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Sabbah D, Santana RB. Targeted connective tissue resection with the dual-flap surgical approach in the treatment of drug-induced gingival enlargement: Case study. Clin Adv Periodontics 2024. [PMID: 39428917 DOI: 10.1002/cap.10318] [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: 02/01/2024] [Revised: 09/17/2024] [Accepted: 09/24/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Drug-induced gingival enlargement (DIGE) is a common side effect of medications such as anticonvulsants, calcium channel blockers, and immunosuppressants. The treatment of choice for the condition is drug withdrawal or substitution in combination with the nonsurgical phase. In some cases, additional internal or external bevel gingivectomy is needed to achieve periodontal health. Special approaches may be needed in severe DIGE cases superimposed on periodontitis. The aim of this report is to describe the dual-flap internal gingivectomy (DFIG) approach for the simultaneous management of soft and hard tissues via the simultaneous reduction of the connective tissue bulkiness from the superficial flap and preservation of keratinized tissues. METHODS A generalized Stage IV grade C periodontitis with DIGE was treated. An initial partial thickness flap was elevated and thinned out to a thickness of 1.0-1.5 mm. Then, a second partial-thickness flap was raised, and a thick band of connective tissue was removed. Proper positioning of the primary flap onto the periosteum was obtained and flap adaptation was achieved with localized gingivoplasty. RESULTS Healthy soft tissue was developed with DFIG by debulking the enlarged connective tissues and apical gingival margin positioning with a predictable wide band of keratinized attached gingiva was achieved. CONCLUSIONS: The DFIG surgical approach provides adequate access for root instrumentation and preserves KT width. The procedure effectively reduces soft tissue thickness and improves soft tissue contours, in DIGE cases superimposed to periodontitis. KEY POINTS Gingival enlargement is related to excessive production and deposition of collagen in the inner layer of the connective tissue and the surface of the alveolar bone. The dual-flap internal gingivectomy (DFIG) approach allows for targeted excision of the inner layer of the connective tissue from the buccal primary flap while preserving the width of the keratinized tissue. Adequate soft tissue contours and volume are obtained following the DFIG procedure.
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Affiliation(s)
- David Sabbah
- Department of Periodontology and Oral Implantology, Maurice H. Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Ronaldo B Santana
- Department of Periodontology and Oral Implantology, Maurice H. Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
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2
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Sawamura H, Koyasu S, Sugimoto A, Fujimura S, Nakamoto Y. Gingival Hyperplasia Masquerading as Tumor Lesion, Possibly Linked to Amlodipine Use. Clin Nucl Med 2024; 49:989-990. [PMID: 38914084 DOI: 10.1097/rlu.0000000000005322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT A 70-year-old woman under amlodipine treatment for hypertension presented with a hemorrhagic mass in the mandibular gingiva. Imaging studies revealed high signal intensity in T2-weighted MRI and moderate 18 F-FDG accumulation at the lesion's periphery. Although no malignancy was detected, the lesion continuously grew, prompting excision. Histopathological examination confirmed gingival hyperplasia attributed to amlodipine use. Drug-induced gingival hyperplasia typically presents as diffuse swelling; however, this lesion manifested as a polyp, posing diagnostic challenges. Reports on imaging findings for drug-induced gingival hyperplasia are limited. Understanding imaging patterns alongside clinical history aids in accurate diagnosis.
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Affiliation(s)
| | - Sho Koyasu
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Sugimoto
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology, Head, and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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3
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Mainas G, Santamaria P, Zoheir N, Alamri MM, Hughes F, Lu EMC, Nibali L. Association between calcium-channel blockers and gingival enlargement: A case-control study. J Dent 2024; 149:105315. [PMID: 39159743 DOI: 10.1016/j.jdent.2024.105315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES As reported by the existing literature, calcium-channel blockers (CCB) can lead to gingival enlargement. The aims of this study were to investigate the factors associated with gingival enlargement in patients on CCB and to assess the saliva and gingival crevicular fluid (GCF) profile of patients on CCB with gingival enlargement. METHODS A total of 131 participants were included. Data were collected from 91 patients taking CCB for treatment of systemic hypertension. The presence of drug-induced gingival enlargement (DIGE) was assessed clinically and associated with patient factors. Patients with DIGE were group-matched for gender and ethnicity with an equal number of consecutive CCB non-DIGE patients (control 1), no-CCB no-DIGE (control 2) and periodontally healthy with no DIGE (control 3) for the saliva and GCF analysis. A bead-based multiplex immunoassay was used to assess a panel of biomarkers. RESULTS Twenty-two percent of patients on CCB were diagnosed with DIGE. Lack of daily interdental cleaning and self-reported diagnosis of type II diabetes were associated with the diagnosis of DIGE. When analysing patients only on CCB, those with DIGE had higher GCF levels of vascular endolthelial growth factor (VEGF) (p = 0.032), epidermal growth factor (EGF) (p = 0.030) and matrix metalloproteinase-8 (MMP-8) (p = 0.008). Among the salivary markers, only MMP-8 showed a statistically significant difference across groups (p < 0.001). CONCLUSIONS This is the first study investigating saliva and GCF biomarkers in patients with DIGE and different control groups, suggesting that causes of the overgrowth might involve inflammatory processes, tissue damage pathways, and potentially an impact on growth factors like VEGF. Future research should verify these results in independent populations and explore the underlying pathogenic mechanisms in-depth. CLINICAL SIGNIFICANCE Calcium-channel blockers (CCB) can lead to gingival enlargement. This study confirms lack of interdental cleaning and type II diabetes as risk factors. Elevated levels of VEGF, EGF, and MMP-8 in gingival crevicular fluid and MMP-8 in saliva suggest inflammatory processes and growth factors might play roles in this condition.
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Affiliation(s)
- Giuseppe Mainas
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Pasquale Santamaria
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Noha Zoheir
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Meaad Mohammed Alamri
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK; Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, KSA
| | - Francis Hughes
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Emily Ming-Chieh Lu
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
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Sun S, Pan Y, Zhang J, Jiang Y. Nifedipine-Influenced Enlargement of the Masticatory Mucosa in an Elderly Edentulous Patient: A Rare Case Report with a Two-Year Follow-Up. Case Rep Dent 2024; 2024:6889574. [PMID: 38576511 PMCID: PMC10994707 DOI: 10.1155/2024/6889574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/02/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
Drug-influenced gingival enlargement is a common side effect associated with certain medications, particularly calcium channel blockers like nifedipine, which has been extensively documented. However, the occurrence of nifedipine-influenced masticatory mucosa overgrowth in edentulous patients is rare. Here, we present a case of nifedipine-influenced mucosal enlargement persisting in a 67-year-old edentulous patient 3 months after the extraction of all his teeth. The patient underwent flap surgery and alveoloplasty to excise the overgrown tissue, followed by complete denture restoration. The antihypertensive medication was replaced with valsartan. A 2-year follow-up revealed no recurrence of overgrowth, indicating the effectiveness of this management strategy for such clinical situation.
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Affiliation(s)
- Shoufu Sun
- Department of Stomatology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, 1111 Xianxia Road, Shanghai 200336, China
| | - Yufan Pan
- Xianxia Community Care Center, 140 Furong River Road, Shanghai 200336, China
| | - Jichun Zhang
- Department of Stomatology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, 1111 Xianxia Road, Shanghai 200336, China
| | - Yunan Jiang
- Department of Stomatology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, 1111 Xianxia Road, Shanghai 200336, China
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Gingival Enlargement Caused by Calcium Channel Blockers. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
Calcium channel blockers, a group of drugs widely used in the treatment of cardiovascular patients, although effective, often cause gingival enlargement, a side effect that is rarely recognized in clinical practice and is not given sufficient importance. Gingival enlargement caused by calcium channel blockers can be localized or generalized, mild or severe. It can negatively affect patients’ appearance, mastication, and speech, thus considerably reducing the quality of life of patients. Risk factors and pathogenesis of this side effect have been the subject of many studies but are still unknown, making this condition a major therapeutic challenge, especially if the cessation of the offending drug is not possible. This study aimed to review the etiology, potential risk factors, pathogenesis, clinical features, and therapy possibilities for gingival enlargement caused by calcium channel blockers.
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Wu Y, Peng FH, Gao X, Yan XX, Zhang F, Tan JS, Hu S, Hua L. Safety of chronic high-dose calcium channel blockers exposure in children with pulmonary arterial hypertension. Front Cardiovasc Med 2022; 9:918735. [PMID: 36158824 PMCID: PMC9489906 DOI: 10.3389/fcvm.2022.918735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Chronic calcium channel blockers (CCBs) are indicated in children with idiopathic/heritable pulmonary arterial hypertension (IPAH/HPAH) and positive response to acute vasodilator challenge. However, minimal safety data are available on the long-term high-dose exposure to CCBs in this population. Methods Patients aged 3 months to 18 years who were diagnosed with IPAH/HPAH and treated with CCB in the past 15 years were retrospectively reviewed. The maximum tolerated dose and the long-term safety of high-dose CCBs on the cardiovascular and noncardiovascular systems were assessed. Results Thirty-two eligible children were enrolled in the study, with a median age of 9 (6–11) years old. Thirty-one patients were treated with diltiazem after diagnosis. The median maximum tolerated dose was 12.9 (9.8–16.8) mg/kg/day. Children younger than 7 years used higher doses than children in the older age group, 16.4 (10.5–28.5) mg/kg/day vs. 12.7 (6.6–14.4) mg/kg/day, P < 0.05. Patients were followed up for a median period of 6.2 (2.6–10.8) years. One patient died from a traffic accident, and others showed a stable or improved WHO functional class status. Thirteen (40.6%) and 10 (31.3%) patients developed arrhythmias and hypotension. Nine (28.1%) patients had sinus bradycardia, five (21.9%) had first-degree or second-degree type II atrial-ventricular blocks, and two (6.3%) had second-degree type II atrial-ventricular blocks. Most of these arrhythmias were transient and relieved after CCB dose adjustment. The most reported noncardiovascular adverse effect was gingival hyperplasia (13, 40.6%), accompanied by different degrees of dental dysplasia. No liver or kidney dysfunction was reported. Conclusion Diltiazem was used in a very high dose for eligible children with IPAH/HPAH. The toxicity of long-term CCB use on the cardiovascular system is mild and controllable. Clinicians should also monitor the noncardiovascular adverse effects associated with drug therapy.
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Affiliation(s)
- Yan Wu
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fu-Hua Peng
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Gao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-Xin Yan
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - FengWen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang-Shan Tan
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Song Hu
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Hua
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Lu Hua
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Chen PH, Chuang YT, Huang CF, Lu HK. Expression of epithelial–mesenchymal transition-associated proteins and proliferating cell nuclear antigen in dihydropyridine-induced gingival overgrowth fibroblasts: A preliminary study. J Dent Sci 2022; 18:551-559. [PMID: 37021214 PMCID: PMC10068551 DOI: 10.1016/j.jds.2022.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 11/15/2022] Open
Abstract
Background/purpose The clinical features of dihydropyridine-induced gingival overgrowth (DIGO), including extracellular matrix accumulation and cell hyperplasia, are regulated by inflammatory factors (e.g., Interleukin-1β [IL-1β]) in combination with calcium channel blockers (e.g., nifedipine [Nif]). We speculated that IL-1β and Nif (IL-1β/Nif) may be the main factor modulating the proliferative potential and turnover of fibroblasts in DIGO. Materials and methods We cultured four DIGO fibroblast strains and analysed the possible effects of IL-1β/Nif treatments on epithelial-mesenchymal transition (EMT)-associated proteins. We developed short hairpin ribonucleic acids (shRNAs) and used them to explore the role of IL-1β/Nif in regulating proliferating cell nuclear antigen (PCNA) levels in DIGO tissues. Results Our results revealed that compared with control cells, DIGO cells stimulated with IL-1β/Nif had higher levels of the EMT-associated proteins Snail, Slug, and Twist. Moreover, both drugs enhanced androgen receptor (AR), Slug, and PCNA expression. Conclusion Taken together, our data indicate that proinflammatory cytokines in combination with calcium channel blockers can regulate the expression of EMT-associated proteins and increase the proliferative potential of DIGO fibroblasts.
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Affiliation(s)
- Po-Han Chen
- Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yaw-Tung Chuang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chiung-Fang Huang
- Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsein-Kun Lu
- Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Corresponding author. Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei City, 110301, Taiwan. Fax: +886 2 2737 2181#3211.
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Wan Jamil WAF, AL-Rawas M, Abd Ghani H, Alawi R, Johari Y. Oral Rehabilitation of a Patient With Generalized Inflammatory Gingival Overgrowth Exacerbated by Felodipine: A Case Report. Cureus 2022; 14:e24332. [PMID: 35607547 PMCID: PMC9123398 DOI: 10.7759/cureus.24332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/27/2022] Open
Abstract
Gingival enlargement may manifest as a side effect of medications (calcium channel blockers, anticonvulsants, or immunosuppressants) and may be associated with inflammation, malignancy, or genetic inheritance. This condition has a significant impact on a patient’s quality of life and affects their oral health status. This case report describes the management of a 68-year-old gentleman who presented with generalized gingival enlargement and chronic periapical abscess originating from tooth 34, which served as an abutment for a fixed partial prosthesis. The patient's medical history revealed that felodipine, an antihypertensive medication, was prescribed to him. A comprehensive treatment plan was developed to improve the patient’s quality of life.
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Portnoy PS, Lee SY, McMullen A, Qu V. Amlodipine-Induced Gingival Overgrowth: A Health Justice Issue. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Morikawa S, Nasu M, Miyashita Y, Nakagawa T. Treatment of calcium channel blocker-induced gingival overgrowth without modifying medication. Drug Ther Bull 2021; 60:44-47. [PMID: 34911794 DOI: 10.1136/dtb.2021.238872rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mana Nasu
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoko Miyashita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Biology of Drug-Induced Gingival Hyperplasia: In Vitro Study of the Effect of Nifedipine on Human Fibroblasts. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11073287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: It has been proven that the antihypertensive agent nifedipine can cause gingival overgrowth as a side effect. The aim of this study was to analyze the effects of pharmacological treatment with nifedipine on human gingival fibroblasts activity, investigating the possible pathogenetic mechanisms that lead to the onset of gingival enlargement. Methods: The expression profile of 57 genes belonging to the “Extracellular Matrix and Adhesion Molecules” pathway, fibroblasts’ viability at different drug concentrations, and E-cadherin levels in treated fibroblasts were assessed using real-time Polymerase Chain Reaction, PrestoBlue™ cell viability test, and an enzyme-linked immunoassay (ELISA), respectively. Results: Metalloproteinase 24 and 8 (MMP24, MMP8) showed significant upregulation in treated cells with respect to the control group, and cell adhesion gene CDH1 (E-cadherin) levels were recorded as increased in treated fibroblasts using both real-time PCR and ELISA. Downregulation was observed for transmembrane receptors ITGA6 and ITGB4, the basement membrane constituent LAMA1 and LAMB1, and the extracellular matrix protease MMP11, MMP16, and MMP26. Conclusions: The obtained data suggested that the pathogenesis of nifedipine-induced gingival overgrowth is characterized by an excessive accumulation of collagen due to the inhibition of collagen intracellular and extracellular degradation pathways.
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Morikawa S, Nasu M, Miyashita Y, Nakagawa T. Treatment of calcium channel blocker-induced gingival overgrowth without modifying medication. BMJ Case Rep 2021; 14:14/1/e238872. [PMID: 33431541 PMCID: PMC7802645 DOI: 10.1136/bcr-2020-238872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Gingival overgrowth is a common side effect of calcium channel blockers used in the treatment of cardiovascular diseases. While controversial, management includes discontinuing the calcium channel blocker. We report the case of a 66-year-old Japanese man with hypertension and type 2 diabetes mellitus who was diagnosed with severe periodontitis covering almost all the teeth. The patient had been on nifedipine (40 mg/day) and amlodipine (10 mg/day) medication for 5 years. With his physician's consent, nifedipine was discontinued during his treatment for periodontitis, which consisted of oral hygiene instructions and scaling and root planing on all areas. Gingivectomy was performed on the areas of hard fibrous swelling. Nifedipine was resumed during periodontal treatment when the patient's hypertension worsened. His periodontal scores improved when he resumed treatment. We report that significant improvement in gingival overgrowth can occur with basic periodontal treatment, surgery and sustained intensive follow-up without adjusting calcium channel blockers.
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Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mana Nasu
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoko Miyashita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque-induced gingival conditions. J Periodontol 2019; 89 Suppl 1:S17-S27. [PMID: 29926958 DOI: 10.1002/jper.17-0095] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system. IMPORTANCE Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis. FINDINGS The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy. CONCLUSIONS Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.
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Affiliation(s)
- Shinya Murakami
- Osaka University, Graduate School of Dentistry-Department of Periodontology, Osaka, Japan
| | - Brian L Mealey
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Iain L C Chapple
- Department of Periodontology, University of Birmingham School of Dentistry, Birmingham, UK
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Asif SM, Shaik N, Barthunia B, Kaleem SM, Zakirulla M, Kota MZ, Baig FAH. Nifedipine induced gingival enlargement in an edentulous patient: a case report with one year follow up. BMC Oral Health 2018; 18:227. [PMID: 30587167 PMCID: PMC6307157 DOI: 10.1186/s12903-018-0690-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/07/2018] [Indexed: 12/25/2022] Open
Abstract
Background Gingival enlargement due to calcium channel blockers is a common complaint reported by patients. It can be localized or generalized and can range from mild to severe, affecting patients appearance and function. Nifedipine induced gingival enlargement is noticed only in 10 % of patients and very few cases of Nifedipine induced gingival enlargement in an edentulous patient have been documented in the literature. Case presentation Here in, we report a case of gingival enlargement in a 70 year old hypertensive edentulous patient who was on low dose Nifedipine therapy. Patient wanted complete dentures. We planned to excise the overgrowth and followed up for 1 year. Conclusion Nifedipine induced gingival enlargement noticed only in 10 % of patients. Hence, there is a need for physicians and dentist to make a coordinated treatment plan and practice care while prescribing these drugs which are associated with gingival overgrowth.
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Affiliation(s)
- Shaik Mohammed Asif
- Department of Diagnostic Sciences and Oral biology , College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Naheeda Shaik
- Department of Periodontology, Mamata Dental College, Khammam, India
| | - Bhavna Barthunia
- Department of Oral Medicine and Radiology, Daswani Dental College and Research Hospital, Kota, Rajasthan, India
| | - Sultan Mohammed Kaleem
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - M Zakirulla
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Zahir Kota
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Fawaz Abdul Hamid Baig
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
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Murakami S, Mealey BL, Mariotti A, Chapple IL. Dental plaque-induced gingival conditions. J Clin Periodontol 2018; 45 Suppl 20:S17-S27. [DOI: 10.1111/jcpe.12937] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Shinya Murakami
- Osaka University; Graduate School of Dentistry-Department of Periodontology; Osaka Japan
| | - Brian L. Mealey
- Department of Periodontics; The University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Angelo Mariotti
- Division of Periodontology, College of Dentistry; The Ohio State University; Columbus OH USA
| | - Iain L.C. Chapple
- Department of Periodontology; University of Birmingham School of Dentistry; Birmingham UK
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Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics 2018; 10:E36. [PMID: 29558445 PMCID: PMC5874849 DOI: 10.3390/pharmaceutics10010036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
The long-term use of prescription and over-the-counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years. Given the large number of medications currently available, the number of research studies examining potential drug-nutrient interactions is quite limited. A comprehensive, updated review of the potential drug-nutrient interactions with chronic use of the most often prescribed medications for commonly diagnosed conditions among the general U.S. adult population is presented. For the majority of the interactions described in this paper, more high-quality intervention trials are needed to better understand their clinical importance and potential consequences. A number of these studies have identified potential risk factors that may make certain populations more susceptible, but guidelines on how to best manage and/or prevent drug-induced nutrient inadequacies are lacking. Although widespread supplementation is not currently recommended, it is important to ensure at-risk patients reach their recommended intakes for vitamins and minerals. In conjunction with an overall healthy diet, appropriate dietary supplementation may be a practical and efficacious way to maintain or improve micronutrient status in patients at risk of deficiencies, such as those taking medications known to compromise nutritional status. The summary evidence presented in this review will help inform future research efforts and, ultimately, guide recommendations for patient care.
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Affiliation(s)
- Emily S Mohn
- Jean Mayer USDA Human Nutrition Research Center on Aging, and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Hua J Kern
- Nutrition & Scientific Affairs, Nature's Bounty Co., Ronkonkoma, NY 11779, USA.
| | - Edward Saltzman
- Jean Mayer USDA Human Nutrition Research Center on Aging, and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Susan H Mitmesser
- Nutrition & Scientific Affairs, Nature's Bounty Co., Ronkonkoma, NY 11779, USA.
| | - Diane L McKay
- Jean Mayer USDA Human Nutrition Research Center on Aging, and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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18
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Sandoval MJ, Zekeridou A, Spyropoulou V, Courvoisier D, Mombelli A, McLin V, Giannopoulou C. Oral health of pediatric liver transplant recipients. Pediatr Transplant 2017; 21. [PMID: 28670817 DOI: 10.1111/petr.13019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 01/25/2023]
Abstract
To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P<.001) and primary diagnosis of cholestatic disease (P=.04). Gingival inflammation was associated with plaque (P<.001), use of immunosuppressive medication (P=.04), and was more pronounced in children with cholestatic disease (P=.007). Children and young adults with liver transplants presented a rather poor oral health status. Liver transplant physicians should counsel patients for regular dental follow-up in order to avoid serious dental infections.
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Affiliation(s)
- Marίa José Sandoval
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Alkisti Zekeridou
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vasiliki Spyropoulou
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | | | - Andrea Mombelli
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Valérie McLin
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, School of Dental Medicine, University of Geneva, Geneva, Switzerland
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Gopal V, Quo BC, Chainani-Wu N. Amlodipine-Induced Gingival Overgrowth With Unusual Presentation as a Gingival Mass and Rapid Regression After Dose Reduction. Clin Adv Periodontics 2017; 7:25-29. [PMID: 32689727 DOI: 10.1902/cap.2016.160013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/24/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gingival overgrowth, a known side effect of calcium channel blockers, particularly nifedipine, usually presents as a diffuse overgrowth. An unusual presentation of amlodipine-induced gingival overgrowth is presented here, with a large, erythematous gingival mass as the most prominent feature, and rapid, almost complete resolution of the mass after reduction of amlodipine dosage. CASE PRESENTATION A boy, aged 7 years, presented with a gingival mass first noticed a week previously, with no associated discomfort or bleeding. His medical history was significant for Wiskott-Aldrich syndrome, bone marrow transplant 5 years previously, and subsequent development of severe chronic graft-versus-host-disease. His medication included: 1) amlodipine; 2) enalapril; 3) tacrolimus; 4) sulfamethoxazole/trimethoprim; 5) voriconazole; 6) hydrocortisone cream; and 7) intravenous immunoglobulin infusions. Allergies included: 1) vancomycin; 2) metoclopramide; 3) clonidine; and 4) latex. Examination revealed mild generalized gingival overgrowth and the presence of a large, erythematous, sessile, soft, non-tender mass on the mandibular right gingiva between the primary lateral incisor and canine, resembling a pyogenic granuloma. No suppuration, bleeding on probing, or radiographic abnormalities were noted. A recommendation was made to the physician of the patient to replace amlodipine with a different class of antihypertensive. In response, amlodipine dosage was decreased by 50% to 2.5 mg daily. At a 2-week follow-up visit, considerable reduction in size of the gingival mass had occurred, and shortly after complete resolution was reported by his parents. No other intervention, such as scaling or excision, had been performed. CONCLUSION Discontinuation or reduction of the amlodipine dose to <5 mg daily prior to any surgical intervention should be considered in patients taking amlodipine presenting with a gingival mass.
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Affiliation(s)
| | - Brian C Quo
- Private practice, Palo Alto, CA.,Craniofacial Department, The Lucile Packard Children's Hospital at Stanford, Palo Alto, CA
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20
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Beaumont J, Chesterman J, Kellett M, Durey K. Gingival overgrowth: Part 1: aetiology and clinical diagnosis. Br Dent J 2017; 222:85-91. [DOI: 10.1038/sj.bdj.2017.71] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/30/2022]
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21
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Umeizudike KA, Olawuyi AB, Umeizudike TI, Olusegun-Joseph AD, Bello BT. Effect of Calcium Channel Blockers on Gingival Tissues in Hypertensive Patients in Lagos, Nigeria: A Pilot Study. Contemp Clin Dent 2017; 8:565-570. [PMID: 29326507 PMCID: PMC5754977 DOI: 10.4103/ccd.ccd_536_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Long-term treatment of common chronic cardiac conditions such as hypertension with calcium channel blockers (CCBs) has long been associated with gingival hyperplasia. This oral side effect may affect esthetics and function, yet often overlooked and therefore underreported among Nigerians. Aim: This study aimed to determine the association of CCBs with gingival overgrowth (GO) in hypertensive patients. Methods: This was a hospital-based, case–control study conducted among 116 hypertensive patients (58 CCB and 58 non-CCB age-matched controls) attending the medical outpatient clinic of a tertiary health institution in Lagos, Nigeria. Data collection tools included interviewer-administered questionnaires and periodontal examination. Sociodemographic details, medical history, and periodontal indices (gingival index, plaque index, class of GO according to drug-induced GO [DIGO] Clinical Index) were recorded. Results: The mean age was 59.4 ± 12.6 years, females representing 50.9%. In the CCB group, 39 (67.2%) participants were on amlodipine and 19 (32.8%) were on nifedipine. The mean duration of CCB use was 55.6 ± 53 months. DIGO was higher in CCB (36.2%) than that in non-CCB participants (17.2%) (χ2 = 4.4, P = 0.036). The risk of GO was higher in CCB users (odds ratio [OR] 2.7, [95% confidence interval (CI)]: 1.1–6.5). Amlodipine users had higher DIGO (37.5%) than that of nifedipine users (21.1%) (OR 2.3, [95% CI]: 1.0–5.3). The predominant class of DIGO among the CCB users was Class 2 DIGO Clinical Index (90.5%). Conclusion: The study reveals that the risk of GO is nearly three times in CCB than that of non-CCB users and twice higher in amlodipine than nifedipine users in Nigeria.
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Affiliation(s)
- Kehinde Adesola Umeizudike
- Department of Preventive Dentistry, Faculty of Dental Sciences, College of Medicine University of Lagos, Lagos, Nigeria
| | - Adetokunbo B Olawuyi
- Department of Oral and Maxillofacial Pathology/Biology, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Babawale T Bello
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
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22
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Abstract
Gingival overgrowth occurs mainly as a result of certain anti-seizure, immunosuppressive, or antihypertensive drug therapies. Excess gingival tissues impede oral function and are disfiguring. Effective oral hygiene is compromised in the presence of gingival overgrowth, and it is now recognized that this may have negative implications for the systemic health of affected patients. Recent studies indicate that cytokine balances are abnormal in drug-induced forms of gingival overgrowth. Data supporting molecular and cellular characteristics that distinguish different forms of gingival overgrowth are summarized, and aspects of gingival fibroblast extracellular matrix metabolism that are unique to gingival tissues and cells are reviewed. Abnormal cytokine balances derived principally from lymphocytes and macrophages, and unique aspects of gingival extracellular matrix metabolism, are elements of a working model presented to facilitate our gaining a better understanding of mechanisms and of the tissue specificity of gingival overgrowth.
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Affiliation(s)
- P C Trackman
- Boston University Goldman School of Dental Medicine, Department of Periodontology and Oral Biology, Division of Oral Biology, Boston, MA 02118, USA.
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23
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Bullon P, Gallardo I, Goteri G, Rubini C, Battino M, Ribas J, Newman HN. Nifedipine and Cyclosporin Affect Fibroblast Calcium and Gingiva. J Dent Res 2016; 86:357-62. [PMID: 17384032 DOI: 10.1177/154405910708600411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It has been stated that cyclosporin and nifedipine produce gingival overgrowth. However, the specific pathogenic mechanism remains uncertain. We used an experimental rat model to test the hypothesis that changes in collagen metabolism and numbers of gingival blood vessels are not mediated by intracellular calcium concentration (ratiometric Fura-2 AM measurement) in gingival fibroblasts. In the cyclosporin group, both width (364.2 ± 67.5 μm) and microvessel density (number of vessels/mm2, stained with anti-CD34 antibody) (41.6 ± 5.1) of gingiva were statistically different when compared with those in the control group (width = 184.3 ± 35.2 μm, microvessel density = 19.6 ± 2.4). The nifedipine group showed the highest content of collagen (proportion of total stroma occupied by collagen, stained with Picro-Mallory) (nifedipine group = 66.3 ± 9.4, cyclosporin group = 55.2 ± 7.9, control group = 30.1 ± 10.2). Freshly cultured fibroblasts from the cyclosporin group exhibited higher ratiometric values of fluorescence than did both the control and nifedipine groups (p = 0.03). Our results support the hypothesis that changes in gingival collagen metabolism are not mediated by calcium intracellular oscillations.
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Affiliation(s)
- P Bullon
- Department of Periodontology, Facultad de Odontologia, University of Sevilla, c/Avicena s/n, 41009 Sevilla, Spain.
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24
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Krishnamoorthy K, Nair K. Gingival overgrowth due to amlodipine. Indian Heart J 2016; 68:431. [PMID: 27316509 PMCID: PMC4911459 DOI: 10.1016/j.ihj.2016.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022] Open
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Pascoe VL, Fenves AZ, Wofford J, Jackson JM, Menter A, Kimball AB. The spectrum of nephrocutaneous diseases and associations. J Am Acad Dermatol 2016; 74:247-70; quiz 271-2. [DOI: 10.1016/j.jaad.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/31/2022]
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Chang J, Wang L, Lu S, Huang C, Lu H. NF-κB Enhances Androgen Receptor Expression through 5′-UTR Binding in Gingival Cells. J Dent Res 2015; 94:1439-45. [DOI: 10.1177/0022034515594117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dihydropyridine-induced gingival overgrowth (DIGO) is a side effect observed in patients treated for hypertension. The disease is aggravated by inflammation. Nifedipine (Nif), a dihydropyridine, causes gingival overgrowth by increasing the expression of the androgen receptor (AR). Furthermore, the proinflammatory cytokine interleukin 1β (IL-1β) induces collagen α1(I) expression through the AR in DIGO fibroblasts. These observations prompted us to investigate whether and how nuclear factor kappa B (NF-κB) affects AR expression in DIGO. Therefore, gingival fibroblasts obtained from the tissues of patients with DIGO and healthy subjects were stimulated with IL-1β, Nif, or both. mRNA and protein expression was detected with real-time polymerase chain reaction and Western blotting. High correlation coefficients were observed for the mRNA expression of the AR, connective tissue growth factor, and collagen α1(I) induced by both drugs. Western blot analysis showed that IL-1β and Nif increased and activated NF-κB more in DIGO cells than in healthy cells. An electrophoretic mobility shift assay demonstrated that the promoter and 5′-untranslated regions (5′-UTRs) of the AR gene contains 3 binding sites for the NF-κB p65 subunit. A chromatin immunoprecipitation assay revealed that the NF-κB p65 subunit was associated with AR 5′-UTRs in gingival fibroblasts. A site-directed mutagenesis study indicated that a mutation of NF-κB binding sites reduced Nif- and IL-1β-induced AR promoter activities. Collectively, these data indicate that NF-κB is an essential transcriptional regulator of AR gene expression and thus plays a crucial role in collagen overproduction in DIGO fibroblasts.
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Affiliation(s)
- J.H. Chang
- Department of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - L.F. Wang
- Department of Biochemistry, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - S.L. Lu
- Department of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - C.F. Huang
- Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - H.K. Lu
- Department of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
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Gopal S, Joseph R, Santhosh VC, Kumar VVH, Joseph S, Shete AR. Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study. J Indian Soc Periodontol 2015; 19:308-11. [PMID: 26229273 PMCID: PMC4520117 DOI: 10.4103/0972-124x.153483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Saumiya Gopal
- Department of Periodontics, KMCT Dental College, Mukkom, Kerala, India
| | - Rosamma Joseph
- Department of Periodontics, Government Dental College, Calicut, Kerala, India
| | | | | | - Shiny Joseph
- Department of Periodontics, Al-Azar Dental College, Thodupuzha, Kerala, India
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28
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Kalsi HJ, Hussain Z, Darbar U. An update on crown lengthening part 1: gingival tissue excess. ACTA ACUST UNITED AC 2015; 42:144-6, 149-50, 153. [DOI: 10.12968/denu.2015.42.2.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Harpoonam Jeet Kalsi
- Specialist Registrar in Restorative Dentistry, Eastman Dental Hospital, London, UK
| | - Zahra Hussain
- Consultant in Restorative Dentistry, Eastman Dental Hospital, London, UK
| | - Ulpee Darbar
- Consultant in Restorative Dentistry, Eastman Dental Hospital, London, UK
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Li WL, Wu CH, Yang J, Tang M, Chen LJ, Zhao SL. Local Inflammation Alters MMP-2 and MMP-9 Gelatinase Expression Associated with the Severity of Nifedipine-Induced Gingival Overgrowth: a Rat Model Study. Inflammation 2015; 38:1517-28. [DOI: 10.1007/s10753-015-0126-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Nonsurgical management of nifedipine induced gingival overgrowth. Case Rep Dent 2014; 2014:741402. [PMID: 25165585 PMCID: PMC4137614 DOI: 10.1155/2014/741402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/08/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022] Open
Abstract
Drug-induced gingival overgrowth is frequently associated with three particular drugs: phenytoin, cyclosporin, and nifedipine. As gingival enlargement develops, it affects the normal oral hygiene practice and may interfere with masticatory functions. The awareness in the medical community about this possible side effect of nifedipine is less when compared to the effects of phenytoin and cyclosporin. The frequency of gingival enlargement associated with chronic nifedipine therapy remains controversial. Within the group of patients that develop this unwanted effect, there appears to be variability in the extent and severity of the gingival changes. Although gingival inflammation is considered a primary requisite in their development, few cases with minimal or no plaque induced gingival inflammation have also been reported. A case report of gingival overgrowth induced by nifedipine in a patient with good oral hygiene and its nonsurgical management with drug substitution is discussed in this case report.
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Seferos N, Daskala I, Kotsiou A, Tsamouri M, Tesseromatis C. Nifedipine-induced histological changes in the parotid glands of hypertensive rats. Braz Oral Res 2014; 28:S1806-83242014000100230. [PMID: 24918367 DOI: 10.1590/1807-3107bor-2014.vol28.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/03/2014] [Indexed: 12/27/2022] Open
Abstract
Nifedipine is a widely used anti-anginal and anti-hypertensive agent. It is associated with significant gingival changes attributed more to collagen hyperplasia than to enhancement of protein synthesis. We investigated the influence of nifedipine on morphological changes in the parotid glands of rats in a model of hypertension. Twenty-eight male Wistar rats (8-10 weeks; 200±15 g) were divided into four groups (A-D). Hypertension was induced by surgical means in groups C and D. Animals in groups B and D were treated with nifedipine (0.85 mg/kg) via a gastroesophageal catheter the day after surgery (experimental day-1) for 2 weeks. A significant difference was observed between the control group and nifedipine group and between the control group and hypertension group with regard to the weight of the parotid gland and its surface area. Histological findings demonstrated changes in the parotid glands of hypertensive animals with mild vessel dilatation and infiltration of inflammatory cells. These histological findings seemed to be due more to changes in venous function than to alterations in gland architecture.
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Affiliation(s)
- Nikos Seferos
- Department of Pharmacology, Medical School, University of Athens, Athens, Greece
| | - Ioanna Daskala
- Department of Pharmacology, Medical School, University of Athens, Athens, Greece
| | | | - Madeleine Tsamouri
- Department of Pathology, General District Hospital ?Red Cross?, Athens, Greece
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Andrew W, Evelyn W, Francis M, Mark J, Mark C. Pattern of Gingival Overgrowth among Patients on Antihypertensive Pharmacotherapy at a Nairobi Hospital in Kenya. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojst.2014.44025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Vahabi S, Moslemi M, Nazemisalman B, Yadegari Z. Phenytoin Effects on Proliferation and Induction of IL1<i>β</i> and PGE2 in Pediatric and Adults’ Gingival Fibroblasts. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojst.2014.49061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kim SS, Jackson-Boeters L, Darling MR, Rieder MJ, Hamilton DW. Nifedipine induces periostin expression in gingival fibroblasts through TGF-beta. J Dent Res 2013; 92:1022-8. [PMID: 24004653 DOI: 10.1177/0022034513503659] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Gingival enlargement is a fibrotic condition that can arise from systemic administration of the dihydropyridine calcium channel blocker nifedipine. Periostin, a transforming growth factor-beta (TGF-β)-inducible matricellular protein, has been associated with fibrosis in numerous tissues, but its expression has never been examined in nifedipine-influenced gingival enlargement (NIGE). The objective of this study was to assess if periostin up-regulation is associated with NIGE and whether nifedipine induces periostin expression in gingival fibroblasts. In NIGE tissue (n = 6), periostin is overexpressed in the gingival connective tissue compared with healthy control tissue (n = 6). The transcription factor p-SMAD2/3, which is associated with canonical TGF-β signaling, localizes to the nuclei in both HGFs and oral epithelial cells in NIGE tissues, but not in control healthy tissue. In vitro culture of HGFs with 30 and 100 ng/mL of nifedipine significantly increased periostin mRNA and protein levels, which correlated with increased levels of active TGF-β and increased phosphorylation and nuclear localization of SMAD3. Blocking of canonical TGF-β signaling through inhibition of the TGF-β receptor I with SB431542 significantly reduced nifedipine-induced SMAD3 phosphorylation and periostin expression. Our results demonstrate that nifedipine up-regulates periostin in HGFs in a TGF-β-dependent manner.
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Affiliation(s)
- S S Kim
- Department of Anatomy & Cell Biology, Children's Health Research Institute, London, ON, Canada
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36
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Calcium channel blocker-induced gingival enlargement. J Hum Hypertens 2013; 28:10-4. [PMID: 23739159 DOI: 10.1038/jhh.2013.47] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/01/2013] [Accepted: 05/01/2013] [Indexed: 01/10/2023]
Abstract
Despite the popularity and wide acceptance of the calcium channel blockers (CCBs) by the medical community, their oral impact is rarely recognized or discussed. CCBs, as a group, have been frequently implicated as an etiologic factor for a common oral condition seen among patients seeking dental care: drug-induced gingival enlargement or overgrowth. This enlargement can be localized or generalized, and can range from mild to extremely severe, affecting patient's appearance and function. Treatment options for these patients include cessation of the offending drug and substitution with another class of antihypertensive medication to prevent recurrence of the lesions. In addition, depending on the severity of the gingival overgrowth, nonsurgical and surgical periodontal therapy may be required. The overall objective of this article is to review the etiology and known risk factors of these lesions, their clinical manifestations and periodontal management.
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The possible potential therapeutic targets for drug induced gingival overgrowth. Mediators Inflamm 2013; 2013:639468. [PMID: 23690667 PMCID: PMC3652200 DOI: 10.1155/2013/639468] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/29/2013] [Indexed: 12/14/2022] Open
Abstract
Gingival overgrowth is a side effect of certain medications. The most fibrotic drug-induced lesions develop in response to therapy with phenytoin, the least fibrotic lesions are caused by cyclosporin A, and the intermediate fibrosis occurs in nifedipine-induced gingival overgrowth. Fibrosis is one of the largest groups of diseases for which there is no therapy but is believed to occur because of a persistent tissue repair program. During connective tissue repair, activated gingival fibroblasts synthesize and remodel newly created extracellular matrix. Proteins such as transforming growth factor (TGF), endothelin-1 (ET-1), angiotensin II (Ang II), connective tissue growth factor (CCN2/CTGF), insulin-like growth factor (IGF), and platelet-derived growth factor (PDGF) appear to act in a network that contributes to the development of gingival fibrosis. Since inflammation is the prerequisite for gingival overgrowth, mast cells and its protease enzymes also play a vital role in the pathogenesis of gingival fibrosis. Drugs targeting these proteins are currently under consideration as antifibrotic treatments. This review summarizes recent observations concerning the contribution of TGF-β, CTGF, IGF, PDGF, ET-1, Ang II, and mast cell chymase and tryptase enzymes to fibroblast activation in gingival fibrosis and the potential utility of agents blocking these proteins in affecting the outcome of drug-induced gingival overgrowth.
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Pedaballi P, Sundaram R, Ramachandran M. Prevalence of gingival enlargement secondary to calcium channel blockers in patients with cardiovascular diseases. J Indian Soc Periodontol 2012; 16:430-5. [PMID: 23162342 PMCID: PMC3498717 DOI: 10.4103/0972-124x.100925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 04/16/2012] [Indexed: 11/04/2022] Open
Abstract
AIM The purpose of the present study was to determine the prevalence and extent of gingival overgrowth in patients treated with calcium channel blockers for cardiovascular diseases. BACKGROUND Calcium channel blockers are widely used in the treatment of hypertension, vasoplastic angina, and cardiacarrythmias. Gingival overgrowth resulting from the use of calcium channel blockers is of primary concern to dentists. The purpose of the present study is to determine the prevalence and extent of gingival overgrowth in patients treated with calcium channel blockers for various cardiovascular diseases, to assess their periodontal status and to correlate the factors like age, sex, duration, dosage, type of drugs that result in gingival overgrowth. MATERIALS AND METHODS A cross-sectional study was done in cardiac patients treated with calcium channel blockers, visiting The Railway hospital, Perumbur, Chennai. Information regarding medical history, type, duration, dosage of medication were recorded and analyzed. The periodontal condition of the patients was assessed using the plaque index, gingival index, calculus index, papillary bleeding index, and extent of gingival overgrowth using appropriate indices. The data was later subjected to statistical analysis. RESULTS In this study, a total of 213 cardiac patients (145 males and 68 females) who met the inclusion and exclusion criteria were screened. The patients were between 19 and 69 years. CONCLUSIONS From the results of the present study it can be concluded that gingival overgrowth does occur with calcium channel blockers. Elderly males appeared to be more susceptible to the development of drug-induced gingival overgrowth, which was independent of dosage, duration of drug administered but the presence of local factors seemed to aggravate the same.
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Affiliation(s)
- Priya Pedaballi
- Department of Periodontology, RMDCH, Annamalai University, Chidambaram, Tamil Nadu, India
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Sunil PM, Nalluswami JS, Sanghar SJ, Joseph I. Nifedipine-induced gingival enlargement: Correlation with dose and oral hygiene. J Pharm Bioallied Sci 2012; 4:S191-3. [PMID: 23066250 PMCID: PMC3467881 DOI: 10.4103/0975-7406.100268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/04/2022] Open
Abstract
Gingival enlargement is a common finding in a routine dental practice. Though it has many etiological factors, enlargement due to drugs which are administered to treat the systemic problems is of major concern which needs attention. Here, we present a case of nifedipine-induced gingival enlargement and discuss the reason for the enlargement.
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Affiliation(s)
- Paramel Mohan Sunil
- Department of Oral Pathology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
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Kumar P, Mastan K, Chowdhary R, Shanmugam K. Oral manifestations in hypertensive patients: A clinical study. J Oral Maxillofac Pathol 2012; 16:215-21. [PMID: 22923893 PMCID: PMC3424937 DOI: 10.4103/0973-029x.99069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of this work was to determine the frequency and nature of oral manifestations in a hypertensive patient. Materials and Methods: The study sample consisted of 465 known hypertensive patients, between the age group of 20-80 years of which 250 patients were males and 215 were females. 105 were between the age group of 1-40 years, 136 in 41-50 years, 110 in 51-60 years, and 114 in 60 and above year of age. Data were statistically analyzed Student's t-test. Results: 79.14% of the patients presented with Russell's periodontal index score ranging from 2- 4.9 which suggested an established periodontal lesion. The risk factors for old men and women to develop hypertension were 90%, among those who survived to ages 65 to 89 years. Conclusion: The frequency of potential oral manifestations in patients with hypertension was significantly high, thus showing an association of gingival and periodontal pathology in hypertensive patients
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Affiliation(s)
- Prashant Kumar
- Department of Oral Pathology, S.Nijalingappa Institute of Dental Sciences, Gulbarga, India
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Miranda J, Brunet L, Roset P, Farré M, Mendieta C. Reliability of two measurement indices for gingival enlargement. J Periodontal Res 2012; 47:776-82. [DOI: 10.1111/j.1600-0765.2012.01495.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karnik R, Bhat KM, Bhat GS. Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital. Gerodontology 2012; 29:209-13. [PMID: 22506838 DOI: 10.1111/j.1741-2358.2011.00603.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the prevalence of amlodipine-induced gingival overgrowth (GO) among elderly subjects attending an Indian teaching hospital and find any association with demographic factors, drug variables, oral hygiene status and gingival inflammation. METHODS A cross-sectional pilot study included 157 dentate patients aged 60 years or more, taking Amlodipine for at least 3 months. Data were collected from past medical records and oral examination. Clinical assessment of GO was correlated with patient's age, gender, drug dosage (2.5, 5 or 10 mg/day), duration of drug therapy (3-4, 4-6, 6-12, 12-24 and >24 months) and also with subjects' plaque index and gingival index scores. RESULTS Eight patients (5.09%) had GO. No statistically significant relation was observed between age (p = 0.79), gender (p = 0.56), drug dosage (p = 0.25) and duration of drug intake (p = 0.62) and prevalence of GO. GO prevalence related highly significantly (p < 0.001) with plaque and gingival index scores. CONCLUSIONS Prevalence of amlodipine-associated GO in the sample of elderly Indian patients was noted higher than that previously reported. Plaque and gingival inflammation were highly correlated with this condition, while demographic characteristics and drug dosage did not relate significantly.
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Affiliation(s)
- Rohit Karnik
- Yogita Dental College and Hospital, Khed, Maharashtra, India.
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Kwok V, Caton JG, Polson AM, Hunter PG. Application of evidence-based dentistry: from research to clinical periodontal practice. Periodontol 2000 2012; 59:61-74. [DOI: 10.1111/j.1600-0757.2011.00437.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Shetty AK, Shah HJ, Patil MA, Jhota KN. Idiopathic gingival enlargement and its management. J Indian Soc Periodontol 2011; 14:263-5. [PMID: 21731254 PMCID: PMC3118079 DOI: 10.4103/0972-124x.76935] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 11/24/2010] [Indexed: 11/16/2022] Open
Abstract
Idiopathic gingival enlargement is a proliferative fibrous lesion of the gingival tissue that causes esthetic and functional problems. Both genetically and pharmacologically induced forms of gingival enlargement exist. This case report addresses the diagnosis and treatment of a case of idiopathic gingival enlargement in a 13-year-old female. The patient presented with generalized diffuse gingival enlargement involving the maxillary and mandibular arches extending on buccal and lingual/palatal surfaces and covering incisal / occlusal third of the tooth resulting in difficulty in speech and mastication since last three years. Patient also gave a history of surgical treatment being carried out four years back in upper anterior region suggesting of recurrence. Biopsy report confirmed the diagnosis of gingival hyperplasia. Gingivectomy was carried out in all four quadrants by using four different methods.
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Affiliation(s)
- Arvind K Shetty
- Department of Periodontics and Oral Implantology, Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, India
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Idiopathic gingival hyperplasia: a case report with a 17-year followup. Case Rep Dent 2011; 2011:986237. [PMID: 22567452 PMCID: PMC3335718 DOI: 10.1155/2011/986237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/05/2011] [Indexed: 01/08/2023] Open
Abstract
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.
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Sousa CP, Navarro CM, Sposto MR. Clinical assessment of nifedipine-induced gingival overgrowth in a group of brazilian patients. ISRN DENTISTRY 2011; 2011:102047. [PMID: 21991453 PMCID: PMC3186915 DOI: 10.5402/2011/102047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 05/04/2011] [Indexed: 01/21/2023]
Abstract
Although it has been established that nifedipine is associated with gingival overgrowth (GO), there is little information on the prevalence and severity of this condition in the Brazilian population. The aim of this study was to assess the occurrence of nifedipine-induced GO in Brazilian patients and the risk factors associated using a Clinical Index for Drug Induced Gingival Overgrowth (Clinical Index DIGO). The study was carried out on 35 patients under treatment with nifedipine (test group) and 35 patients without treatment (control group). Variables such as demographic (age, gender), pharmacological (dose, time of use), periodontal (plaque index, gingival index, probing depth, clinical insertion level, and bleeding on probing), and GO were assessed. Statistical analysis showed no association between GO and demographic or pharmacological variables. However, there was an association between GO and periodontal variables, except for plaque index. According to our study, the Clinical Index DIGO can be used as a parameter to evaluate GO. Therefore, we conclude that the presence of gingival inflammation was the main risk factor for the occurrence of nifedipine-induced GO.
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Affiliation(s)
- Cliciane Portela Sousa
- Department of Diagnosis and Oral Surgery, Dental School, UNESP, 14801-903 Araraquara, SP, Brazil
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Shimizu T, Kubota T, Nakasone N, Abe D, Morozumi T, Yoshie H. Microarray and quantitative RT-PCR analyses in calcium-channel blockers induced gingival overgrowth tissues of periodontitis patients. Arch Oral Biol 2010; 56:277-84. [PMID: 21035109 DOI: 10.1016/j.archoralbio.2010.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 08/20/2010] [Accepted: 10/01/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of the present study was to analyse transcriptomes and mRNA expression levels for specific genes in calcium-channel blocker-induced gingival overgrowth (GO) tissues. DESIGN Eight gingival tissues samples (from both GO negative and positive sites) were harvested from four GO patients for microarray analyses. Twelve candidate genes were selected for further quantitative real time reverse transcription-polymerase chain reaction (qRT-PCR) analyses. Ten GO tissues from periodontitis patients and ten control gingival tissues from healthy subjects were compared by qRT-PCR. Mann-Whitney U-test was used for statistical evaluation. RESULTS In GO positive tissues, 163-1631 up-regulated and 100-695 down-regulated genes were identified with more than two-fold changes compared with GO negative tissues amongst patients by microarray experiments. No commonly expressed genes amongst the eight sets of microarray data were found. The clustering analysis confirmed that the entire transcriptome patterns showed similarities in individuals, but differences amongst the four patients. The qRT-PCR and statistical analyses for the candidate genes, though, revealed differential gene expressions between GO-positive and negative tissues. We found that matrix metalloproteinase (MMP)-1 and MMP-12 as well as cathepsin-L were significantly up-regulated whilst keratin-10 and transforming growth factor-β1 were significantly down-regulated in GO tissues of periodontitis patients compared with the control gingival tissues of healthy subjects. CONCLUSION The microarray analyses revealed that GO pathogenesis was complex and individually varied, though GO-affected gingival tissues were controlled at least by genes related to collagen metabolisms including regulated MMPs, cathepsin-L, growth factors, and keratins to maintain tissue homeostasis in vivo.
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Affiliation(s)
- Taro Shimizu
- Division of Periodontology, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, Japan
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Drug-induced gingival hyperplasia and scaffolds: they may be valuable for horizontal food impaction. Med Hypotheses 2010; 74:984-5. [PMID: 20172659 DOI: 10.1016/j.mehy.2010.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/17/2010] [Indexed: 12/14/2022]
Abstract
Food impaction is a severe clinical trouble that bothers most people especially middle aged and old people. It is reported that the rate of food impaction is 92.2%. The incidence of 40-59 years old is 98.9%. It is a disease of high prevalence in population. It has influenced people's social intercourse and everyday life because it may cause halitosis, gingivalitis, periodontitis, gingival abscess, alveolar bone absorption, root caries, eventually lead to severe results from teeth loose to deletion and so on. Several reasons are involved with food impaction such as gingival recession, periodontal disease, caries, age, excessive attrition, etc. Food impaction can be divided into two kinds: vertical and horizontal food impaction. At present, there are some clinical methods such as crown or dental filling for vertical one, but horizontal food impaction is still difficult to deal with. Though some methods are being adopted like making crowns and removable obstructers, the problems have never been settled effectively for the injury to teeth and inconvenience of these treatments. Here we put forward a hypothesis that periodontal tissues can regenerate much the same as normal situation by way of using drug to induce gingiva hyperplasia initiatively and implanting scaffolds. Then horizontal food impaction will be cured when the interproximal clearance is filled with periodontal tissues. It will bring the patient hope.
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Matsumoto H, Takeuchi R, Ono M, Akimoto Y, Kobayashi N, Fujii A. Drug-induced gingival overgrowth and its tentative pharmacotherapy. JAPANESE DENTAL SCIENCE REVIEW 2010. [DOI: 10.1016/j.jdsr.2009.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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