients receiving full-mouth periodontal debridement (FMPD) 'Group-FMPD' and 'Group-PDT' included participants receiving methylene blue-assisted PDT in the selected area along with FMPD. Clinical periodontal assessments included the evaluation of plaque scores (PS), bleeding on probing (BOP), probing depth (PD) and hyperplastic index (HI). The total bacterial counts of Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), and Tannerella forsythia (T. forsythia) were estimated and expressed as log CFU/mL of each bacteria. Cytokines including interleukin (IL)-1β and IL-6 were analyzed using enzyme-linked immunosorbent assay (ELISA) kit.

RESULTS

The mean percentage of PS and BOP statistically significantly reduced with both FMPD and PDT from baseline to 4 weeks (p < 0.05). Although mean PD significantly reduced in both the groups at all time points, there was significantly higher reduction with PDT as compared to FMPD at 2 weeks post treatment (p < 0.05). Inter-group comparison showed PDT demonstrated significantly higher HI at 2- and 4-weeks post treatment (p < 0.05). The mean log CFU/mL of P. gingivalis and T. forsythia showed statistically significantly higher reduction with PDT than FMPD (p < 0.05) at both 2-and 4-weeks follow-up. T. denticola reported significantly reduced levels at 2 weeks follow-up period only with PDT (p < 0.05). No statistically significant difference appeared when both treatment modalities were compared with one another (p > 0.05). Four weeks after periodontal treatment, IL-6 significantly reduced with PDT compared to FMPD (p < 0.05).

CONCLUSION

PDT assisted in reducing bacterial counts and improving hyperplastic index in OTGE.

Generalized hereditary gingival fibromatosis in a child: clinical, histopathological and therapeutic aspects

Hereditary gingival fibromatosis (HGF) is a rare genetic condition characterized by slow and progressive gingival enlargement. The gingival overgrowth often delays teeth eruption and may cause serious functional and aesthetic problems. We reported a case of a 10-year-old female child presenting a generalized gingival enlargement covering almost all the maxillary and mandibular teeth and resulted in problems for swallowing, speaking, and poor aesthetics. An incisional biopsy was performed and revealed a hypocellular and hypovascular dense collagenous tissue covered by squamous epithelium exhibiting acanthosis and elongated rete ridges. The diagnosis was HGF. The treatment instituted was an association of gingivectomy with a rigorous program of oral hygiene and follow-up. Herein, we describe a rare non-syndromic case of generalized HGF, including clinical and microscopical features, as well as highlighting the importance of correct diagnosis of this genetic condition.

Nizam MN, Alshammari A. An Update on the Mechanisms of Phenytoin Induced Gingival Overgrowth

Background:

Phenytoin induced gingival overgrowth, a side effect with multifactorial aetiology, is characterized by an increase in the volume of extracellular tissues, particularly collagenous components, with varying degrees of inflammation.

Objective:

The aim of this paper is to review the available literature regarding the pathophysiological mechanisms of phenytoin induced gingival overgrowth.

Methods:

A thorough literature search of the PubMed/ Embase/ Web of science/ Cochrane central database was conducted to identify the mechanisms involved in the process of phenytoin-induced gingival overgrowth using the following keywords: Phenytoin; Anticonvulsant; Gingival Overgrowth; Gingival Enlargement, Gingival Hyperplasia; Drug Induced Gingival Enlargement; Drug Induced Gingival Overgrowth

Results:

According to the available evidence, several mechanisms have been proposed addressing the pathophysiological mechanism of phenytoin induced gingival overgrowth both at a cellular and molecular level. Evidence suggests that the inflammatory changes in the gingival tissues orchestrate the interaction between phenytoin and fibroblasts particularly resulting in an increase in the extracellular matrix content.

Conclusion:

However, the mechanism of production of inflammatory mediators is not fully understood. This, together with the high prevalence of Phenytoin induced gingival overgrowth, warrants further research in this area in order to develop treatment and preventive strategies for the management of this condition.

Dental plaque-induced gingival conditions

OBJECTIVE

This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system.

IMPORTANCE

Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis.

FINDINGS

The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy.

CONCLUSIONS

Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.

Awareness of the Relationship between Systemic and Periodontal Diseases among Physicians and Dentists in Saudi Arabia and Kuwait: Cross-sectional Study

Background:

Previous studies have shown possible association between periodontal diseases and Diabetes Mellitus (DM), Cardiovascular Disease (CVD) and Adverse Pregnancy Outcomes (APO). Increasing the knowledge of physicians and dentists regarding the association between periodontal disease and systemic diseases should improve their ability to provide a high standard of treatment for the disease and prevent its consequences. In our study, we sought to identify knowledge gaps in the awareness of the relationship between systemic and periodontal diseases among dentists and physicians from the Kingdom of Saudi Arabia and the State of Kuwait.

Methods:

A cross-sectional study was performed with a convenient sample of selected physicians and dentists in Saudi Arabia and Kuwait using a self-developed structured questionnaire. Physicians’ and dentists’ awareness were assessed regarding current evidence of the relationship between systemic diseases and conditions (DM, CVD, APO) and periodontal diseases.

Results:

A total of 134 (21.5%) of the identified physicians and 485 (78%) of the identified dentists participated in this study. More than half of the participants (52.1% physicians and 67.5% dentists) agreed that there is a relationship between periodontal diseases and DM, CVD and APO. Dentists had a statistically higher level of awareness compared with the physicians. The findings related to the awareness of the dentist sub groups highlighted that periodontists were significantly more likely to have a good level of knowledge.

Conclusion:

Within the limitations of this study, we concluded that the awareness of physicians and dentists regarding the relationship between periodontal diseases and systemic diseases (DM, CVD, APO) is generally low, Therefore, improved collaboration between medical and dental health providers is recommended.

Change of TGF-β1 Gene Expression and TGF-β1 Protein Level in Gingival Crevicular Fluid and Identification of Plaque Bacteria in a Patient with Recurrent Localized Gingival Enlargement before and after Gingivectomy

This case report highlights the change of TGF-β1 gene expressions and TGF-β1 protein level in gingival crevicular fluid (GCF) and identification of plaque bacteria in a patient with recurrent localized gingival enlargement before and after gingivectomy treatment. A 26-year-old woman came to AG Dental Care Clinic, South Sulawesi, Indonesia, in October 2015 with a chief complaint that her gingiva often bled spontaneously and she felt pain on her gingiva and felt less comfortable and no self-confidence with her anterior and posterior gingival condition on the right maxilla region which is slightly larger than normal. She often felt that her gingiva could bleed spontaneously when she was talking or remains silent though. The patient is disturbed by the malodor she felt. At that moment, the patient sought for gingivectomy treatment. Three years afterward, the patient came back with the same complaint. Gingival crevicular fluid has been taken from the gingival sulcus before and after gingivectomy. Clinical and GCF follow-up examination was performed one week and three weeks after gingivectomy, and successful results on biological, functional, and aesthetic parameters were observed.

Allergy to acrylate in composite in an orthodontic patient: a case report

Acrylate allergies have been reported in dental professionals as a result of repeat exposure to various acrylate monomers and in dental patients with removable prostheses or longstanding composite restorations. To date, there is only one report of an allergic reaction in a young patient from small volumes of resin-based orthodontic adhesive. This case report demonstrates a recent case of gingival inflammation and lip oedema attributed to an acrylate allergy arising from the composite adhesive used with fixed appliances. The impact on orthodontic treatment is reported and the wider implications for dentistry are discussed.