Phenobarbitone induced gingival hyperplasia

Are Newer Antiseizure Medications Better Off in Maintaining Oral Health in Persons with Epilepsy?

BACKGROUND AND OBJECTIVES

Persons with epilepsy (PWE) have poor dental hygiene, contributed by the severity of epilepsy, ignoring oral health, and the medications used. A continuing need exists for a better understanding of the effects of antiseizure medications (ASMs) on oral health. Several studies have shown the effects of older ASMs on oral health, but there is a lack of those exploring oral side effects of newer ASMs.

METHODS

A cross-sectional study was conducted in which 69 PWE on ASMs were compared with 33 controls. A structured questionnaire was used to collect data on demographics, oral hygiene practices, and medication history including use of older and newer ASMs. Dental examination along with plaque, gingival, Decayed, Missing, and Filled Teeth (DMFT), and Decayed, Missing, and Filled teeth Surface (DMFS) indices were assessed. PWE were divided into three groups based on whether they were on older ASMs, newer ASMs, or a combination of both. Data was statistically analyzed.

RESULTS

PWE have poor dental health with significantly higher gingival index, plaque index, calculus, DMFS, and DMFT scores compared to controls ( P < 0.001). Concerning ASMs, patients on older ASMs had poor dental health with higher gingival index, gingivitis, and periodontitis compared to those on newer ASMs ( P < 0.005). Patients on polytherapy tended to have worse periodontal parameters. Gingival hyperplasia was common in patients taking phenytoin alone compared to those taking folic acid along with phenytoin ( P < 0.05).

CONCLUSION

Older ASMs, especially phenytoin, can be associated with significant oral side effects. Newer ASMs are relatively safe, but further research is needed to fully understand their long-term effects.

Learning from history: Lord Brain and Hashimoto's encephalopathy

We present two historic cases of severe encephalopathy associated with antithyroid antibodies. The first was published by Lord Brain of Eynsham, and the second was from our department's archives. Although both cases are from archival sources, they continue to inform current clinical care. We briefly review the poorly defined entity, Hashimoto's encephalopathy, and discuss diagnostic advances for autoimmune encephalopathy and for Creutzfeldt-Jakob disease. We advocate for giving a trial of corticosteroids to patients with 'encephalopathy, not otherwise specified' while awaiting antibody results or more definitive testing. Our case, initially diagnosed as having Creutzfeldt-Jakob disease, responded remarkably (with video evidence) to a trial of corticosteroids.

Encephalopathy Associated with Autoimmune Thyroid Disease: A Potentially Reversible Condition

Autoimmune thyroid disease may occasionally associate with unspecific neurological symptoms, which are more commonly insidious, include cognitive or behavioural symptoms, and may associate with tremor, myoclonus, or ataxia. We report a 61-year-old female patient who presented with chronic headache, insidious mood, and cognitive disturbance which evolved in a few months to dementia associated with exuberant limb myoclonus. Diagnostic workup revealed high anti-thyroid peroxidase antibody titers and an inflammatory CSF profile, and it was negative for other possible etiologies. Treatment with steroids induced significant improvement. The diagnosis of encephalopathy associated with autoimmune thyroid disease is still controversial given the fact that the clinical presentation and diagnostic workup are unspecific, the pathophysiology is still undetermined, and the diagnosis is mostly of exclusion. No direct correlation is found between anti-thyroid antibody titers and clinical presentation, and it is currently speculated that other still unrecognized antibodies may be responsible for this clinical entity. It is extremely important to recognize this entity because it is potentially treatable with immunotherapies. It is also increasingly recognized that clinical improvement with first-line treatment with steroids may be absent or incomplete, and other immunotherapies as immunosuppressants, intravenous immunoglobulin, or plasma exchange must be attempted in the clinical suspicion of EEAT.

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.

Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report

BACKGROUND

Drug-influenced gingival overgrowth is an unaesthetic overgrowth of gingiva principally associated with intake of drugs like phenytoin, cyclosporin A and nifedipine. Its occurrence in both dentate and edentulous regions of oral cavity is poorly understood.

OBJECTIVES

This report highlights clinical and histological description, aetiology and management of gingival overgrowth in a partially edentulous (non-denture wearer) 60-year-old female patient with epilepsy on phenytoin and phenobarbital drugs from past 7 years.

MATERIALS AND METHODS

Patient's intraoral examination revealed lobulated and fibrotic consistency gingival overgrowth around teeth and on partially edentulous ridges of upper and lower arches along with generalised tooth mobility. Under medical consultation, full mouth extraction, surgical excision of overgrowth followed by complete denture rehabilitation and replacement of combination drugs with sodium valproate were accomplished.

RESULTS

Histologically, the lesion showed fibro-epithelial hyperplasia. Clinical results after 6 months demonstrated almost complete resolution of gingival overgrowth.

CONCLUSION

The findings of present case suggest that gingival overgrowth can occur even in partially edentulous ridges (not exposed to denture wear) that could be due to persistence of gingival overgrowth, which may not resolve completely following tooth extraction or occurs because of incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa.

Unusual presentations of Hashimoto's encephalopathy: trigeminal neuralgiaform headache, skew deviation, hypomania

Hashimoto's encephalopathy (HE) is a term used to describe an encephalopathy of presumed autoimmune origin characterized by high titers of antithyroid-peroxidase antibodies. We describe three patients showing unusual clinical presentations like trigeminal-neuralgia, skew deviation, hypomania associated with HE. The purpose of this article is to describe the patients with unusual clinical pictures of HE, something that has not been reported in elsewhere in medical literature.

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.

Drug-induced gingival enlargement - Part II. Antiepileptic drugs: not only phenytoin is involved

INTRODUCTION: Gingival enlargement is the term now used to describe medication-related gingival overgrowth or gingival hyperplasia, a common reactionary phenomenon that occurs with the use of several types of therapeutic agents, including antiepileptic drugs. This disorder has been recognized since 1939, shortly after the introduction of phenytoin. METHODS: Review of literature concerning etiology, pathogenesis and management of antiepileptic drug induced gingival enlargement. CONCLUSIONS: It is important that neurologists become aware of the potential etiologic agents of antiepileptic drug induced gingival enlargement and its characteristic features in order to be able to prevent, diagnose and successfully manage it.