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Abstract
Non-plaque induced diffuse gingival overgrowth represents a broad class of conditions caused by several etiological factors. The aim of this review is to highlight the most recent updates and classifications of all the existent gingival overgrowths. In addition, we highlighted the diagnostic pathway that should be employed in patients affected by gingival overgrowth. Gingival overgrowth can be related to syndromic diseases including a wide spectrum of genetic and chromosomal alterations. However, thanks to scientific sharing and the availability of genetic panels it is possible to obtain an accurate phenotypic identification of well-known syndromes and also to identify new ones. This narrative review shows that through rigid, strict diagnostic protocols, the work of the clinician is greatly facilitated, despite the wide variety of pathologies considered. In conclusion, the exchange of specialists’ competencies and the multidisciplinary management of these patients, are crucial to reach diagnosis and the correct clinical-therapeutic management.
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Başçıl S, Turhan İyidir Ö, Bayraktar N, Ertörer ME, Başçıl Tütüncü N. Severe chronic periodontitis is not common in Acromegaly: Potential protective role of gingival BMP-2. Turk J Med Sci 2021; 51:1172-1178. [PMID: 33421969 PMCID: PMC8283429 DOI: 10.3906/sag-2006-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background/aim Advanced chronic periodontitis is observed rarely in acromegaly. Periodontal tissue including the alveolar bone is seemed to be spared from the systemic metabolic derangements of bone in this patient population. Chronic elevation of growth hormone, IGF-1, and bone morphogenetic proteins may play a role in periodontal tissue regeneration in acromegalics. In this study, we aimed to evaluate the potential roles of local gingival bone morphogenetic proteins (BMP) in periodontal tissue pathology in acromegaly. Materials and methods Thirty-five patients with acromegaly and 22 healthy subjects were recruited. All the participants were examined by the same periodontologist for the diagnosis of periodontal diseases. BMP-2 and -4 were studied in gingival crevicular fluid. Results Gingival BMP-2 and BMP-4 levels were similar in acromegaly and control groups in general, with and without chronic periodontitis. For all the participants, gingival BMP-2 levels were statistically lower in those participants with chronic periodontitis then those without periodontitis (29.4 ± 11.2 vs. 41.2 ± 23.2, respectively, p = 0.027). Causal relation between the gingival BMP levels and periodontal tissue health status was tested with one way ANOVA which revealed a significant difference between gingival BMP-2 levels in those with different degrees of periodontal tissue pathology (p = 0.025). When analyzed separately, gingival BMP-2 levels revealed a causal relation with the degree of periodontal pathology with borderline significance only in patients with acromegaly (p = 0.057). Conclusion Acromegaly is a disease with an unexpectedly low frequency of advanced periodontitis, irrespective of the long disease duration and pathognomonic oral manifestations. BMP-2 might have a protective role against chronic advanced periodontitis in these patients.
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Affiliation(s)
- Sibel Başçıl
- Department of Periodontology, Faculty of Dentistry, Başkent University, Adana, Turkey
| | - Özlem Turhan İyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Nilüfer Bayraktar
- Department of Biochemistry,Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Melek Eda Ertörer
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Neslihan Başçıl Tütüncü
- Department of Endocrinology and Metabolism, Faculty of Medicine, Başkent University, Ankara, Turkey
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Roumeau S, Thevenon J, Ouchchane L, Maqdasy S, Batisse-Lignier M, Duale C, Pham Dang N, Caron P, Tauveron I, Devoize L. Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study. Endocr Connect 2020; 9:824-833. [PMID: 32738132 PMCID: PMC7487182 DOI: 10.1530/ec-20-0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The dental and periodontal impact of GH/IGF-1 hypersecretion has been poorly investigated until now. Our aim is to precisely describe the oro-dental state of acromegalic patients and to study the impact of GH/IGF-1 hypersecretion on patients' reported oral health-related quality of life (OHRQoL). METHODS After collecting characteristics of their disease, acromegalic patients answered the GOHAI questionnaire assessing their OHRQoL, the AcroQoL questionnaire and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam CT if necessary). RESULTS In total, 29 patients aged 59.1 ± 16.0 years were included. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0 ± 7.8. 16/29 patients had a gingivitis and 18/29 a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis was found, probably because the frequency of a protective thick gingival biotype was increased (9/29). No case of generalized gingival hypertrophy or diffuse hypercementosis was observed. According to the Add-GOHAI score, only 8/26 patients had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11/29 patients had bulky oral bony outgrowths (OBO), such as large maxillary or mandibular tori and multiple vestibular exostosis. CONCLUSIONS The unsatisfactory OHRQoL reported by acromegalic patients contrasts with a rather good objective oro-dental state and annual oral examination seems relevant in this population. Finally, we report that huge OBO could be helpful signposts for the diagnosis of acromegaly.
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Affiliation(s)
- Sylvain Roumeau
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- Correspondence should be addressed to S Roumeau:
| | - Joannice Thevenon
- CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CNRS, ISIT, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Biostatistiques, Clermont-Ferrand, France
| | - Salwan Maqdasy
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, Clermont-Ferrand, France
| | - Marie Batisse-Lignier
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, Clermont-Ferrand, France
| | - Christian Duale
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Inserm CIC 1405, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service de chirurgie maxillo-faciale, Clermont-Ferrand, France
| | - Philippe Caron
- CHU Larrey-Rangueil, Service Endocrinologie et Maladies Métaboliques, Pôle Cardio-Vasculaire et Métabolique, Toulouse, France
| | - Igor Tauveron
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, Clermont-Ferrand, France
| | - Laurent Devoize
- CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Chirurgie Dentaire, Clermont-Ferrand, France
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Lewis JR, Reiter AM. Management of Generalized Gingival Enlargement in a Dog — Case Report and Literature Review. J Vet Dent 2016; 22:160-9. [PMID: 16295803 DOI: 10.1177/089875640502200303] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present report describes treatment of a dog with generalized gingival enlargement and serves as a review of etiology and treatment options for this condition. The combined use of scalpel blade, electrosurgical equipment, and a 12-fluted bur on a high-speed handpiece with water irrigation allowed for accurate excision of excess gingival tissue and contouring of remaining gingiva. Surgery coupled with professional dental cleaning periodontal therapy can decrease the recurrence of this condition. In addition, home oral hygiene is an important component of the treatment plan. The history of patients with gingival enlargement should be reviewed carefully, including drug history and previous medical conditions, in an attempt to elucidate a specific cause and thus allow for greater long-term success.
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Affiliation(s)
- John R Lewis
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA 19104-6010, USA.
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Abraham D, Couldwell WT. Bilateral testicular enlargement and seminoma in a patient with acromegaly. Br J Neurosurg 2009; 18:629-31. [PMID: 15799199 DOI: 10.1080/02688690400022797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Growth hormone (GH) excess has been associated with soft tissue changes and an increase in the incidence of colonic polyps and gastrointestinal cancer. We describe a patient with endogenous GH excess caused by a pituitary tumour, resulting in acromegaly. The patient had bilateral testicular enlargement, with tumour of the right testicle. Pituitary MRI revealed a macroadenoma. After resection of the pituitary tumour, GH levels fell below 0.5 ng/ml, with acromegaly resolution. Testicular resection revealed seminoma. Following acromegaly resolution, the enlarged remaining testicle decreased in size. The implications of the testicular enlargement and seminoma in the presence of a GH-secreting tumour are discussed.
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Affiliation(s)
- D Abraham
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Utah, Salt Lake City 84132, USA
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Absence of periodontitis in acromegalic patients. Clin Oral Investig 2008; 13:165-9. [PMID: 18766388 DOI: 10.1007/s00784-008-0216-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 07/15/2008] [Indexed: 02/07/2023]
Abstract
Acromegaly is a metabolic disorder caused by increased growth hormone (GH) secretion. Common oral features are prognatism, increased interdental spaces, macroglosia, and dental mobility. However, not much is known about the periodontal status of acromegalics. The periodontal status of 16 acromegalic subjects was investigated and compared with 20 controls (similar socioeconomic profile and age). Periodontal probing, followed by the assessment of gingival overgrowth, tooth loss and mobility, and malocclusion was performed. Acromegalic patients' did not present periodontitis and all of them had complete absence of periodontal pockets, while 50% of the control group presented periodontitis. All acromegalic patients presented dental mobility degree 1, mainly in the anterior inferior teeth. Malocclusion (100%) and diastemas (93.75%) were also present in these patients. It was concluded that acromegalic patients may be less prone to periodontal diseases than control subjects.
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Abstract
Diffuse gingival enlargement is defined as an excessive growth of periodontal tissue. It can be considered a relatively common finding, as thousands of patients have been described in the literature. Patients may seek medical attention because of pain, tenderness, interference with speech and/or mastication, halitosis, or unsightly appearance, or gingival enlargement may be an unexpected finding on routine physical examination. Diffuse gingival enlargement has numerous causes, including poor dental hygiene, medications, serious systemic illnesses, genetic conditions, other specific physiologic states, or it may be idiopathic. Given the large number of possible underlying conditions, the work-up of a patient presenting with diffuse gingival enlargement may seem daunting. We present a systemic review of diffuse gingival enlargement, including an algorithm that can be used to direct the work-up of patients presenting with this condition.
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Affiliation(s)
- Pooja Khera
- Department of Dermatology, University of Pittsburgh, USA
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