1
|
Quaranta A, D'Isidoro O, Piattelli A, Hui WL, Perrotti V. Illegal drugs and periodontal conditions. Periodontol 2000 2022; 90:62-87. [PMID: 36183328 PMCID: PMC9828249 DOI: 10.1111/prd.12450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. With regard to the impact of illegal substance use on periodontal conditions, there is moderate evidence that regular long-term use of cannabis is a risk factor for periodontal disease, manifesting as a loss of periodontal attachment, deep pockets, recessions, and gingival enlargements. Limited evidence also shows that the use of cocaine can cause a series of gingival conditions that mostly presents as chemical induced-traumatic lesions (application of cocaine on the gingiva) or necrotizing ulcerative lesions. There is a scarcity of data regarding the impact of other drug use on periodontal health. There is evidence to suggest that regular long-term use of cannabis is a risk factor for periodontal disease and that the use of cocaine can cause a series of periodontal conditions. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information.
Collapse
Affiliation(s)
- Alessandro Quaranta
- School of DentistryUniversity of SydneySydneyNew South WalesAustralia,Smile Specialists SuiteNewcastleNew South WalesAustralia
| | | | - Adriano Piattelli
- Dental SchoolSaint Camillus International University for Health Sciences (Unicamillus)RomeItaly,Casa di Cura Villa SerenaCittà Sant'Angelo, PescaraItaly
| | - Wang Lai Hui
- Smile Specialists SuiteNewcastleNew South WalesAustralia
| | - Vittoria Perrotti
- Department of Medical, Oral and Biotechnological Sciences (DSMOB)University of Chieti‐PescaraChietiItaly
| |
Collapse
|
2
|
Phenytoin Is Promoting the Differentiation of Dental Pulp Stem Cells into the Direction of Odontogenesis/Osteogenesis by Activating BMP4/Smad Pathway. DISEASE MARKERS 2022; 2022:7286645. [PMID: 35493301 PMCID: PMC9050280 DOI: 10.1155/2022/7286645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Abstract
Background The purpose of this study was the evaluation of the potential and mechanism of phenytoin to promote differentiation of human dental pulp stem cells (hDPSC) into odontoblasts/osteoblasts. Methods Fourth-generation human hDPSC originating from healthy pulp of third molars was cultured in control as well as phenytoin-containing media (PHT) for 14 days. qPCR was applied to detect the expression of DSPP, DMP1, and ALP genes. Western blot analysis was used to confirm the findings. One-way analysis of variance (ANOVA) was used for statistical analysis (p < 0.05). Information about phenytoin was assessed from PubChem database, while targets of phenytoin were assessed from six databases. Drug targets were extracted based on the differentially expressed genes (‖logFC‖ ≥ 1, p < 0.05) in the experimental group (50 mg/L PHT, 14 days). GO BP and KEGG pathway enrichment analysis on the obtained drug targets was performed and the target protein functional network diagram was constructed. Results A concentration below 200 mg/L PHT had no obvious toxicity to hDPSC. The expression of DSPP, DMP1, and ALP genes in the 50 mg/L PHT concentration group increased significantly. The WB experiment showed that the protein content of BMP4, Smad1/5/9, and p-Smad1/5 was significantly increased in 50 mg/L PHT in comparison with the NC group (the group without treatment of PHT) at 14 days. Conclusion Phenytoin has the ability of promoting the differentiation of hDPSC into odontoblasts and osteoblasts. BMP4/Smad pathway, inducing odontogenic/osteogenic differentiation of hDPSC, appears a main process in this context.
Collapse
|
3
|
Çakan D, Uşaklıoğlu S. The effect of locally administered phenytoin on wound healing in an experimental nasal septal perforation animal model. Eur Arch Otorhinolaryngol 2022; 279:3511-3517. [DOI: 10.1007/s00405-022-07276-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/17/2022] [Indexed: 01/15/2023]
|
4
|
Fattahi N, Abdolahi A, Vahabzadeh Z, Nikkhoo B, Manoochehri F, Goudarzzadeh S, Hassanzadeh K, Izadpanah E, Moloudi MR. Topical phenytoin administration accelerates the healing of acetic acid-induced colitis in rats: evaluation of transforming growth factor-beta, platelet-derived growth factor, and vascular endothelial growth factor. Inflammopharmacology 2022; 30:283-290. [PMID: 35022915 DOI: 10.1007/s10787-021-00885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
Ulcerative colitis (UC), limited to the colon's innermost lining, has become a global health problem. Immunomodulatory and monoclonal antibodies are used to treat UC despite their side effects and limitations. Phenytoin is used to heal wounds owing to its effects on growth factors, collagen, and extracellular matrix synthesis. This study aimed to evaluate the effect of topical phenytoin administration in UC. Phenytoin was administered in two doses during the treatment. Eighty male Wistar rats (230-280 g) were divided randomly into ten groups of sham, control, hydrocortisone, phenytoin 1%, and 3% groups in 6- or 12-day treatment protocols. The UC model was induced by the administration of acetic acid 4% into the colon. Animals were killed on the 7th and 13th postoperative days. The main outcome measures included body weight loss, microscopic score, and ulcer index measured using specific criteria. Growth factors were measured by western blotting. Results illustrated that body weight loss was reversed in the treatment groups. Ulcer index had decreased on 6- and 12-day treatment protocols. Microscopic scores in 6-day enema treatment significantly decreased compared to the control groups. Transforming growth factor-beta (TGFβ) significantly increased in a time-dependent manner and platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) significantly increased in a time- and dose-dependent manner in phenytoin 1% and 3% in the 6- and 12-day protocols. Phenytoin dose- and time-dependently reversed weight loss. In addition, histopathological parameters included microscopic scores, and the ulcer index was decreased through the induction of growth factors TGFβ, PDGF, and VEGF and consequently accelerated ulcer healing.
Collapse
Affiliation(s)
- Nima Fattahi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Alina Abdolahi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Zakarya Vahabzadeh
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bahram Nikkhoo
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farhad Manoochehri
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sara Goudarzzadeh
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kambiz Hassanzadeh
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Esmael Izadpanah
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Raman Moloudi
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| |
Collapse
|
5
|
Saddik MS, Alsharif FM, El-Mokhtar MA, Al-Hakkani MF, El-Mahdy MM, Farghaly HS, Abou-Taleb HA. Biosynthesis, Characterization, and Wound-Healing Activity of Phenytoin-Loaded Copper Nanoparticles. AAPS PharmSciTech 2020; 21:175. [PMID: 32556636 DOI: 10.1208/s12249-020-01700-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Abstract
Wound-healing is a very complex and evolutionary process that involves a great variety of dynamic steps. Although different pharmaceutical agents have been developed to hasten the wound-healing process, the existing agents are still far from optimal. The present work aimed to prepare and evaluate the wound-healing efficacy of phenytoin-loaded copper nanoparticles (PHT-loaded CuNPs). CuNPs were biosynthesized using licorice aqueous extract. The prepared CuNPs were loaded with PHT by adsorption, characterized, and evaluated for wound-healing efficiency. Results showed that both plain and PHT-loaded CuNPs were monodisperse and exhibited a cubic and hexagonal morphology. The mechanism by which PHT was adsorbed on the surface of CuNPs was best fit by the Langmuir model with a maximum loaded monolayer capacity of 181 mg/g. The kinetic study revealed that the adsorption reaction followed the pseudo-second order while the thermodynamic parameters indicated that the adsorption process was physical in nature and endothermic, and occurred spontaneously. Moreover, the in vivo wound-healing activity of PHT-loaded CuNP impregnated hydroxypropylmethyl cellulose (HPMC) gel was carried out using an excisional wound model in rats. Data showed that PHT-loaded CuNPs accelerated epidermal regeneration and stimulated granulation and tissue formation in treated rats compared to controls. Additionally, quantitative real-time polymerase chain reaction (RT-PCR) analysis showed that lesions treated with PHT-loaded CuNPs were associated with a marked increase in the expression of dermal procollagen type I and a decrease in the expression of the inflammatory JAK3 compared to control samples. In conclusion, PHT-loaded CuNPs are a promising platform for effective and rapid wound-healing.
Collapse
|
6
|
Patocka J, Wu Q, Nepovimova E, Kuca K. Phenytoin - An anti-seizure drug: Overview of its chemistry, pharmacology and toxicology. Food Chem Toxicol 2020; 142:111393. [PMID: 32376339 DOI: 10.1016/j.fct.2020.111393] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022]
Abstract
Phenytoin is a long-standing, anti-seizure drug widely used in clinical practice. It has also been evaluated in the context of many other illnesses in addition to its original epilepsy indication. The narrow therapeutic index of phenytoin and its ubiquitous daily use pose a high risk of poisoning. This review article focuses on the chemistry, pharmacokinetics, and toxicology of phenytoin, with a special focus on its mutagenicity, carcinogenicity, and teratogenicity. The side effects on human health associated with phenytoin use are thoroughly described. In particular, DRESS syndrome and cerebellar atrophy are addressed. This review will help in further understanding the benefits phenytoin use in the treatment of epilepsy.
Collapse
Affiliation(s)
- Jiri Patocka
- Faculty of Health and Social Studies, Department of Radiology and Toxicology, University of South Bohemia Ceske Budejovice, Ceske Budejovice, Czech Republic; Biomedical Research Centre, University Hospital, Hradec Kralove, Czech Republic
| | - Qinghua Wu
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic; College of Life Science, Yangtze University, Jingzhou, 434025, China
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Biomedical Research Centre, University Hospital, Hradec Kralove, Czech Republic; Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.
| |
Collapse
|
7
|
Sharma R, Das P, Kairo A, Kale SS. Phenytoin-Induced Gingival Overgrowth with Predominant Involvement of Hard Palate and Floor of Oral Cavity: A Case Report and Review of Literature. J Neurosci Rural Pract 2020; 11:349-352. [PMID: 32367993 PMCID: PMC7195949 DOI: 10.1055/s-0040-1709249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Drug-induced gingival overgrowth (DIGO) secondary to chronic phenytoin intake for seizure control is a well-recognized phenomenon. Phenytoin-induced gingival overgrowth (PIGO) usually resolves gradually following cessation of phenytoin intake. It is usually seen throughout the dentate regions of the maxillary and mandibular dental arches, but more severely affect their anterior portions exposed to atmosphere. We report a rare case of PIGO predominantly involving hard palate and floor of oral cavity, which has not been reported in English literature till date.
Collapse
Affiliation(s)
- Rajeev Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kairo
- Department of Ear, Nose, and Throat and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
8
|
Role of Epithelial Mesenchymal Transition in Phenytoin Influenced Gingival Overgrowth in Children and Young Adults. A Preliminary Clinical and Immunohistochemical Study. J Clin Pediatr Dent 2019; 43:350-355. [PMID: 31560587 DOI: 10.17796/1053-4625-43.5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To prove the role of epithelial mesenchymal transition (EMT) in the pathogenesis of phenytoin influenced gingival overgrowth (PIGO) in children and young adults. Study design: Thirty male individuals who are to start with oral phenytoin therapy were recruited for the study. All the 30 individuals underwent full mouth scaling and root planning and were then followed up for a period of one year at intervals of 3 months each. Based on the clinical gingival status they were divided into group1 (responders) individuals who showed gingival overgrowth (GO) and group 2 (non responders) individuals who do not show any GO. Gingival tissue samples were obtained from both the groups at the end of 1 year and subjected to immuno histochemical analysis for E-cadherin expression and histo-pathological for alteration in the basement membrane and confirmation of the fibrosis. Results: Decrease in expression of E cadherin, loss of basement membrane integrity and fibrosis were noted on responder group when compared to non responder group at p<0.001. Fibrosis was seen in the epithelial connective tissue junction. Conclusion: Decrease in cell adhesion, degradation of basement membrane and presence of fibrosis could suggest the role of EMT in the pathogenesis of PIGO.
Collapse
|
9
|
Cardoso AM, de Oliveira EG, Coradini K, Bruinsmann FA, Aguirre T, Lorenzoni R, Barcelos RCS, Roversi K, Rossato DR, Pohlmann AR, Guterres SS, Burger ME, Beck RCR. Chitosan hydrogels containing nanoencapsulated phenytoin for cutaneous use: Skin permeation/penetration and efficacy in wound healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 96:205-217. [DOI: 10.1016/j.msec.2018.11.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/27/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
|
10
|
Margiotti K, Pascolini G, Consoli F, Guida V, Di Bonaventura C, Giallonardo AT, Pizzuti A, De Luca A. Lack of pathogenic mutations in SOS1 gene in phenytoin-induced gingival overgrowth patients. Arch Oral Biol 2017; 80:160-163. [DOI: 10.1016/j.archoralbio.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/16/2022]
|
11
|
Abstract
Sodium channel blockers have been the mainstay of the pharmacological management of focal and generalised tonic-clonic seizures for more than 70 years. The focus of this paper will be on phenytoin, carbamazepine, lamotrigine, oxcarbazepine, rufinamide, lacosamide and eslicarbazepine acetate. All these antiepileptic drugs have similar efficacy and share similar dose-dependent, adverse effect profiles, although phenytoin, carbamazepine and oxcarbazepine are more likely to cause idiosyncratic reactions than the others. With the exception of lamotrigine, rufinamide and lacosamide, all are enzyme inducers and most are minor teratogens; although data on teratogenicity are sparse with lacosamide and eslicarbazepine acetate. There is increasing evidence that these drugs differ mechanistically, with the newer agents, lacosamide and eslicarbazepine acetate, having their major pharmacological effect on the slow inactivation state of the sodium channel, which may be associated with better tolerability at higher dosage, although hard evidence in support of this observation is currently not available. Rufinamide is licensed only for Lennox-Gastaut syndrome in children aged 4 years and above. There is a move away from using enzyme inducers, particularly phenytoin and carbamazepine, in everyday clinical practice. There seems little doubt, however, that some sodium channel blockers will have an enduring place in the management of epilepsy well into the 21st century.
Collapse
Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, West Glasgow ACH-Yorkhill, Dalnair Street, Glasgow, G3 8SJ, Scotland, UK.
| |
Collapse
|
12
|
López-González M, Luis E, Fajardo O, Meseguer V, Gers-Barlag K, Niñerola S, Viana F. TRPA1 Channels Mediate Human Gingival Fibroblast Response to Phenytoin. J Dent Res 2017; 96:832-839. [DOI: 10.1177/0022034517695518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- M.J. López-González
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - E. Luis
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - O. Fajardo
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - V. Meseguer
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - K. Gers-Barlag
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - S. Niñerola
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - F. Viana
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| |
Collapse
|
13
|
Abstract
We developed and tested a new putative analgesic cream, based on the anticonvulsant phenytoin in patients suffering from treatment refractory neuropathic pain. The use of commercial topical analgesics is not widespread due to the facts that capsaicin creams or patches can give rise to side effects, such as burning, and analgesic patches (e.g., lidocaine 5% patches) have complex handling, especially for geriatric patients. Only in a few countries, compounded creams based on tricyclic antidepressants or other (co-)analgesics are available. Such topical analgesic creams, however, are easy to administer and have a low propensity for inducing side effects. We, therefore, developed a new topical cream based on 5% and 10% phenytoin and described three successfully treated patients suffering from neuropathic pain. All patients were refractory to a number of other analgesics. In all patients, phenytoin cream was effective in reducing pain completely, without any side effects, and the tolerability was excellent. The onset of action of the phenytoin creams was within 30 minutes. Phenytoin cream might become a new treatment modality of the treatment of neuropathic pain.
Collapse
|
14
|
Abstract
Phenytoin induces lymphoid proliferation, resulting in complications that can range from tissue hyperplasia to lymphoma. Some of the complications resolve spontaneously after drug discontinuation. This report describes for the first time a case of dysphagia with lack of velopharyngeal coordination and nasopharyngeal reflux combined with massive palatine tonsillar hypertrophy. The condition did not develop before phenytoin administration, was induced by phenytoin, and spontaneously resolved upon drug discontinuation. The patient was referred for a video-fluoroscopic swallowing study owing to a recurring nasal reflux of foods that had developed since phenytoin administration. The video-fluoroscopic swallowing study revealed incidentally that the large bilateral elongated masses extended downward into the larynx and disturbed velar elevation. This finding was confirmed by computed tomography of the neck, which showed that palatine tonsillar hypertrophy disturbed the laryngopharynx on both sides. The symptoms (sleep apnea and nasal reflux) and the abnormal imaging findings disappeared without surgery approximately 1 month after drug discontinuation. This case suggests that dysphagia related to phenytoin-induced lymphoid hypertrophy may be treated by phenytoin discontinuation followed by a sufficient amount of time to allow symptom resolution rather than by prompt surgery.
Collapse
|
15
|
|
16
|
Suneja B, Chopra S, Thomas AM, Pandian J. A Clinical Evaluation of Gingival Overgrowth in Children on Antiepileptic Drug Therapy. J Clin Diagn Res 2016; 10:ZC32-6. [PMID: 26894172 PMCID: PMC4740700 DOI: 10.7860/jcdr/2016/16443.7069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/06/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Gingival overgrowth, a well-known side effect of chronic phenytoin therapy has also been known to be caused by other anti epileptic drugs (AED's). Various factors like plaque, gingival inflammation, and periodontal health have been postulated to effect gingival overgrowth. AIM To identify the AED having an effect on gingival overgrowth and to study the factors affecting it. MATERIALS AND METHODS Three groups of 30 children each on monotherapy of phenytoin, sodium valproate, and carbamazepine were longitudinally followed for six months. Their oral and epileptic health status was assessed and were monitored for change in plaque levels, gingival inflammation, probing depth and the status of gingival overgrowth at baseline, at the end of 3 months and finally at the end of 6 months. The data was recorded and statistically analysed. RESULTS Phenytoin caused gingival overgrowth in a significant number of children (53.6%) within 3 months. Sodium valproate also led to gingival overgrowth, but not upto statistically significant levels. Patients on carbamazepine did not show any signs of gingival overgrowth. Gingival overgrowth is seen more on buccal side, in the anterior segment and in the lower arch. No correlation could be found between, either plaque level, or gingival inflammation with gingival overgrowth. Probing depth could be positively correlated with gingival overgrowth. CONCLUSION Phenytoin is the drug, which can be chiefly implicated for causing gingival overgrowth. Sodium valproate carries the potential for gingival overgrowth, although only up to clinically insignificant levels in 6 months. Carbamazepine can be considered a safe drug in children in relation to gingival overgrowth.
Collapse
Affiliation(s)
- Bharat Suneja
- Professor, Department of Pediatric and Preventive Dentistry, BJS Dental College, Ludhiana, India
| | - Saroj Chopra
- Professor (Retd.), Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, India
| | - Abi M Thomas
- Professor, Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, India
| | - Jeyraj Pandian
- Professor, Department of Neurology, Christian Medical College, Ludhiana, India
| |
Collapse
|
17
|
Brown RS, Arany PR. Mechanism of drug-induced gingival overgrowth revisited: a unifying hypothesis. Oral Dis 2014; 21:e51-61. [PMID: 24893951 DOI: 10.1111/odi.12264] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/27/2014] [Accepted: 05/28/2014] [Indexed: 12/26/2022]
Abstract
Drug-induced gingival overgrowth (DIGO) is a disfiguring side effect of anti-convulsants, calcineurin inhibitors, and calcium channel blocking agents. A unifying hypothesis has been constructed which begins with cation flux inhibition induced by all three of these drug categories. Decreased cation influx of folic acid active transport within gingival fibroblasts leads to decreased cellular folate uptake, which in turn leads to changes in matrix metalloproteinases metabolism and the failure to activate collagenase. Decreased availability of activated collagenase results in decreased degradation of accumulated connective tissue which presents as DIGO. Studies supporting this hypothesis are discussed.
Collapse
Affiliation(s)
- R S Brown
- Division of Oral Diagnosis, Department of Comprehensive Dentistry, Howard University College of Dentistry, Washington, DC, USA; Department of Otolaryngology, Georgetown University Medical Center, Washington, DC, USA; Hematology Branch, NHLBI/NIH, Bethesda, MD, USA
| | | |
Collapse
|
18
|
Firmino F, de Almeida AMP, e Silva RDJG, Alves GDS, Grandeiro DDS, Penna LHG. [Scientific production on the applicability of phenytoin in wound healing]. Rev Esc Enferm USP 2014; 48:166-73. [PMID: 24676123 DOI: 10.1590/s0080-623420140000100021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/31/2013] [Indexed: 11/21/2022] Open
Abstract
Phenytoin is an anticonvulsant that has been used in wound healing. The objectives of this study were to describe how the scientific production presents the use ofphenytoinas a healing agent and to discuss its applicability in wounds. A literature review and hierarchy analysis of evidence-based practices was performed. Eighteen articles were analyzed that tested the intervention in wounds such as leprosy ulcers, leg ulcers, diabetic foot ulcers, pressure ulcers, trophic ulcers, war wounds, burns, preparation of recipient graft area, radiodermatitis and post-extraction of melanocytic nevi. Systemic use ofphenytoinin the treatment of fistulas and the hypothesis of topical use in the treatment of vitiligo were found. In conclusion, topical use ofphenytoinis scientifically evidenced. However robust research is needed that supports a protocol for the use ofphenytoinas another option of a healing agent in clinical practice.
Collapse
|
19
|
Şimşek G, Ciftci O, Karadag N, Karatas E, Kizilay A. Effects of topical phenytoin on nasal wound healing after mechanical trauma: An experimental study. Laryngoscope 2014; 124:E449-54. [PMID: 24978057 DOI: 10.1002/lary.24811] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/13/2014] [Accepted: 06/04/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Impaired postoperative wound healing is the second most common morbidity after synechia formation in endoscopic sinus surgery. The aim of this experimental study was to investigate the potential effects of topical phenytoin on wound healing after nasal mucosal trauma in rats. STUDY DESIGN An experimental study at the Inonu University Faculty of Medicine. METHODS Twenty-four rats were randomized into three groups: 1) phenytoin group (n = 8), 2) control group (n = 8), and 3) vehicle group (n = 8). After damaging the right nasal cavity, in the phenytoin group, 1% topical phenytoin cream was applied for 7 days. The rats in the control group did not receive any treatment. The vehicle group was treated with daily topical cold cream for 1 week. The rats were sacrificed at the end, and the nasal cavities were excised. Tissue edema and inflammatory cell infiltration were compared among the groups. Additionally, proliferating cell nuclear antigen (PCNA) and cluster of differentiation 31 (CD31) immunoexpression levels were evaluated. Furthermore, in biochemical analysis, the tissue levels of vascular endothelial growth factor and (EGF) of the groups were investigated. RESULTS In the phenytoin group, tissue edema and inflammatory cell infiltration were significantly decreased, and PCNA and CD31 immunoexpression levels were more prominent (P < .001) and the tissue EGF levels were significantly higher (P < .01). CONCLUSIONS Topical phenytoin treatment may alter the nasal wound healing after mechanical trauma. The potential beneficial effects of topical phenytoin on nasal mucosa should be investigated by further experimental and human trials. LEVEL OF EVIDENCE NA.
Collapse
Affiliation(s)
- Gökçe Şimşek
- Faculty of Medicine, Department of Otolaryngology-Head & Neck Surgery, Kirikkale University Kirikkale, Turkey
| | | | | | | | | |
Collapse
|
20
|
Galvez-Contreras AY, Gonzalez-Castaneda RE, Luquin S, Guzman-Muniz J, Moy-Lopez NA, Ramos-Zuniga R, Gonzalez-Perez O. Diphenylhydantoin promotes proliferation in the subventricular zone and dentate gyrus. ACTA ACUST UNITED AC 2012; 3:1-9. [PMID: 24478822 DOI: 10.3844/amjnsp.2012.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PROBLEM STATEMENT Diphenylhydantoin (phenytoin) is an antiepileptic drug that generates hyperplasia in some tissue by stimulating Epidermal Growth Factor (EGFR) and Platelet-Derived Growth Factor beta (PDGFR-β) receptors and by increasing serum levels of basic fibroblast growth factor (bFGF, FGF2 or FGF-β). Neural stem cells in the adult brain have been isolated from three regions: the Subventricular Zone (SVZ) lining the lateral wall of the lateral ventricles, the Subgranular Zone (SGZ) in the dentate gyrus at the hippocampus and the Subgranular Zone (SZC) lining between the hippocampus and the corpus callosum. Neural stem cells actively respond to bFGF, PDGFR-β or EGF by increasing their proliferation, survival and differentiation. The aim of this study was to evaluate the effect of phenytoin on proliferation and apoptosis in the three neurogenic niches in the adult brain. APPROACH We orally administrated phenytoin with an oropharyngeal cannula for 30 days: 0 mg kg-1 (controls), 1, 5, 10, 50 and 100 mg kg-1. To label proliferative cells, three injections of 100 mg kg-1 of BrdU was administrated every 12 h. Immunohistochemistry against BrdU or Caspase-3 active were performed to determine the number of proliferative or apoptotic cells. RESULTS Our results showed that phenytoin induces proliferation in the SVZ and the SGZ in a dose-dependent manner. No statistically significant effects on cell proliferation in the SCZ neither in the apoptosis rate at the SVZ, SGZ and SCZ were found. CONCLUSION These data indicate that phenytoin promotes a dose-dependent proliferation in the SVZ and SGZ of the adult brain. The clinical relevance of these findings remain to be elucidated.
Collapse
Affiliation(s)
- Alma Y Galvez-Contreras
- Laboratory of Neuroscience, Facultad de Psicologia, Universidad de Colima, Colima, 28040, Mexico ; Department of Neuroscience, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco 44340, Mexico
| | - Rocio E Gonzalez-Castaneda
- Department of Neuroscience, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco 44340, Mexico
| | - Sonia Luquin
- Department of Neuroscience, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco 44340, Mexico
| | - Jorge Guzman-Muniz
- Laboratory of Neuroscience, Facultad de Psicologia, Universidad de Colima, Colima, 28040, Mexico
| | - Norma A Moy-Lopez
- Laboratory of Neuroscience, Facultad de Psicologia, Universidad de Colima, Colima, 28040, Mexico
| | - Rodrigo Ramos-Zuniga
- Department of Neuroscience, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco 44340, Mexico
| | - Oscar Gonzalez-Perez
- Laboratory of Neuroscience, Facultad de Psicologia, Universidad de Colima, Colima, 28040, Mexico ; Department of Neuroscience, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco 44340, Mexico
| |
Collapse
|