Cytology and molecular mechanisms of drug-induced gingival hypertrophy: a rewiew

Exploring the Prevalence of Oral Features for Early Detection of PTEN Hamartoma Tumour Syndrome

AIMS

Patients with PTEN hamartoma tumour syndrome (PHTS) have an increased risk of developing cancer due to a pathogenic germline variant in the PTEN tumour suppressor gene. Early recognition of PHTS facilitates initiation of cancer surveillance which is highly effective in preventing the development of advanced malignancies. PHTS is rare and due to its varied phenotype, even within families, oral abnormalities may be a valuable tool in the identification of these patients at an early stage before cancer development.

MATERIALS AND METHODS

Between 1997 and 2020, phenotypic characteristics were evaluated in 81 paediatric (median age: 9 years) and 86 adult (median age: 40 years) PHTS patients by one of 2 medical experts during yearly surveillance visits at a Dutch PHTS expertise centre. Oral features evaluated included gingival hypertrophy, oral papillomas, and high palate (in adults).

RESULTS

Within adults, gingival hypertrophy was present in 94%, oral papillomas in 88%, and a high palate in 89%. All adult patients had at least one of these oral features, and 99% showed at least 2 oral features. Oral features were less common in paediatric patients, especially under 11 years of age. Gingival hypertrophy was observed in 44% and oral papillomas in 54% of paediatric patients.

CONCLUSIONS

The presence of 2 or 3 oral features may indicate PHTS in adults or adolescents, especially if macrocephaly is present. Dental professionals are well-positioned to recognise these oral manifestations could be related to PHTS. They can initiate an overall clinical assessment of the patient by alerting the patient's medical practitioner of the findings and the possible need for genetic testing. This could significantly improve outcomes, including life expectancy, for patients and possibly for their relatives.

CLINICAL RELEVANCE

Dental professionals are ideally placed to recognise oral features and initiate early assessment of PHTS which could significantly improve patient outcomes.

Clinical presentation and management of drug-induced gingival overgrowth: A case series

BACKGROUND

We report three patients with drug-induced gingiva overgrowth (DIGO) caused by nifedipine, a calcium channel blocker, who were treated and followed up for 1–3 years. We discussed their symptoms, treatment process, treatment prognosis, and follow-up results.

CASE SUMMARY

All the patients had a history of nifedipine treatment to control hypertension. Besides nifedipine, Patient 1 was prescribed immunosuppressant cyclosporine A to control nephritis, which is also implicated in GO. Thus, we assumed that a synergistic effect between the drugs contributed to the severity of Patient 1’s condition. This condition has been reported to be more pronounced in patients with periodontitis. In the course of treatment, Patients 1 and 2 did not stop or change drugs. After initial periodontal treatment, periodontal surgery, and later periodontal support and better plaque control, their gingival hyperplasia was well managed and controlled. Under the guidance of a physician, Patient 3 replaced her calcium-channel blocker drug with losartan potassium and hydrochlorothiazide tablets. She received initial treatment without surgery, obtaining a good curative effect.

CONCLUSION

Patients’ compliance, self-plaque control, and professional periodontal therapy have a vital role in treating and preventing the recurrence of DIGO.

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.