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El Tabaa MM, Aboud MM, Anis A, Rashad E, Sokar SS. Targeting SRD5A1 and MMP-2/NLRP3/TGF-β1 axis alleviates the amlodipine-induced gingival hyperplasia in rats: Emerging role of saw palmetto and folic acid. Food Chem Toxicol 2024; 189:114731. [PMID: 38740241 DOI: 10.1016/j.fct.2024.114731] [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: 01/19/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Saw palmetto (SAW), the herbal drug used to treat prostatic hyperplasia, exerts its antiproliferative effects by blocking steroid 5 alpha-reductase (SRD5A1) activity, that has also been involved in gingival hyperplasia (GH) pathogenesis. Concurrently, folic acid (FA) could reduce GH prevalence via its antioxidant and anti-inflammatory effects. Thus, this study tended to assess the potential therapeutic efficacy of SAW, alone and along with FA, against amlodipine-induced gingival inflammation and overgrowth in rats. Rats were grouped into (CONT, AIGH, SAW, SAW-treated, FA-treated, and SAW + FA-treated). SAW and FA were administered once daily for 4 weeks. Gingival SRD5A1, CTGF, GSK-3β, and NLRP3 expressions, as well as T, DHT, MDA, TAC, ET-1, and MMP2 levels were determined. In addition, histopathological and immunohistochemical analyses of TNF-α, IL-6, TGF-β1, and α-SMA were documented. Results declared that SAW and FA administration markedly ameliorated amlodipine-associated GH and may be presenting a novel therapeutic avenue in the future.
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Affiliation(s)
- Manar Mohammed El Tabaa
- Pharmacology & Environmental Toxicology, Environmental Studies & Research Institute (ESRI), University of Sadat City, Sadat City, 32897, Menoufia, Egypt.
| | - Mahmoud Moustafa Aboud
- Dental Science, Environmental Studies & Research Institute (ESRI), University of Sadat City, Sadat City, 32897, Menoufia, Egypt.
| | - Anis Anis
- Pathology, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, 32897, Menoufia, Egypt.
| | - Eman Rashad
- Cytology and Histology Department, Faculty of Veterinary Medicine, Cairo University, Egypt.
| | - Samia Salem Sokar
- Pharmacology & Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
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Chapman KA, Bartke D, Vogel-Farley V, Cobb M, Chapman M. Dental complications in homocystinurias. Mol Genet Metab Rep 2023; 36:100999. [PMID: 37637152 PMCID: PMC10451019 DOI: 10.1016/j.ymgmr.2023.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Background Cystathionine beta synthase deficiency (causing classical homocystinuria) has been associated with high-arched palates and crowded teeth, but little has been said about other oral health complications. Other homocystinurias (e.g., the remethylation defects) also have had little reported in terms of oral health. Individuals with the homocystinurias have been described as having bone density issues which can correlate with oral health. Moreover, elevations in homocysteine have a theoretical impact on tooth health and the paucity of clinical reports of oral health issues in homocystinuria may be the consequence of lack of attention by the medical community. Significance Oral health is essential to overall health. If inadequate attention is paid to the oral health complications which can be seen in homocystinurias, then appropriate referrals and attention in therapeutic guidelines will not reflect the importance of oral health. Specific aims/research question What oral health complications are reported by individuals with homocystinurias? Do these differ according to diagnosis? Methods Data were collected from patients with homocystinurias by a series of questionnaires using the RARE-X platform. All subjects were consented prior to the collection of their data. All research was performed in accordance with the Declaration of Helsinki. Demographic data were collected as the initial questionnaire and other data were collected via the oral health questionnaire. Analysis Questionnaires were opened to the community in mid-2022 and collection of data for this study ended with data submitted up to November 2022. Descriptive statistics were done. Due to the small size of the cohort, additional statistical analyses were not attempted. Results Patients with homocystinuria, not related to cystathionine beta synthase deficiency, are reporting some tooth structure differences. The cohort taken as a whole does not have increased risk for gingivitis, but there appears to be a risk for long-term gum disease possibly due to the rate of osteoporosis/osteopenia in this population. A large number of individuals have malalignment and malocclusion of the teeth. These data highlight oral health as an important component of care in individuals with the homocystinurias as is true of the general population at large.
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Affiliation(s)
- Kimberly A. Chapman
- Children's National Rare Disease Institute, Washington, DC, United States of America
| | | | | | | | - Mary Chapman
- UPMC Children's Hospital of Pittsburgh, Department of Pediatric Dentistry, Pittsburgh, PA, United States of America
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Zarandi-Nowroozi M, Djinbachian R, von Renteln D. Polypectomy for Diminutive and Small Colorectal Polyps. Gastrointest Endosc Clin N Am 2022; 32:241-257. [PMID: 35361334 DOI: 10.1016/j.giec.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diminutive and small colorectal polyps are common findings during colonoscopies, and rarely contain dysplastic elements and progress to colorectal cancer. With improving technology and the advent of artificial intelligence, detection rates of small or diminutive polyps and adenomas are rising, resulting in increasing costs associated with colonoscopy. Incomplete resection rates are an outcome of interest because it correlates with interval colorectal cancer. More effort is warranted to standardize training programs and sensitize endoscopists to the importance of personal performance as a quality metric of colonoscopy. This article reviews indications, methods, and recent developments in polypectomy for small and diminutive polyps.
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Affiliation(s)
- Melissa Zarandi-Nowroozi
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Roupen Djinbachian
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Daniel von Renteln
- Department of Medicine, Division of Gastroenterology, Montreal University Hospital (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal, QC H2X 0A9, Canada.
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Abstract
Several medicines can have an impact on oral health or have implications for dental treatment. It is important that general dental practitioners review the medicines that their patients are taking and consider their potential impact. In this article we highlight some of the medicines or groups of medicines that can affect dental treatment and oral health.
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Affiliation(s)
- Gursahib Sohal
- Division of Dentistry, The University of Manchester, Manchester, UK
| | - Manas Dave
- Division of Dentistry, The University of Manchester, Manchester, UK
| | - Neil Patel
- Division of Dentistry, The University of Manchester, Manchester, UK
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Asadi-Pooya AA, Rostaminejad M, Zeraatpisheh Z, Mirzaei Damabi N. Cosmetic adverse effects of antiseizure medications; A systematic review. Seizure 2021; 91:9-21. [PMID: 34052629 DOI: 10.1016/j.seizure.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We systematically reviewed the existing literature on the cosmetic adverse effects of antiseizure medications (ASMs) in order to depict a clear picture of these unwanted side effects of ASMs with a particular attention to hair loss, hirsutism, acne, and gingival hyperplasia. METHODS This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE, and Google Scholar from the inception to 25 March, 2021 were systematically searched. These key words (title/abstract) were used: "hair loss" OR "hirsutism" OR "acne" OR "gingival hyperplasia" AND "seizure" OR "epilepsy" OR "anriseizure" OR "antiepileptic". The exclusion criteria included: non-original studies, articles not in English, and animal studies. RESULTS The primary search yielded 3938 studies; 127 studies were related to the topic and were included in the current systematic review. The most robust evidence on cosmetic adverse effects of ASMs were related to phenytoin (causing gingival hyperplasia, hirsutism, and acne) and valproate (causing hair loss and hirsutism); however, many other ASMs were also implicated in causing these cosmetic adverse effects. CONCLUSION Antiseizure medications may be associated with various cosmetic adverse effects. Phenytoin and valproate are the most notorious ASMs in this regard; but, other ASMs have also been implicated in causing hair loss, hirsutism, acne, and gingival hyperplasia. Physicians should pay more attention to these significant adverse effects that may affect a patient's facial attractiveness, quality of life, and emotional state.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Zahra Zeraatpisheh
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Early N, Fairman K, Ma J, Hong K. Changes in Psychotropic Prescribing for Patients With Dementia, 2014-2016: Potential implications for Pharmacists. Sr Care Pharm 2020; 35:207-219. [PMID: 32340657 DOI: 10.4140/tcp.n.2020.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess changes in psychotropic pharmacotherapy for patients with dementia over a three-year period.<br/> SETTING: National Ambulatory Medical Care Survey, physician office visits from 2014 to 2016.<br/> PRACTICE DESCRIPTION: Retrospective analysis of publicly available, nationally representative data on patient characteristics; diagnoses, including comorbidities; and treatments, including medications. Included were patients with a diagnosis of Alzheimer's disease or dementia who were 18 years of age or older. No sample exclusions were applied.<br/> INTERVENTION: Time period, comparing calendar year (CY) 2014 versus the calendar years 2015 and 2016 using Pearson chi-square tests.<br/> MAIN OUTCOME MEASURE(S): Prescribing rates of psychotropic medications, grouped by therapy class.<br/> RESULTS: The sample included 647 patients (337 in 2014 and 310 in 2015-2016). A majority (69.5%) of the patients were 75 years of age or older; 62.4% were female. Prescribing rates remained relatively stable for antipsychotics (15.1% in 2014 to 12.9% in 2015-16; P = 0.607); antidepressants (35.0% to 27.7%; P = 0.263); acetylcholinesterase inhibitors (38.6% to 33.9%; P = 0.446); and memantine (19.4% to 16.8%; P = 0.551). Significant increases were noted for sedatives (11.9% to 21.7%; P = 0.037) and anticonvulsants (10.0% to 27.6%, P = 0.001).<br/> CONCLUSION: Clinically significant increases in the prescribing of anticonvulsants and sedatives suggest the possibility that these agents are used to combat behavioral and psychological symptoms of dementia in patients with dementia. Further research is required to assess the rationale, efficacy, and safety of these uses.
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Candotto V, Pezzetti F, Baj A, Beltramini G, Lauritano D, Di Girolamo M, Cura F. Phenytoin and gingival mucosa: A molecular investigation. Int J Immunopathol Pharmacol 2020; 33:2058738419828259. [PMID: 31663446 PMCID: PMC6822187 DOI: 10.1177/2058738419828259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several distinct classes of drugs, such as anticonvulsants, immunosuppressants, and calcium channel blockers, caused gingival overgrowth. One of the main drugs associated with the gingival overgrowth is the anti-epileptic such as phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. In our study, we evaluate the effect of phenytoin, a drug whose active substance is phenytoin, on gingival fibroblasts of healthy volunteers. Gene expression of 29 genes was investigated in gingival fibroblasts’ cell culture treated with phenytoin compared with untreated cells. Among the studied genes, only 13 genes (CXCL5, CXCL10, CCR1, CCR3, CCR5, CCR6, IL-1A, IL-1B, IL-5, IL-7, IL-6R, BMP-2, and TNFSF-10) were statistically significant. All but one gene resulted downregulated after 24 h of treatment with phenytoin. BPM2 was the only, although weakly, up-expressed gene. Probably, we have not highlighted overexpression of the other inflammatory molecules because the study was performed on healthy people. Many studies show that phenytoin induces the overexpression of these cytokines but, probably, in our study, the drug does not have the same effect because we used gingival fibroblasts of healthy people.
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Affiliation(s)
- Valentina Candotto
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Furio Pezzetti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Baj
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Beltramini
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dorina Lauritano
- Centre of Neuroscience of Milan, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | | | - Francesca Cura
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Cagetti MG, Wolf TG, Tennert C, Camoni N, Lingström P, Campus G. The Role of Vitamins in Oral Health. A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030938. [PMID: 32028631 PMCID: PMC7037089 DOI: 10.3390/ijerph17030938] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 12/31/2022]
Abstract
The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.
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Affiliation(s)
- Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Science, University of Milan, IT-20142 Milan, Italy; (M.G.C.); (N.C.)
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Paediatric Dentistry, University of Bern, CH-3010 Bern, Switzerland; (C.T.); (G.C.)
- Correspondence: ; Tel.: +41-(0)31-664098
| | - Christian Tennert
- Department of Restorative, Preventive and Paediatric Dentistry, University of Bern, CH-3010 Bern, Switzerland; (C.T.); (G.C.)
| | - Nicole Camoni
- Department of Biomedical, Surgical and Dental Science, University of Milan, IT-20142 Milan, Italy; (M.G.C.); (N.C.)
| | - Peter Lingström
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, SE-41390 Gothenburg, Sweden;
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, University of Bern, CH-3010 Bern, Switzerland; (C.T.); (G.C.)
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, IT-07100 Sassari, Italy
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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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11
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Tonguç MÖ, Ünal S, Arpaci RB. Gingival enlargement in children with sickle cell disease. J Oral Sci 2018; 60:105-114. [DOI: 10.2334/josnusd.16-0796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mine Ö. Tonguç
- Department of Periodontology, Faculty of Dentistry, Suleyman Demirel University
| | - Selma Ünal
- Depatment of Pediatrics, Faculty of Medicine, Mersin University
| | - Rabia B. Arpaci
- Depatment of Pathology, Faculty of Medicine, Mersin University
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McNamara NA, Romanowski EMF, Olson DP, Shellhaas RA. Bone Health and Endocrine Comorbidities in Pediatric Epilepsy. Semin Pediatr Neurol 2017; 24:301-309. [PMID: 29249510 DOI: 10.1016/j.spen.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antiseizure medications and dietary therapies have associated effects on the endocrine system. We provided an overview of the relationship between epilepsy treatment and bone health in children with epilepsy. Additionally, we discussed the effects of epilepsy treatment on other endocrine systems including thyroid function, growth, reproduction, and weight. The effect of epilepsy on bone health is multifactorial; there are direct and indirect effects of medication and dietary treatments as well as a decrease in physical activity, decreased sunlight exposure, decreased vitamin D levels, and additional comorbidities. Some medications have a greater effect on vitamin D and bone health than others, however all antiseizure medical treatments are associated with lower vitamin D levels in pediatric patients. We have provided practical suggestions for vitamin D surveillance in children with epilepsy as well as replacement strategies. Children with epilepsy have an increased likelihood of additional endocrine disorders including subclinical hypothyroidism, decreased growth, weight abnormalities, reproductive and sexual dysfunction. To a great extent, this is medication specific. Though more studies are needed to elucidate optimal treatment and monitoring of bone health and other endocrinopathies in children with epilepsy, it is critical that caregivers pay close attention to these issues to provide optimal comprehensive care to their patients.
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Affiliation(s)
- Nancy A McNamara
- Divisions of Pediatric Neurology, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
| | | | - David P Olson
- Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Renee A Shellhaas
- Divisions of Pediatric Neurology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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13
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López-González M, Luis E, Fajardo O, Meseguer V, Gers-Barlag K, Niñerola S, Viana F. TRPA1 Channels Mediate Human Gingival Fibroblast Response to Phenytoin. J Dent Res 2017; 96:832-839. [DOI: 10.1177/0022034517695518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- M.J. López-González
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - E. Luis
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - O. Fajardo
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - V. Meseguer
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - K. Gers-Barlag
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - S. Niñerola
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
| | - F. Viana
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández–CSIC, Alicante, Spain
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Abstract
INTRODUCTION The aim of this report is to present a severe case of phenytoin (PHT)-induced gingival hyperplasia in a Saudi patient. MATERIALS AND METHODS A 12-year-old male epileptic patient, undergoing PHT therapy, was diagnosed clinically with severe gingival hyperplasia. His treatment consisted meticulous oral care and weekly professional prophylaxis. The patient was advised oral folic acid supplementation (0.5 mg/day) and was also recommended 0.2% chlorhexidine gluconate mouthwash twice daily. RESULTS There was significant reduction in the hyperplastic tissue within 4 weeks of treatment. CONCLUSION It is possible to treat PHT-induced gingival hyperplasia non-surgically with intensive dental care, correct oral hygiene and oral folic acid supplements.
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Affiliation(s)
- Yousef A AlJehani
- Assistant Professor, Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, Phone: +966500655550, e-mail:
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15
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Adverse drug events in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:35-47. [PMID: 25442252 DOI: 10.1016/j.oooo.2014.09.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/18/2014] [Accepted: 09/10/2014] [Indexed: 01/19/2023]
Abstract
Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and the new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. Some examples include osteonecrosis, seen with not only bisphosphonates but also antiangiogenic agents, and the distinctive ulcers caused by mammalian target of rapamycin inhibitors. As newer therapeutic agents are approved, it is likely that more adverse drug events will be encountered. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely, xerostomia, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, white lesions, dysesthesia, osteonecrosis, infection, angioedema, and malignancy. Oral health care providers should be familiar with such events, as they will encounter them in their practice.
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Brown RS, Arany PR. Mechanism of drug-induced gingival overgrowth revisited: a unifying hypothesis. Oral Dis 2014; 21:e51-61. [PMID: 24893951 DOI: 10.1111/odi.12264] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/27/2014] [Accepted: 05/28/2014] [Indexed: 12/26/2022]
Abstract
Drug-induced gingival overgrowth (DIGO) is a disfiguring side effect of anti-convulsants, calcineurin inhibitors, and calcium channel blocking agents. A unifying hypothesis has been constructed which begins with cation flux inhibition induced by all three of these drug categories. Decreased cation influx of folic acid active transport within gingival fibroblasts leads to decreased cellular folate uptake, which in turn leads to changes in matrix metalloproteinases metabolism and the failure to activate collagenase. Decreased availability of activated collagenase results in decreased degradation of accumulated connective tissue which presents as DIGO. Studies supporting this hypothesis are discussed.
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Affiliation(s)
- R S Brown
- Division of Oral Diagnosis, Department of Comprehensive Dentistry, Howard University College of Dentistry, Washington, DC, USA; Department of Otolaryngology, Georgetown University Medical Center, Washington, DC, USA; Hematology Branch, NHLBI/NIH, Bethesda, MD, USA
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Nayyar AS, Khan M, Vijayalakshmi KR, Suman B, Subhas GT, Nataraju B, Anitha M. Phenytoin, folic acid and gingival enlargement: Breaking myths. Contemp Clin Dent 2014; 5:59-66. [PMID: 24808697 PMCID: PMC4012119 DOI: 10.4103/0976-237x.128666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Epilepsy is described as a chronic neurological disorder characterized by recurrent seizures of cerebral origin, presenting with episodes of sensory, motor or autonomic phenomenon with or, without loss of consciousness. A recent meta-analysis of published and unpublished studies puts an overall prevalence rate of epilepsy in India at 5.59 per 1,000 populations. There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the anti-epileptic therapy in the prevention of anti-epileptic drug induced gingival enlargement. However, studies conducted in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy so as to justify the use of folic acid as a routine adjuvant to the usual anti-epileptic therapy to prevent this inevitable adverse effect without destabilizing the ongoing regimen leading to the precipitation of seizures in an otherwise stable patient (breakthrough seizures). Materials and Methods: A total of 100 patients between the ages 18 and 50 years were clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was performed prior to the start of and after 1 year of phenytoin therapy. Statistical Analysis Used: The statistical analysis was carried out using t-test and the baseline serum folate levels and the serum folate levels obtained after 1 year of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula. Results: The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin induced gingival enlargement. Conclusions: The results of the study suggest a higher incidence of gingival enlargement with an early onset and increased severity in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.
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Affiliation(s)
- Abhishek Singh Nayyar
- Departments of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - Mubeen Khan
- Departments of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - K R Vijayalakshmi
- Departments of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - B Suman
- Departments of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - G T Subhas
- Departments of Neurology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - B Nataraju
- Departments of Neurology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - M Anitha
- Department of Clinical Biochemistry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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Singh Nayyar A, Khan M, Vijayalakshmi KR, Subhas GT, Nataraju B, Anitha M. A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses. Surg Neurol Int 2013; 4:133. [PMID: 24231926 PMCID: PMC3814993 DOI: 10.4103/2152-7806.119232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background: There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the antiepileptic therapy in the prevention of antiepileptic drug-induced gingival enlargement. However, studies in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin-induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy. The statistical analysis was done using t-test and the baseline serum folate levels and the serum folate levels obtained after 6 months of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula. Methods: A total of 25 patients aged between 18 and 50 years, clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was done prior to the start of and after 6 months of phenytoin therapy. Results: The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin-induced gingival enlargement. Conclusions: The results of the study suggest a higher incidence of gingival enlargement in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.
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Affiliation(s)
- Abhishek Singh Nayyar
- Department of Oral Medicine and Radiology, Government Dental College and Research Institute, Bangalore, Karnataka, India
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Tolou-Ghamari Z, Zare M, Habibabadi JM, Najafi MR. Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy. Int J Prev Med 2013; 4:S330-7. [PMID: 23776747 PMCID: PMC3678241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 02/27/2013] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The challenge of antiepileptic drugs (AEDs) management is to attain the best compromise between the desire to maximize seizure control and the need to keep side-effects within tolerable limits for the individual patient. To reduce devastation in Iranian epileptic patients, the aim of this study was to explore the overall outcome following AEDs prescription. METHODS A cross-sectional study of 36 patients located at the epilepsy ward, conducted to Isfahan Neurosciences Research Centre was carried out during the year 2011. Female (n = 17) and male subjects (n = 19) with a mean age of 27 years (range; 7-74 years) were studied. Variables including, sex, age, age of seizure onset, type, and number of AEDs, biochemical and hematological data were recorded in d-Base and statistical analyses were performed using SPSS (version 18) for windows. RESULTS The main drug to control seizure attack was carbamazepine and valproic-acid. The following tests were the most frequently influenced; alkaline phosphatase (AP), lymphocyte (Lymph), white blood cell (WBC) counts and hemoglobin (Hgb). There was a significant increase in (AP) (mean; 534.6 u/l(↑); [P = 0.02] in three patients and (Lymph) (55%(↑); [43-84] %(↑); [P = 0.04] in seven patients. WBC was lower than 4400 mm(3↓) (P = 0.02) in six patients. Hgb was significantly lower in 70.6% of women (11.8(↓); [10-14.2] g/dl(↓); [P = 0.04] and 68.4% of men population (12.3(↓); [9.7-13.8] g/dl(↓); [P = 0.01]. Mean age of epilepsy onset was 15.6 years (range: Birth-74 years). Analysis of drug prescriptions showed that the incidence of monotherapy and polypharmacy (2 up to six AEDs simultaneously) was 19.4% plus 80.6% respectively. CONCLUSIONS In Iranian epileptic population, effectiveness of treatment should be attributed by the close supervising of AEDs in relation to clinical circumstance, laboratory data, and therapeutic drug monitoring. Any significant change in patients' biochemical and hematological data may require close verifying for the rapid detection of severe anemia, leukopenia, lymphocytosis, osteomalacia, or liver failure.
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Affiliation(s)
- Zahra Tolou-Ghamari
- Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zare
- Department of Neurology, Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jafar Mehvari Habibabadi
- Department of Neurology, Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad-Reza Najafi
- Department of Neurology, Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Antiepileptic drugs, hyperhomocysteinemia and B-vitamins supplementation in patients with epilepsy. Epilepsy Res 2012; 102:1-7. [DOI: 10.1016/j.eplepsyres.2012.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/20/2012] [Accepted: 07/03/2012] [Indexed: 11/20/2022]
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Lohner S, Fekete K, Berti C, Hermoso M, Cetin I, Koletzko B, Decsi T. Effect of folate supplementation on folate status and health outcomes in infants, children and adolescents: a systematic review. Int J Food Sci Nutr 2012; 63:1014-20. [PMID: 22574624 DOI: 10.3109/09637486.2012.683779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this systematic review was to collect all available randomized controlled trials on the effect of folate supplementation on folate status and health outcomes within the paediatric age group. The method included a structured search strategy on MEDLINE, Embase and Cochrane databases, with formal inclusion/exclusion criteria and data extraction procedure. We included 26 studies. We conclude that both serum and erythrocyte folate values reflect folate intake; however, serum folate reacts more rapidly to folate intake than erythrocyte folate. As to health outcomes, we found no evidence indicating that additional intake of folate can influence haematological parameters in non-anaemic paediatric patients. We were unable to find evidence of a favourable effect of folate supplementation on the growth of infants. However, the limited data available suggest that supplementing the diet of low-birth-weight infants with folic acid may moderate the rapid fall of serum and red cell folate in the first months of life.
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Abstract
Gingival overgrowth is a common adverse effect of therapy with Phenytoin, having important medical and cosmetic implications. Poor periodontal hygiene is an important risk factor for severity of Phenytoin-induced gingival overgrowth (PIGO), which is a time-dependent process. There is complex interplay of altered fibroblast biology, connective tissue turnover, inflammatory processes, and growth factors on a background of genetic susceptibility to produce increase in various components of interstitial matrix in PIGO tissue. Treatment options have included change of PHT to another anti-seizure drug, measures to improve periodontal hygiene and gingivectomy. There is conclusive evidence that folic acid supplementation significantly decreases the incidence of PIGO.
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Affiliation(s)
- R Arya
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Millichap JG. Folic Acid Supplement Prevents Phenytoin-Induced Gingival Hyperplasia. Pediatr Neurol Briefs 2011. [DOI: 10.15844/pedneurbriefs-25-5-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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