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

Bone-targeting engineered small extracellular vesicles carrying anti-miR-6359-CGGGAGC prevent valproic acid-induced bone loss

The clinical role and underlying mechanisms of valproic acid (VPA) on bone homeostasis remain controversial. Herein, we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density (BMD) in both patients and mice. This effect was attributed to VPA-induced elevation in osteoclast formation and activity. Through RNA-sequencing, we observed a significant rise in precursor miR-6359 expression in VPA-treated osteoclast precursors in vitro, and further, a marked upregulation of mature miR-6359 (miR-6359) in vivo was demonstrated using quantitative real-time PCR (qRT-PCR) and miR-6359 fluorescent in situ hybridization (miR-6359-FISH). Specifically, the miR-6359 was predominantly increased in osteoclast precursors and macrophages but not in neutrophils, T lymphocytes, monocytes and bone marrow-derived mesenchymal stem cells (BMSCs) following VPA stimulation, which influenced osteoclast differentiation and bone-resorptive activity. Additionally, VPA-induced miR-6359 enrichment in osteoclast precursors enhanced reactive oxygen species (ROS) production by silencing the SIRT3 protein expression, followed by activation of the MAPK signaling pathway, which enhanced osteoclast formation and activity, thereby accelerating bone loss. Currently, there are no medications that can effectively treat VPA-induced bone loss. Therefore, we constructed engineered small extracellular vesicles (E-sEVs) targeting osteoclast precursors in bone and naturally carrying anti-miR-6359 by introducing of EXOmotif (CGGGAGC) in the 3'-end of the anti-miR-6359 sequence. We confirmed that the E-sEVs exhibited decent bone/osteoclast precursor targeting and exerted protective therapeutic effects on VPA-induced bone loss, but not on ovariectomy (OVX) and glucocorticoid-induced osteoporotic models, deepening our understanding of the underlying mechanism and treatment strategies for VPA-induced bone loss.

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.

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.

Dental health status and hygiene in children with cerebral palsy: A matched case-control study

BACKGROUND

Children with cerebral palsy (CP) are at risk for oral pathology and parafunctional habits, and are reliant on caregivers for oral hygiene.

AIM

To evaluate oral hygiene habits and oral examination findings among a group of children with CP and a healthy age- and gender-matched control group.

DESIGN

A comparative, cross-sectional study, consisting of a questionnaire component and a standard dental examination component, each applied to both groups.

RESULTS

Eighty-three children with CP and 84 healthy children were included. Parents of children with CP were more likely to be of low educational level and lack a professional line of occupation (P < .05). Children with CP were less likely to be responsible for oral hygiene maintenance, adhere to toothbrushing, or receive procedural dental care (P < .001). Food packing and drooling were significantly more likely in children with CP. Malocclusion type III was more prevalent among children with CP, as was higher gingival index and gingival enlargement index-horizontal component (P < .001). There were no differences in caries experience between the CP and control groups.

CONCLUSIONS

Children with CP have suboptimal oral hygiene habits, limited access to procedural dental care, higher parafunctional habits, and increased periodontal pathology.

Self-correction of pathologic tooth migration after nonsurgical periodontal treatment in a metabolic syndrome patient with severe periodontitis and drug-influenced gingival enlargement

Drug-influenced gingival enlargement (DIGE) and reduced bone support caused by periodontitis are two of the etiologic factors for pathologic tooth migration (PTM). Comprehensive management, including surgical, orthodontic, and prosthodontic treatment, is usually required for recovery from severe DIGE and PTM. An 85-year-old Taiwanese male with a history of hypertension and uncontrolled diabetes mellitus (DM) visited our dental department for severe gingival enlargement and spontaneous bleeding. He was diagnosed as having advanced periodontitis and DIGE. Remarkable PTM occurred on the front sextants of his dentition. The patient's DM was gradually controlled, and his calcium channel blocker treatment was substituted with a new regimen for 7 months. One year after nonsurgical periodontal treatment and reinforcing the patient's oral care, both DIGE and PTM were spontaneously resolved without any surgical or orthodontic intervention. We advocate the value of early diagnosis, improving patient's oral hygiene, and meticulous nonsurgical treatment for both DIGE and PTM.

Cosmetic adverse effects of antiseizure medications; A systematic review

BACKGROUND

We systematically reviewed the existing literature on the cosmetic adverse effects of antiseizure medications (ASMs) in order to depict a clear picture of these unwanted side effects of ASMs with a particular attention to hair loss, hirsutism, acne, and gingival hyperplasia.

METHODS

This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE, and Google Scholar from the inception to 25 March, 2021 were systematically searched. These key words (title/abstract) were used: "hair loss" OR "hirsutism" OR "acne" OR "gingival hyperplasia" AND "seizure" OR "epilepsy" OR "anriseizure" OR "antiepileptic". The exclusion criteria included: non-original studies, articles not in English, and animal studies.

RESULTS

The primary search yielded 3938 studies; 127 studies were related to the topic and were included in the current systematic review. The most robust evidence on cosmetic adverse effects of ASMs were related to phenytoin (causing gingival hyperplasia, hirsutism, and acne) and valproate (causing hair loss and hirsutism); however, many other ASMs were also implicated in causing these cosmetic adverse effects.

CONCLUSION

Antiseizure medications may be associated with various cosmetic adverse effects. Phenytoin and valproate are the most notorious ASMs in this regard; but, other ASMs have also been implicated in causing hair loss, hirsutism, acne, and gingival hyperplasia. Physicians should pay more attention to these significant adverse effects that may affect a patient's facial attractiveness, quality of life, and emotional state.

Prioritization of predisposing factors of gingival hyperplasia during orthodontic treatment: the role of amount of biofilm

Background

The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm.

Methods

This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement”.

Results

A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR: 3.5, 95% CI: 1.1–10.55) and duration of treatment (OR: 2.03, 95% CI: 1.01–4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment.

Conclusions

Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.

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.

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.

Comparison of Osteogenic Potential of Phenytoin with Dexamethasone in Cultured Dental Pulp Stem Cells

Background

One of the adverse effects of phenytoin (diphenylhydantoin, DPH) is enlargement of facial features. Although there are some reports on anabolic action of phenytoin on bone cells, the osteogenic potential of DPH on mesenchymal stem cells has not been studied. The purpose of this study was to evaluate the osteogenic potential of DPH on dental pulp stem cells (DPSCs).

Methods

Human DPSCs were isolated and characterized by flow cytometry; presence of CD29 and CD44 and absence of CD34 and CD45 were performed to confirm the mesenchymal stem cells. Isolated DPSCs were differentiated either in conventional osteogenic medium with Dexamethasone or medium containing different concentration of phenytoin (12.5, 25, 100, and 200 µM). The osteogenic differentiation evaluated by performing western blot test for Runt-related transcription factor 2 (RUNX2), osteopontin and alkaline phosphatase (ALP) also alizarin red S staining to measure the mineralization of cells.

Results

Our results showed morphological changes and mineralization of DPSCs by using DPH were comparable with dexamethasone. Moreover, western blot results of DPH group showed significant increase of ALP, RUNX2 and osteopontin (OSP) in comparison with control.

Conclusion

The data of present study showed the osteogenic activity of phenytoin, considering as an alternative of dexamethasone for inducing osteogenic differentiation of dental pulp stem cells.

Clinical periodontal and dental findings in liver transplant patients: a systematic review and meta-analysis

Objectives This systematic review aimed to investigate the oral health of post-liver transplant recipients (postLTx), in terms of dental and periodontal clinical results.Data sources Pubmed/MEDLINE and Cochrane Library databases were searched electronically.Data selection Prospective, cross-sectional and case-control studies comparing periodontal and dental health of postLTx patients with healthy and/or pre-liver transplant patients.Data extraction This was performed independently by two authors. Quality assessment was done by using tools from the National Heart, Lung, and Blood Institute.Data synthesis Nine studies were eligible for inclusion in the systematic review. A meta-analysis was performed on gingival inflammation, expressed by scores, on four studies including healthy controls. The gingival index scores were significantly higher in postLTx patients compared with healthy controls (p <0.001). The weighted mean difference was 0.91 (95% confidence interval, 0.44 to 1.38, heterogeneity I² = 99.5%). Increased tendency of gingival enlargement was noticed in postLTx patients, especially after immunosuppression with Cyclosporine A. Controversial results were reported for the prevalence of caries in postLTx recipients, but there seems to be an increase.Conclusion The results suggest that patients with liver transplants, due to systemic condition and immunosuppressive therapy, exhibit a higher degree of gingival inflammation compared with unexposed patients.Prospero registration number: CRD42019121893.

Analytical Method Development for Sodium Valproate through Chemical Derivatization

Background

Sodium valproate has anticonvulsant activity and is structurally different to conventional antiepileptic drugs. The problem with valproic acid is the lack of a chromophore, which means that gas chromatography is the sole assay methodology. The introduction of benzoyl and phenyl groups to the molecule is a useful derivatisation, which enables the creation of detectable chromophores for HPLC analysis for pharmaceutical dosages as well as biological systems. Methodology. Sodium valproate was derivatised by the addition of a chromophore to its structure by introducing a methyl benzoyl or a phenyl group. Trichlorophenol and 2-hydroxyacetophenone were used to introduce phenyl and benzoyl groups to valproic acid, respectively. The reaction used was estrification reaction using coupling agents. An analytical method was then developed and validated using reverse-phase HPLC. The method was validated for parameters like linearity, range, accuracy precision, and robustness.

Results

The developed method was easy and feasible and can be applied to both routine analysis and bioanalysis. The method was very sensitive and could quantify valproic acid at a very low concentration of 0.75 × 10⁻⁵ mg/ml. The developed method was found to be linear (R² = 0.997), accurate, precise, and robust.

Conclusion

The proposed chemical derivatisation and the developed analytical method are novel. The developed analytical procedure is the first of its kind; it is easy and feasible and can be used to quantify and detect sodium valproate at very low concentrations compared to other available methods in the literature.

Association between periodontitis and systemic medication intake: A case-control study

BACKGROUND

To investigate the frequency of systemic drugs taken by elderly patients with or without periodontitis and the possible association between medication consumption and the severity of periodontitis.

METHODS

A total of 1221 patients, including 608 with generalized moderate to severe periodontitis (periodontitis group) and 613 age- and gender-matched individuals with healthy periodontium (healthy group) were selected. Systemic conditions, medications and periodontal status were recorded. Medication intake frequency (%) was compared using unconditional logistic regression.

RESULTS

The top three most common medications were angiotensin-converting enzyme (ACE) inhibitors (17.9%), antidepressants (17.8%), and lipid-lowering medications (16.5%). Both ACE inhibitors and antidepressants showed statistically higher intake frequency in the periodontitis group relative to healthy controls (21.5% versus 14.4%; odds ratio [OR] = 1.64), (21.1% versus 14.5%, OR = 1.57) (P < 0.01). Additionally, intake of oral hypoglycemic agents, calcium channel blockers (CCB), insulin, and diuretics were significantly higher in the periodontitis group with OR = 2.49, 2.32, 2.08 and 1.79, respectively (P < 0.05). Several medications demonstrated a disease severity-dependent association comparing generalized severe periodontitis with moderate periodontitis and healthy group: oral hypoglycemic agents (17.4% versus 16.8% versus 8.0%), CCB (14.8% versus 14.4% versus 8.0%) and anticonvulsants (13.4% versus 7.7% versus 6.4%) with OR of 2.43, 1.99, and 2.28 (severe periodontitis versus healthy group), respectively.

CONCLUSION

There was a significantly higher frequency of medication intake related to cardiovascular disease and diabetes in patients with periodontitis. A disease severity-dependence with medication intake frequency was also noted. This study provides indirect evidence for the possible relationship between systemic diseases and periodontitis.

The Management of Drug-Influenced Gingival Enlargement

<br/> Drug-influenced gingival enlargement (DIGE) is a reaction to specific medications, namely phenytoin, ciclosporin and calcium channel blockers. DIGE is encountered increasingly in clinical practice due to the widespread use of calcium channel blocker drugs particularly. Approaches to its management are discussed in this review.<br/> Methods: Narrative review of the literature and discussion of clinical implications.<br/> Findings: Management of DIGE involves nonsurgical treatment and may require surgical reduction of the overgrown gingival tissues. Management is complicated by the difficulties in achieving adequate plaque control, given the unfavourable contour of the enlarged gingival tissues, and the high frequency of recurrence of DIGE after surgical management. Replacing the drug involved can be very beneficial in selected cases, but the management of the underlying medical condition limits its application. The decision to replace a drug is not the responsibility of the dental practitioner, but the patient's physician may make it after consultation.<br/> Conclusions: Management of DIGE can be challenging and may require close co-operation between the dental practitioner and a hygienist, a periodontist and the patient's physician. Long term supportive maintenance programmes need to be in place for optimal outcomes.

Oral health status of children with epilepsy in Hong Kong

AIM

This study assessed and compared the oral health status, dental trauma experience and oral health habits of children with and without epilepsy.

METHODS

Thirty-five children with epilepsy aged 3-18 years old were recruited from the pediatric neurology clinics of 2 university-affiliated district hospitals. A sample of 35 age- and gender-matched healthy children was recruited as controls. Clinical data on caries, gingival health, oral hygiene level and dental trauma were collected and compared between the groups. Information about children's oral health habits and reported dental trauma experience were obtained by structured questionnaire.

RESULTS

Children with epilepsy had significantly poorer gingival health than healthy controls. No significant differences in dental caries experience, oral hygiene level, dental trauma experience, oral health habits and dental care service utilization were observed between the children with and without epilepsy. Among the children with epilepsy, those taking more than 1 antiepileptic drug had a greater prevalence of dental caries when compared with those receiving mono-antiepileptic drug therapy. The presence of gingival hyperplasia indicated poorer gingival health in epileptic children.

CONCLUSION

The study shows that children with epilepsy had poorer oral health status in terms of gingival health than those without epilepsy.

Comparison of effects of bracket types and treatment duration on periodontal health of adult patients

Objective

The aim of this study was to assess the effect of fixed orthodontic treatments with steel-ligated conventional brackets and self-ligating brackets (SLBs) on periodontal clinical parameters.

Materials and Methods

Seventy-seven patients (24 male and 53 female) aged between 18 and 30 years were enrolled in the study. Periodontal parameters including plaque index (PI), gingival index (GI), and bleeding on probing (BOP) index were obtained from all the bonded teeth.

Results

When the effect of bracket type and duration of treatment on gingival tissues was examined, there was no statistically significant difference between the treatment times (P = 0.670) and bracket types (P = 0.596) in terms of PI. The GI was significantly different between the different treatment durations (P = 0.045); it was higher in patients with a treatment duration of 18–36 months. However, the GI did not change according to the bracket types (P = 0.270). This result was not significantly different between different treatment durations (P = 0.270). There was no significant difference between the treatment periods (P = 0.189) in terms of BOP index, and this result did not change according to the bracket types (P = 0.621).

Conclusion

SLBs do not require ligatures, which may facilitate plaque accumulation. However, our results showed that SLBs were not advantageous over CBs in terms of periodontal health.

Periodontal Management of Cyclosporin A-Induced Gingival Overgrowth: A Nonsurgical Approach

Gingival overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs. The expression and the severity of this tissue-specific condition are influenced by a variety of factors, mainly drug and periodontal variables. Such increased volume of gingiva may compromise normal oral functions, aesthetics in addition to the patients' ability to practice optimal oral hygiene. The management of gingival overgrowth includes nonsurgical approach, surgical approach, or both of them for severe cases of gingival overgrowth as well as drug withdrawal. This case report illustrates a successful nonsurgical management of a 21-year-old patient with cyclosporin A-induced gingival overgrowth who experienced a total regression of the gingival enlargement without any surgical procedure or drug substitution. And it highlights therefore the key role of supportive periodontal therapy in maintaining good and stable outcomes over 2 years of follow-up.

Periodontal complications of prescription and recreational drugs

Drug use for both therapeutic and recreational purposes is very widespread in most societies. The range of drugs used, the variations in response to these drugs and other health and behavioral confounders mean that drug use may be an important contributor to individualized periodontal diagnoses. In this narrative review, we review the main reported effects of drugs on the periodontal tissues and periodontal disease processes. Although some of the more common adverse drug reactions on periodontal tissues are well described, in many other cases the evidence for these drug effects is quite limited and based on small case series or isolated reports. Prescription drugs are responsible for a range of effects, including drug-induced gingival overgrowth and increased gingival bleeding, and influence periodontal inflammation and periodontal breakdown. The effects of recreational drugs on the periodontal tissues is less well researched, perhaps for the obvious reason that assembling large cohorts of recreational drug users presents particular challenges. Use of nearly all of these substances is associated with poorer periodontal and dental health, although there is almost certainly a large degree of behavioral confounding in these findings. Overall, further studies of adverse drug reactions on the periodontal tissues are required as this continues to be an important and increasing factor in periodontal health determination.

Dental Decay and Oral Findings in Children and Adolescents Affected by Different Types of Cerebral Palsy: A Comparative Study

OBJECTIVE

To compare dental caries and oral findings in patients affected by different types of Cerebral Palsy (CP).

STUDY DESIGN

This cross-sectional study involved 120 children and adolescents with a diagnosis of CP. WHO diagnostic criteria were used to determine DMFT (caries diagnosis), the pocket depth and attachment level (periodontitis diagnosis). Additionally, the study evaluated dental erosion, traumatic dental injuries, treatment needs index (TNI), oral habits, malocclusions, gingival overgrowth, and dental fluorosis.

RESULTS

The most frequent CP type was spastic (62.5%), followed by mixed (18.3%), ataxic (10%), and athetoid (9.1). Patients affected by mixed CP showed a higher prevalence in decayed, DMFT index and TNI compared with the other types of CP (p<0.05). The frequency of malocclusion in the clinical evaluation was 87.5% and in plaster models was 49.2%.

CONCLUSIONS

Dental caries was an important issue in mixed and athetoid CP groups. Oral habits and malocclusions were the most significant oral health problems in individuals with CP.

Comparative evaluation of oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs

Background

Epilepsy is a gathering of neurological disorders characterized by epileptic seizures. Epileptic children, who are on active treatment with antiepileptic drugs, have a well-recognized side effect of gingival enlargement. Therefore, all efforts should be made, particularly for the population who are diagnosed or affected by the systemic disease. This study was conducted with an aim to determine oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs.

Materials and Methods

The cross-sectional observational study was conducted in the department of pedodontics and attached general hospital. A sample size of 120 participants with 60 healthy and 60 epileptic children between age 2 and 14 years were included. Oral health status of participants was examined using oral hygiene simplified index and plaque index. Gingival enlargement was assessed using Miranda-Brunet index. For statistical analysis, one-way ANOVA test, independent t-test, and Pearson's Chi-square test were used.

Results

From the total participants included in the study, 49% of participants had good oral hygiene from healthy group, and 28% participants had poor oral hygiene from the epileptic group. Sodium valproate was the most common drug used and was associated with increased gingival enlargement.

Conclusion

Conclusion can be drawn that epileptic children under medication had poor oral hygiene and an increased risk for gingival enlargement as compared to their healthy counterparts. It must be stressed that the epileptic patients should be given dental care without conditions and provided with best possible care to restore esthetics and functions.

Gingival enlargement in orthodontic patients: Effect of treatment duration

INTRODUCTION

In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults.

METHODS

The sample consisted of 260 subjects (ages, 10-30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE.

RESULTS

We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28-fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0-45.3; G2, RR = 27.0, 95% CI = 12.1-60.3; G3 = 28.1; 95% CI = 12.6-62.5).

CONCLUSIONS

The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment.

A Clinical Evaluation of Gingival Overgrowth in Children on Antiepileptic Drug Therapy

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.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

OBJECTIVE

The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment.

METHODS

A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models.

RESULTS

The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE.

CONCLUSION

Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment.

Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study

BACKGROUND

Gingival overgrowth (GO) is a known side-effect of calcium channel blockers. Although there have been several case reports, few studies have examined the prevalence of nifedipine, diltiazem, and amlodipine. This study was conducted to determine the prevalence and risk factors for GO in patients treated with calcium channel blockers.

MATERIALS AND METHODS

A cross-sectional study was conducted in out patient Department of Medicine, Government Medical College, Calicut. 133 patients taking antihypertensives were examined for the presence of GO using two different indices: Vertical GO in 6 points around each tooth and horizontal Miranda-Brunet index in the interdental area. Gingival index (GI), plaque index, and probing depth were also evaluated.

RESULTS

The frequency of GO was significantly higher in nifedipine-treated cases than other drug groups. Frequency of GO was 75% for nifedipine, 31.4% for amlodipine and 25% for amlodipine + metoprolol. Higher gingival, plaque and calculus were observed in patients taking calcium channel blockers. Among the possible risk factors, only the GI showed a significant correlation with GO.

CONCLUSIONS

Patients taking antihypertensives had poor oral hygiene. Patients taking nifedipine showed a higher frequency of GO. Gingival inflammation acts as a predisposing factor.

Serum cyclophilin A concentrations in renal transplant recipients receiving cyclosporine A: clinical implications for gingival overgrowth

OBJECTIVE

The aim of this study was to investigate the clinical factors in relation to the cyclosporine A (CsA) induced gingival overgrowth (GO).

STUDY DESIGN

Seventy-three participants were assigned as GO+ and GO-. Factors including demographic, pharmacological, gingival variables and the serum cyclophilin A (CyPA) concentration were analyzed.

RESULTS

The occurrence of GO was 39.72%. Papillary bleeding index (PBI) had a significantly higher risk of GO than plaque index (PI), the ratio of CsA to CyPA, and serum CyPA concentration (odds ratio = 364.323, 25.791, 1.002, 0.096, respectively). The severity of GO correlated with PI, the ratio of CsA to CyPA, PBI, serum concentrations of CsA and CyPA (r = 0.366, 0.355, 0.344, 0.305, and -0.232, respectively).

CONCLUSIONS

Since a cross-sectional study is not able to explain whether plaque and inflammation are the cause or consequence of GO, the ratio of CsA to CyPA may be a valuable marker for predicting GO.

Treatment of drug-induced gingival overgrowth by full-mouth disinfection: A non-surgical approach

BACKGROUND

Drug-induced gingival overgrowth is a common finding in the modern era. These gingival overgrowths are usually treated by various modalities namely substitution of drugs, surgical, and non-surgical treatment. The recent concept mainly involves full-mouth scaling and root planing (the entire dentition in two visits within 24 hours, i.e., two consecutive days) followed by chair side mouth rinsing by the patient with a 0.2% chlorhexidine solution for 2 minutes and brushing the tongue of the patient with 1% chlorhexidine gel. This is followed by an additional subgingival irrigation (three times, repeated within 10 minutes) of all pockets with a 1% chlorhexidine gel.

MATERIALS AND METHODS

Twenty patients between the ages of 20 and 50 years with drug-induced gingival overgrowth were treated using the full-mouth disinfection approach. The patients were evaluated at 3 months and 6 months after therapy. The data obtained for plaque index, bleeding on probing index, probing pocket depth, and gingival overgrowth scores were tabulated and compared statistically using the one sample unpaired t test.

STATISTICAL ANALYSIS

Statistically significant difference (P < 0.05) was found in PI GBI, PPD, and GO score between baseline, 3 months, and 6 months.

RESULTS

All clinical parameters improved significantly after therapy without the need of further surgical treatment.

CONCLUSIONS

Full-mouth disinfection might be a beneficial treatment concept in patients with drug-induced gingival overgrowth, thus decreasing the need for surgical therapy.

Effect of adjunctive roxithromycin therapy on interleukin-1β, transforming growth factor-β1 and vascular endothelial growth factor in gingival crevicular fluid of cyclosporine A-treated patients with gingival overgrowth

BACKGROUND AND OBJECTIVE

Systemic macrolide antibiotic administration has been shown to result in the elimination or reduction cyclosporine A-induced gingival overgrowth. Roxithromycin (ROX) is known to have anti-inflammatory, immunomodulatory and tissue reparative effects. This study was to evaluate the effect of adjunctive ROX therapy on cyclosporine A-induced gingival overgrowth and interleukin (IL)-1β, transforming growth factor (TGF)-β1 and vascular endothelial growth factor (VEGF) levels in gingival crevicular fluid of renal transplant patients.

MATERIAL AND METHODS

Thirty-one patients with clinically significant overgrowth and 16 periodontally healthy subjects were included in this randomized, double-blind, placebo-controlled, parallel-arm study. Patients received scaling and root planing (SRP) at baseline and randomized to take either ROX or placebo for 5 d. The clinical parameters, including plaque index, papillary bleeding index, probing depth and gingival overgrowth scores, were recorded. The amounts of IL-1β, TGF-β1 and VEGF in gingival crevicular fluid were detected by ELISA. Periodontal parameters as well as gingival crevicular fluid biomarker levels were evaluated at baseline and at 1 and 4 wk post-therapy.

RESULTS

Following SRP plus ROX and SRP plus placebo therapy, significant improvements in clinical periodontal parameters of both study groups were observed (p < 0.025). In the ROX group, adjunctive ROX therapy resulted in a greater gingival overgrowth scores reduction compared with those in the placebo group at 4 wk (p < 0.017). Initial amounts of IL-1β, TGF-β1 and VEGF for both the ROX and placebo groups were significantly higher than those for healthy subjects (p < 0.017), with no statistical difference between the two study groups. At 1 and 4 wk post-therapy, significant decreases in the amounts of IL-1β, TGF-β1 and VEGF were observed in both study groups when compared with baseline (p < 0.025), but there was no difference in the levels of IL-1β and VEGF between the two study groups. The amount of decrease in TGF-β1 levels for the ROX group was statistically significant compared to that for the placebo group at 4 wk after treatment (p < 0.017).

CONCLUSION

Our study indicated that combination of ROX with non-surgical therapy improves gingival overgrowth status and decreases gingival crevicular fluid TGF-β1 levels in patients with severe gingival overgrowth. The reduction of gingival crevicular fluid TGF-β1 following ROX therapy suggests an anti-inflammatory/immunomodulatory effect of ROX on the treatment of cyclosporine A-induced gingival overgrowth.

Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: a cross-sectional study

Background

There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT).

Methods

330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models.

Results

Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index > 25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index > 30 (RR 1.32; 95% CI 1.20-1.46).

Conclusions

Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.

Gingival inflammation assessment: Image analysis

Background:

Gingival inflammation may be caused by injury or plaque-related disease and reduction in inflammation can be a useful indicator of gingival recovery. There has been little research on development of non-index method to measure gingival condition. The study aimed to investigate the quantitative analysis of gingival swelling and color characteristics of gingiva by digital images before and after treatment of individual patients.

Material and Methods:

Twenty volunteers with gingival inflammation were recruited and digital images were taken. Duplicate measurements were made on the first visit by the same examiner. At a subsequent visit (1 month) following scaling and root planing, second images were taken. Gingival changes were determined by assessing redness and tooth surface area visible between the level of the inter-proximal papillae and the gingival margin.

Results:

Significant difference was found between the pre-operative and post-operative photographs with regard to swelling and gingival redness.

Conclusion:

Thus this method aids in quantitative analysis of swelling and color characteristics of gingiva by digital images may become a valuable, objective, practicable non-index and inexpensive evaluation procedure of gingival inflammation.

Sodium valproate induced gingival enlargement with pre-existing chronic periodontitis

Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Currently, more than 20 prescription medications are associated with gingival enlargement. Although the mechanisms of action may be different, the clinical and microscopic appearance of drug-induced gingival enlargement is similar with any drug. Gingival enlargement produces esthetic changes, and clinical symptoms including pain, tenderness, bleeding, speech disturbances, abnormal tooth movement, dental occlusion problems, enhancement of caries development and periodontal disorders. Sodium valproate is considered to produce gingival enlargement, but very rarely. This case report features sodium valproate induced gingival enlargement in a patient with pre-existing chronic periodontitis, who came to the Dental Department, Chinmaya Mission Hospital, Bangalore. The case is special as the patient did not develop the enlargement in spite of taking phenytoin for 1 year and developed enlargement with sodium valproate within 6 months.

Periodontal status and its correlation with haematological parameters in patients with leukaemia

AIM

This cross-sectional study evaluated periodontal status in patients with leukaemia and its correlation with haematological parameters.

METHODS

Patients with different types of leukaemia and minimum age of 14 years were eligible. Calibrated examiners assessed Seymour index (SI), plaque index (PlI), gingival index (GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment loss (CAL) and performed an interview. Haematological parameters were obtained from haemogram performed on the same day of the periodontal examinations.

RESULTS

Sixty-eight patients were evaluated, which corresponded to an 85% response rate. Periodontal parameters were in agreement with plaque accumulation (PlI 1.28 ± 0.5, GI 0.74 ± 0.4, PD 2.27 ± 0.6, BOP 33%, CAL 2.31 ± 1.6). PlI and CAL were statistically lower in acute leukaemia (1.13 ± 0.61 and 1.96 ± 1.7) in comparison with chronic leukaemia (1.46 ± 0.44 and 2.74 ± 1.4). Moreover, older age (95% confidence interval [CI]: 0.27-1.56), higher educational level (CI: -1.94 to -0.64) and smoker (CI: 0.39-1.96) were associated with CAL. Correlation between periodontal and haematological parameters was not observed. Correlations between GI x SI and PD x SI were statistically significant (r(S) = 0.390, p = 0.001; r(S) = 0.517, p = 0.000 respectively).

CONCLUSIONS

Periodontal parameters were consistent with plaque accumulation and did not correlate with haematological parameters irrespective of the leukaemia type.

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.

Valproic acid increases susceptibility to endotoxin shock through enhanced release of high-mobility group box 1

High-mobility group box 1 (HMGB1) is a nuclear factor and a secreted protein. During inflammation, HMGB1 is secreted into the extracellular space where it can interact with the receptor for advanced glycation end products and trigger proinflammatory signals. Extracellular HMGB1 plays a critical role in several inflammatory diseases such as sepsis and rheumatoid arthritis. Valproic acid (VPA) is one of the most frequently prescribed antiepileptic drugs. The present study was undertaken to investigate the effect of VPA on secretion of HMGB1 in systemic inflammatory responses induced by lipopolysaccharide. Pretreatment with VPA increased the susceptibility of mice to lipopolysaccharide in endotoxemia. Valproic acid induced HMGB1 release and nuclear factor κB activation in RAW-blue cells. Valproic acid promoted the phosphorylation of ERK1/2 but not that of p38 or JNK. The MEK1/2 inhibitor PD98059 also suppressed HMGB1 release and activation of nuclear factor κB induced by VPA. Valproic acid induced expression of γ-aminobutyric acid receptors in macrophages, and picrotoxin, a γ-aminobutyric acid A receptor antagonist, inhibited the VPA-activated phosphorylation of ERK and VPA-induced HMGB1 release. These results suggest that VPA may exacerbate innate immune responses to endotoxin through enhanced release of HMGB1.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients

OBJECTIVE

Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT/HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOT/HSCT recipients.

METHODS

Literature search was made through MEDLINE. The associations between orofacial diseases and SOT/HSCT were assessed using observational studies and case series and were classified into 'association', 'no association', and 'unclear association'.

RESULTS

Lip/oral cancers, drug-induced gingival overgrowth (DIGO), infections, including hairy leukoplakia and, less frequently, post-transplantation lymphoproliferative disorders (PTLDs) and oral lichenoid lesions of graft-versus-host disease (GVHD), were associated with SOT. Lip/oral cancers, GVHD, mucositis, DIGO, infections and, less frequently, PTLDs were associated with HSCT. Associations of orofacial granulomatosis-like lesions and oral mucosa-associated lymphoid tissue-type lymphoma with SOT, and of pyogenic granuloma and hairy leukoplakia with HSCT were unclear. Periodontal disease and dental caries were not associated with SOT/HSCT. For none of the local treatments was there a strong evidence of effectiveness.

CONCLUSIONS

Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.

Cyclosporine-induced gingival overgrowth correlates with NFAT-regulated gene expression: a pilot study

OBJECTIVE

To determine whether incidence and severity of cyclosporine A (CsA)-induced gingival overgrowth (GO) is related to expression nuclear factor of activated T cells-regulated genes (NFAT-regulated genes).

MATERIAL AND METHODS

Expression of NFAT-regulated genes was determined in 36 transplant patients medicated with CsA by real-time PCR before and 2 h after drug intake and residual NFAT activity was estimated as ratio of both measurements. Demographic, periodontal and pharmacologic parameters were recorded and GO assessed from models. Subjects were divided into two groups according to the degree of GO (responders: GO score≥10%). Groups were compared using parametric and non-parametric tests. The association of various CsA-specific and periodontal parameters on incidence and extent of GO were determined using regression analysis.

RESULTS

Responders had a more than twofold lower residual NFAT activity than non-responders (7.9% and 18.1%, respectively; p<0.001). Multiple regression analysis revealed gingival inflammation, salivary CsA concentration, and residual NFAT activity to be significant factors influencing the expression of GO. Seventy-seven percent of the variability of GO could be explained by these parameters.

CONCLUSIONS

This study showed that pharmacodynamic parameters such as residual NFAT activity may be promising prognostic indicators to identify patients with increased risk for GO.

Idiopathic gingival hyperplasia: a case report with a 17-year followup

This is a case report of a patient with idiopathic gingival hyperplasia and an undiagnosed genetic disorder that demonstrated static encephalopathy, mental retardation, developmental delay, seizures, hypotonia, and severe gingival hypertrophy. The clinical dental management and attempts to obtain a genetic diagnosis are described.

Gingival overgrowth among patients medicated with cyclosporin A and tacrolimus undergoing renal transplantation: a prospective study

BACKGROUND

The aim of this study is to make a longitudinal evaluation of the incidence and severity of gingival overgrowth (GO) induced by immunosuppressive agents, such as tacrolimus (Tcr) and cyclosporin A (CsA), in the absence of calcium channel blockers in patients undergoing renal transplantation (RT).

METHODS

This longitudinal study is conducted in 49 patients with RT who were divided into a CsA group (n = 25) and Tcr group (n = 24). The individuals were assessed at four time intervals: before transplant and 30, 90, and 180 days after RTs. Demographic data and periodontal clinical parameters (plaque index, cemento-enamel junction to the gingival margin, probing depth, clinical attachment level, bleeding on probing [BOP], and GO) were collected at all time intervals.

RESULTS

The mean GO index was significantly lower in the Tcr group compared to the CsA group after 30 (P = 0.03), 90 (P = 0.004), and 180 (P = 0.01) days of immunosuppressive therapy. One hundred eighty days after RTs, a clinically significant GO was observed in 20.0% of individuals in the CsA group and 8.3% of individuals in the Tcr group. However, this difference was not statistically significant (P = 0.41). There was a reduction in periodontal clinical parameters regarding the time of immunosuppressive therapy for PI and BOP (P <0.001) in both groups.

CONCLUSION

Although there was no statistical difference in the incidences of clinically significant GO after 180 days of immunosuppressive therapy, it was observed that GO occurred later in the Tcr group, and the severity of GO in this group was lower than in patients who used CsA.

Gingival overgrowth in renal transplant recipients: a study concerning prevalence, severity, periodontal, and predisposing factors

Gingival overgrowth (GO) is the main oral manifestation in transplant recipients who use calcineurin inhibitors. In the present study, factors for GO development were investigated in Brazilian renal transplant recipients who were prescribed cyclosporine (CsA) or tacrolimus (TAC). Demographic, pharmacological, clinical, and periodontal data were obtained from 83 patients, as well as HLA expression in 51 of them. The prevalence of GO was high (47%), but its severity was low according to periodontal indices. The prevalence of GO was greater among patients who used CsA (n = 49) than those receiving used TAC (n = 34) namely, 61% versus 26.5% (P = .003). Comparisons between patients with versus without GO were performed independent of the administered immunossupressant. The group with GO showed a greater degree of gingival inflammation index. HLA-A68 had greater expression among patients without GO (P = .04). The risk factors for GO occurrence were evaluated using a multivariate analysis that identified gingival inflammation and HLA-A24 expression as risk factors. Increased age and use of TAC were identified as protective factors. GO showed a high prevalence, yet a light intensity. Patients who were younger, men, or received CsA showed a greater occurrence of GO. The risk factors identified for GO development were the presence of gingival inflammation and HLA-A24 expression.

Gingival inflammation assessment by image analysis: measurement and validation

AIM

Gingival inflammation may be caused by injury or plaque-related diseases and reduction in inflammation can be a useful indicator of gingival recovery. There has been little research on development of non-index methods to measure gingival condition. The aims of the study were to investigate the reliability of the measurement of changes in gingival redness and swelling, using image analysis, and to compare this approach with an established method for assessing gingival overgrowth [J Clin Periodontol 28 (2001) 81].

METHOD

Twenty volunteers with gingival inflammation were recruited and digital images were taken. Duplicate measurements were made on the first visit by two examiners. At a subsequent visit following periodontal treatment, second images were taken. Gingival changes were determined by assessing redness and tooth surface area visible between the level of the inter-proximal papillae and the gingival margin. Tooth area measurements were compared with the established gingival overgrowth method.

RESULTS

The method showed excellent reliability for both intra- and inter-examiner measurements of 0.968-0.998 and 0.769-0.947, respectively, according to the classification by Donner and Eliasziw of the Fleiss coefficient of reliability (repeat measures taken during the patients' first attendance). High correlation was found for gingival encroachment when compared with the established gingival overgrowth method.

CONCLUSION

This technique proved a reliable method for investigating changes in gingival redness. High correlation was found for gingival encroachment when compared with an established method.

Non-surgical periodontal treatment of cyclosporin A-induced gingival overgrowth: immunohistochemical results

AIM

The present study was planned to analyze the effects of a 12-month non-surgical periodontal treatment on histologic and immunohistochemical features of cyclosporin A (CsA)-induced gingival overgrowth (GO).

MATERIALS AND METHODS

Gingival samples were collected from 21 liver transplant subjects exhibiting CsA-induced GO prior to, and 12 months after non-surgical periodontal therapy including oral hygiene instructions, scaling and 2-month recall appointments, and also from 18 healthy control subjects. Gingival biopsy specimens were stained with hematoxylin-eosin and monoclonal antibodies for vimentin, CD3 (T-lymphocytes), CD20 (B-lymphocytes), CD34 (endothelium) and Ki-67 (fibroblasts proliferation rate), using a streptavidin-biotin-peroxidase complex method.

RESULTS

Total inflammatory cells, gingival vessels and fibroblast proliferation rate demonstrated significant reduction after non-surgical periodontal treatment (P < 0.0001) in overgrown gingiva, while B- and T-lymphocytes remained nearly unchanged (P = 0.61 and 0.33, respectively). At the 12-month evaluation no significant differences were found when comparing the gingival biopsies from CsA-treated patients and those from healthy controls (P > 0.05).

CONCLUSIONS

Control of clinical inflammation by means of non-surgical periodontal treatment results both in lowering of inflammatory infiltrate and in changes in connective tissue composition. Thus, plaque-induced inflammation would seem to modulate the drug-gingival tissue interaction.

CLINICAL RELEVANCE

A strict plaque control program play a pivotal role in the management of transplant patients exhibiting cyclosporin A-GO.