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Droździk A, Droździk M. Drug-Induced Gingival Overgrowth-Molecular Aspects of Drug Actions. Int J Mol Sci 2023; 24:5448. [PMID: 36982523 PMCID: PMC10052148 DOI: 10.3390/ijms24065448] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Drug-induced gingival overgrowth (DIGO) is one of the side effects produced by therapeutic agents, most commonly phenytoin, nifedipine and cyclosporin A. However, the precise mechanism of DIGO is not entirely understood. A literature search of the MEDLINE/PubMed databases was conducted to identify the mechanisms involved in DIGO. The available information suggests that the pathogenesis of DIGO is multifactorial, but common pathogenic sequelae of events emerge, i.e., sodium and calcium channel antagonism or disturbed intracellular handling of calcium, which finally lead to reductions in intracellular folic acid levels. Disturbed cellular functions, mainly in keratinocytes and fibroblasts, result in increased collagen and glycosaminoglycans accumulation in the extracellular matrix. Dysregulation of collagenase activity, as well as integrins and membrane receptors, are key mechanisms of reduced degradation or excessive synthesis of connective tissue components. This manuscript describes the cellular and molecular factors involved in the epithelial-mesenchymal transition and extracellular matrix remodeling triggered by agents producing DIGO.
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Affiliation(s)
- Agnieszka Droździk
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72, 70-111 Szczecin, Poland
| | - Marek Droździk
- Department of Pharmacology, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72, 70-111 Szczecin, Poland
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Sedghi LM, Bacino M, Kapila YL. Periodontal Disease: The Good, The Bad, and The Unknown. Front Cell Infect Microbiol 2021; 11:766944. [PMID: 34950607 PMCID: PMC8688827 DOI: 10.3389/fcimb.2021.766944] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
Periodontal disease is classically characterized by progressive destruction of the soft and hard tissues of the periodontal complex, mediated by an interplay between dysbiotic microbial communities and aberrant immune responses within gingival and periodontal tissues. Putative periodontal pathogens are enriched as the resident oral microbiota becomes dysbiotic and inflammatory responses evoke tissue destruction, thus inducing an unremitting positive feedback loop of proteolysis, inflammation, and enrichment for periodontal pathogens. Keystone microbial pathogens and sustained gingival inflammation are critical to periodontal disease progression. However, recent studies have revealed the importance of previously unidentified microbes involved in disease progression, including various viruses, phages and bacterial species. Moreover, newly identified immunological and genetic mechanisms, as well as environmental host factors, including diet and lifestyle, have been discerned in recent years as further contributory factors in periodontitis. These factors have collectively expanded the established narrative of periodontal disease progression. In line with this, new ideologies related to maintaining periodontal health and treating existing disease have been explored, such as the application of oral probiotics, to limit and attenuate disease progression. The role of systemic host pathologies, such as autoimmune disorders and diabetes, in periodontal disease pathogenesis has been well noted. Recent studies have additionally identified the reciprocated importance of periodontal disease in potentiating systemic disease states at distal sites, such as in Alzheimer's disease, inflammatory bowel diseases, and oral cancer, further highlighting the importance of the oral cavity in systemic health. Here we review long-standing knowledge of periodontal disease progression while integrating novel research concepts that have broadened our understanding of periodontal health and disease. Further, we delve into innovative hypotheses that may evolve to address significant gaps in the foundational knowledge of periodontal disease.
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Affiliation(s)
- Lea M. Sedghi
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Bacino
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Yvonne Lorraine Kapila
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
- Department of Periodontology, School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
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Yin S, Jia F, Ran L, Xie L, Wu Z, Zhan Y, Zhang Y, Zhang M. Exosomes derived from idiopathic gingival fibroma fibroblasts regulate gingival fibroblast proliferation and apoptosis. Oral Dis 2020; 27:1789-1795. [PMID: 33140502 DOI: 10.1111/odi.13707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/26/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Exosomes have been proved to play an essential role in intercellular information transmission. However, few researches focused on exosomes derived from gingival fibroblasts (GFs) of IGF. The aim of this study is to investigate the effect of exosomes derived from GFs of IGF (IGF-GFs) on the proliferation and apoptosis of normal gingival fibroblasts (N-GFs). METHODS Gingival fibroblasts were cultured and identified using immunocytochemistry. Exosomes were isolated with exosomes extraction kit and characterized by transmission electron microscopy (TEM) and flow cytometry. PKH67 labeling was further used to trace the intracellular distribution of the exosomes. And MTS assay was used to test the effective concentration and time course of IGF-GFs-derived exosomes. Furthermore, the expression of PCNA, Ki67, Bcl-2, and Bax in N-GFs was analyzed by qRT-PCR and Western blot. RESULTS Exosomes were isolated from IGF-GFs; the identification of exosomes and gingival fibroblasts was successfully finished. Moreover, we found that N-GFs co-cultured with exosomes showed a great increase in PCNA and Bcl-2 levels, and a moderate increase in Ki67 levels. By contrast, the levels of Bax were significantly reduced. CONCLUSION These results suggest that exosomes derived from idiopathic gingival fibroma fibroblasts are involved in the regulation of gingival fibroblast proliferation and apoptosis.
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Affiliation(s)
- Shunhui Yin
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Fengmei Jia
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China.,Liu Zhou People's Hospital, Liuzhou City, China
| | - Liquan Ran
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Liangkun Xie
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Zhiyao Wu
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Yeming Zhan
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Yan Zhang
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Mingzhu Zhang
- Department of Periodontology, The Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
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Aquino-Martinez R, Khosla S, Farr JN, Monroe DG. Periodontal Disease and Senescent Cells: New Players for an Old Oral Health Problem? Int J Mol Sci 2020; 21:E7441. [PMID: 33050175 PMCID: PMC7587987 DOI: 10.3390/ijms21207441] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
The recent identification of senescent cells in periodontal tissues has the potential to provide new insights into the underlying mechanisms of periodontal disease etiology. DNA damage-driven senescence is perhaps one of the most underappreciated delayed consequences of persistent Gram-negative bacterial infection and inflammation. Although the host immune response rapidly protects against bacterial invasion, oxidative stress generated during inflammation can indirectly deteriorate periodontal tissues through the damage to vital cell macromolecules, including DNA. What happens to those healthy cells that reside in this harmful environment? Emerging evidence indicates that cells that survive irreparable genomic damage undergo cellular senescence, a crucial intermediate mechanism connecting DNA damage and the immune response. In this review, we hypothesize that sustained Gram-negative bacterial challenge, chronic inflammation itself, and the constant renewal of damaged tissues create a permissive environment for the abnormal accumulation of senescent cells. Based on emerging data we propose a model in which the dysfunctional presence of senescent cells may aggravate the initial immune reaction against pathogens. Further understanding of the role of senescent cells in periodontal disease pathogenesis may have clinical implications by providing more sophisticated therapeutic strategies to combat tissue destruction.
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Affiliation(s)
- Ruben Aquino-Martinez
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
| | - Sundeep Khosla
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - Joshua N. Farr
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - David G. Monroe
- Department of Medicine, Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (S.K.); (J.N.F.); (D.G.M.)
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
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Ramírez-Rámiz A, Brunet-LLobet L, Lahor-Soler E, Miranda-Rius J. On the Cellular and Molecular Mechanisms of Drug-Induced Gingival Overgrowth. Open Dent J 2017; 11:420-435. [PMID: 28868093 PMCID: PMC5564016 DOI: 10.2174/1874210601711010420] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/03/2017] [Accepted: 06/05/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction: Gingival overgrowth has been linked to multiple factors such as adverse drug effects, inflammation, neoplastic processes, and hereditary gingival fibromatosis. Drug-induced gingival overgrowth is a well-established adverse event. In early stages, this gingival enlargement is usually located in the area of the interdental papilla. Histologically, there is an increase in the different components of the extracellular matrix. Objective: The aim of this manuscript is to describe and analyze the different cellular and molecular agents involved in the pathogenesis of Drug-induced gingival overgrowth. Method: A literature search of the MEDLINE/PubMed database was conducted to identify the mechanisms involved in the process of drug-induced gingival overgrowth, with the assistance of a research librarian. We present several causal hypotheses and discuss the advances in the understanding of the mechanisms that trigger this gingival alteration. Results: In vitro studies have revealed phenotypic cellular changes in keratinocytes and fibroblasts and an increase of the extracellular matrix with collagen and glycosaminoglycans. Drug-induced gingival overgrowth confirms the key role of collagenase and integrins, membrane receptors present in the fibroblasts, due to their involvement in the catabolism of collagen. The three drug categories implicated: calcineuron inhibitors (immunosuppressant drugs), calcium channel blocking agents and anticonvulsant drugs appear to present a multifactorial pathogenesis with a common molecular action: the blockage of the cell membrane in the Ca2+/Na+ ion flow. The alteration of the uptake of cellular folic acid, which depends on the regulated channels of active cationic transport and on passive diffusion, results in a dysfunctional degradation of the connective tissue. Certain intermediate molecules such as cytokines and prostaglandins play a role in this pathological mechanism. The concomitant inflammatory factor encourages the appearance of fibroblasts, which leads to gingival fibrosis. Susceptibility to gingival overgrowth in some fibroblast subpopulations is due to phenotypic variability and genetic polymorphism, as shown by the increase in the synthesis of molecules related to the response of the gingival tissue to inducing drugs. The authors present a diagram depicting various mechanisms involved in the pathogenesis of drug-induced gingival overgrowth. Conclusion: Individual predisposition, tissue inflammation, and molecular changes in response to the inducing drug favor the clinical manifestation of gingival overgrowth.
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Affiliation(s)
- Albert Ramírez-Rámiz
- Department of Odontostomatology. Faculty of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Lluís Brunet-LLobet
- Department of Dentistry. Hospital Universitari Sant Joan de Déu. University of Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- Department of Odontostomatology. Faculty of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Jaume Miranda-Rius
- Department of Odontostomatology. Faculty of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
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Mohamed NS, El-Zehery RRA, Mourad MI, Grawish MEA. Impact of three different mouthwashes on the incidence of gingival overgrowth induced by cyclosporine-A: a randomized controlled experimental animal study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:346-56. [PMID: 26153120 DOI: 10.1016/j.oooo.2015.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/28/2015] [Accepted: 05/10/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effects of three different mouthwashes on the incidence of cyclosporine-A-induced gingival overgrowth. STUDY DESIGN One hundred albino rats were divided into five equal groups. Group I rats received no treatment. Group II rats were administered cyclosporine-A. Group III, IV, and V rats were handled as group II and concomitantly treated with chlorhexidine gluconate, cetylpyridinium chloride, and essential oil mouthwashes, respectively. Ten rats from each group were euthanized after the first week of treatment, and the remaining rats were euthanized after the second week of treatment. The obtained specimens were stained with hematoxylin and eosin, Masson's trichrome, and tumor growth factor beta (TGF-β), matrix metalloproteinase 1 (MMP-1), and interleukin 6 (IL-6) immunohistochemical stains. RESULTS The histologic findings at the end of the first and second weeks revealed marked increases in gingival overgrowth for groups II and IV in comparison with groups III and V. Increased epithelial thickness and collagen accumulation were prominent in groups II and IV compared with the other groups. Groups II and IV revealed the highest immunoreactivities for TGF-β and for IL-6. Groups I, III, and V revealed the highest level of MMP-1 expression. CONCLUSIONS Essential oils and chlorhexidine gluconate mouthwashes significantly reduced the incidence of gingival overgrowth compared with cetylpyridinium chloride.
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Affiliation(s)
| | | | - Mohamed I Mourad
- Assistant Professor of Oral Pathology, Faculty of Dentistry, Mansoura University, Egypt
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Ma S, Liu P, Li Y, Hou L, Chen L, Qin C. Cyclosporine A Inhibits Apoptosis of Rat Gingival Epithelium. J Periodontol 2014; 85:1126-34. [DOI: 10.1902/jop.2013.130512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cetinkaya BO, Pamuk F, Keles GC, Ayas B, Ozfidan GK, Kayisli U, Arik N, Horton H. The role of phosphatase and tensin homolog in drug-induced gingival overgrowth. J Periodontal Res 2013; 49:307-13. [DOI: 10.1111/jre.12108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 11/29/2022]
Affiliation(s)
- B O Cetinkaya
- Department of Periodontology, Faculty of Dentistry, Ondokuzmayis University, Samsun, Turkey
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Mitic K, Popovska M, Pandilova M, Jovanovic R, Spasovski G, Nikolov V. The role of inflammation and apoptosis in cyclosporine A-induced gingival overgrowth. Bosn J Basic Med Sci 2013; 13:14-20. [PMID: 23448605 PMCID: PMC4333923 DOI: 10.17305/bjbms.2013.2407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 11/10/2012] [Indexed: 12/12/2022] Open
Abstract
Cyclosporin A(CsA) - induced gingival overgrowth(GO) is a current problem of tissue-specific mechanism which is still incompletely explained. The apoptotic process has been of particular interest like a new concept in the etiology of this unwanted effect. The aim of our study was to detect the level of apoptosis, expression bcl-2 and p53, associated with the different doses of CsA. in gingival stroma. A cohort of 84 kidney transplant recipients was divided into four subgroups based on average daily dose of therapeutically applied CsA (Neoral®), (100 mg, 125 mg, 150 mg and 175 mg). The control group consisted of 21 patients, clinically diagnosed with periodontitis, who were not subjected to any medicamentous treatment causing gingival overgrowth. The following indexes were analyzed: plaque index (PI), index of gingival inflammation (GI) according to Loe-Silnes, and gingival overgrowth index (GOI) according to MacGaw et al. The tissue samples were subjected to a semiquantitative analysis to detect apoptotical cells and immunohistochemically stained to detect the expression of the bcl-2 and p53 proteins. The difference in percentage of apoptotic cells between the group taking 175 mg and other subgroups, as well as the control group was statistically significant (p<0.05). There was a significant difference in percentage of expression bcl-2 between the 175 mg group compared to the other three subgroups and the control (p=0.001). However, a statistically significant positive correlation between the medicament dose, p53, apoptosis, and bcl-2 was registered (p<0.05). Inflammation plays the most important role in the induction of apoptosis and proliferation in gingival tissues.
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Affiliation(s)
- Kristina Mitic
- Dental Clinical Center St. Pantelejmon, Clinic for Periodontology, Faculty of Dentistry, Skopje 1000, Macedonia.
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Pamuk F, Cetinkaya BO, Gulbahar MY, Gacar A, Keles GC, Erisgin Z, Arik N. Effects of tacrolimus and nifedipine, alone or in combination, on gingival tissues. J Periodontol 2013; 84:1673-82. [PMID: 23289868 DOI: 10.1902/jop.2013.120545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to compare gingival changes induced by short- and long-term tacrolimus and nifedipine administration, alone or in combination, and evaluate the expression levels of tumor suppressor phosphatase and tensin homolog (PTEN) in drug-induced gingival overgrowth. METHODS Eighty rats were equally divided into eight groups: 1) tacrolimus for 8 weeks; 2) nifedipine for 8 weeks; 3) tacrolimus and nifedipine for 8 weeks; 4) 8-week control; 5) tacrolimus for 24 weeks; 6) nifedipine for 24 weeks; 7) tacrolimus and nifedipine for 24 weeks; and 8) 24-week control. Histomorphometric analyses included measurements of epithelial thickness, connective tissue thickness, and height. Stereologic analyses included measurements of volumetric densities of fibroblasts (Vf), collagen fibers (Vcf), and blood vessels (Vbv). In addition, PTEN expression was analyzed using immunohistochemistry. RESULTS Epithelial thickness and connective tissue thickness were significantly increased in groups 5, 6, and 7 compared to group 8 (P <0.05), whereas connective tissue height was significantly increased in groups 5 and 7 (P <0.001). Vf and Vcf were significantly increased in group 7 compared to group 8 (P <0.001). PTEN immunoreactivity was significantly decreased in all experimental groups compared to the control groups (P <0.05). CONCLUSIONS Results suggest that duration of drug administration is a more important risk factor than drug combination. The results include a potentially new insight about PTEN's role in the etiology of drug-induced gingival overgrowth.
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Affiliation(s)
- Ferda Pamuk
- Department of Periodontology, Faculty of Dentistry, Istanbul Aydın University, Istanbul, Turkey
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Castro LA, Elias LSA, Oton-Leite AF, Spíndula-Filho JVD, Leles CR, Batista AC, Mendonça EF. Long-term effects of nifedipine on human gingival epithelium: a histopathological and immunohistochemical study. J Oral Sci 2010; 52:55-62. [DOI: 10.2334/josnusd.52.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Zolghadrasli AA, Zolghadrasli A. Letters. J Wound Care 2008; 17:208. [DOI: 10.12968/jowc.2008.17.5.29184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pressure ulcers are complex chronic wounds for which no gold standard treatment has yet been established, although guidelines have been developed. At present, treatment involves assessment, reduction of pressure, friction and shear forces, optimising local wound care, debridement of necrotic tissue, managing bacterial contamination and correcting nutritional deficits.1 In addition, electrical stimulation, ultraviolet irradiation and local ointments including silver sulphadiazine, neomycin, polymixin and phenytoin have been applied, with varying results.
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