Photographic scoring of gingival overgrowth

Proteomic Analysis in Nifedipine Induced Gingival Overgrowth: A Pilot Study

Objective: The aims of the present study were to investigate the proteomic profile of nifedipine induced overgrown gingiva and compare with non-overgrown gingival tissues obtained from the same patients. Methods: Seven subjects under nifedipine medication for at least 6 months and diagnosed as nifedipine induced gingival overgrowth (NIGO) participated in the study. Periodontal clinical parameters were recorded. Gingival tissue samples were harvested from overgrown (GO+ Group, n=7) and non-overgrown regions (GO- Group, n=7) of the same patients. Proteomics was performed using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) technique. The identified proteins were further classified according to their molecular functions, biological processes and cellular component distribution for functional gene ontology analysis using a web-based bioinformatics tool. Mann Whitney-U and ANOVA tests were performed to compare clinical parameters and identified proteins with proteomics, respectively. Results: Bleeding on probing and gingival overgrowth index of the GO+ group were statistically significantly higher than the GO- group (p

NF-κB Enhances Androgen Receptor Expression through 5′-UTR Binding in Gingival Cells

Dihydropyridine-induced gingival overgrowth (DIGO) is a side effect observed in patients treated for hypertension. The disease is aggravated by inflammation. Nifedipine (Nif), a dihydropyridine, causes gingival overgrowth by increasing the expression of the androgen receptor (AR). Furthermore, the proinflammatory cytokine interleukin 1β (IL-1β) induces collagen α1(I) expression through the AR in DIGO fibroblasts. These observations prompted us to investigate whether and how nuclear factor kappa B (NF-κB) affects AR expression in DIGO. Therefore, gingival fibroblasts obtained from the tissues of patients with DIGO and healthy subjects were stimulated with IL-1β, Nif, or both. mRNA and protein expression was detected with real-time polymerase chain reaction and Western blotting. High correlation coefficients were observed for the mRNA expression of the AR, connective tissue growth factor, and collagen α1(I) induced by both drugs. Western blot analysis showed that IL-1β and Nif increased and activated NF-κB more in DIGO cells than in healthy cells. An electrophoretic mobility shift assay demonstrated that the promoter and 5′-untranslated regions (5′-UTRs) of the AR gene contains 3 binding sites for the NF-κB p65 subunit. A chromatin immunoprecipitation assay revealed that the NF-κB p65 subunit was associated with AR 5′-UTRs in gingival fibroblasts. A site-directed mutagenesis study indicated that a mutation of NF-κB binding sites reduced Nif- and IL-1β-induced AR promoter activities. Collectively, these data indicate that NF-κB is an essential transcriptional regulator of AR gene expression and thus plays a crucial role in collagen overproduction in DIGO fibroblasts.

Combination of inflammatory and amlodipine induced gingival overgrowth in a patient with cardiovascular disease

Gingival overgrowth (GO) is among one of the most important clinical features of gingival pathology frequently seen in periodontal clinic. Amlodipine is a comparatively new calcium channel blocker and is being used with increasing frequency in the management of hypertension and angina. A 48-year-old Indian woman who was on amlodipine for 3 years for hypertension reported to the department of periodontics with the complaint of swollen, un esthetic gums. The patient developed GO 6 months before her first visit to dental hospital. She developed GO very rapidly due to the increase in amlodipine dose due to the severe angina attack 6 months before and due to the use of cholesterol (CHO) lowering drug. The main aim of the case report is to study the severity of amlodipine induced GO in a patient with cardiovascular disease (CVD) and to identify the role of subgingival microorganisms on inflammatory gingival enlargement in the same patient. The severity and rapidity of gingival enlargement in this report could have been triggered by doubling the dose of amlodipine and concomitant use of CHO lowering drug.

Gingival inflammation assessment: Image analysis

Background:

Gingival inflammation may be caused by injury or plaque-related disease and reduction in inflammation can be a useful indicator of gingival recovery. There has been little research on development of non-index method to measure gingival condition. The study aimed to investigate the quantitative analysis of gingival swelling and color characteristics of gingiva by digital images before and after treatment of individual patients.

Material and Methods:

Twenty volunteers with gingival inflammation were recruited and digital images were taken. Duplicate measurements were made on the first visit by the same examiner. At a subsequent visit (1 month) following scaling and root planing, second images were taken. Gingival changes were determined by assessing redness and tooth surface area visible between the level of the inter-proximal papillae and the gingival margin.

Results:

Significant difference was found between the pre-operative and post-operative photographs with regard to swelling and gingival redness.

Conclusion:

Thus this method aids in quantitative analysis of swelling and color characteristics of gingiva by digital images may become a valuable, objective, practicable non-index and inexpensive evaluation procedure of gingival inflammation.

Effect of the topical use of the antioxidant taurine on the two basement membrane proteins of regenerating oral gingival epithelium

BACKGROUND

The essential amino acid taurine has important physiologic and pathologic roles, and has been shown to have osmoregulatory, antioxidative, antiapoptotic, anti-inflammatory, and antilipid activities. However, the response of oral gingival epithelium to taurine during wound healing remains unclear. The goal of this study is to evaluate the expression of laminin 5 and Type IV collagen histologically in regenerating gingival epithelium after direct application of taurine on incised human gingival samples.

METHODS

The study was conducted on 16 gingival samples obtained from gingivectomy specimens of eight adult patients with generalized gingival overgrowth. The samples were divided into two groups: gingiva with 1% taurine-hydrated collagen membrane (n = 8) and saline-hydrated collagen membrane (n = 8) applied specimens. The length of the newly formed epithelium on the wound surface and inflammation was assessed on hematoxylin and eosin-stained sections. Basement membrane formation was evaluated by detection of laminin 5 and Type IV collagen expressions on immunohistochemically stained samples.

RESULTS

Complete new epithelial formation was observed in 1% taurine-treated gingivectomy specimens, whereas incomplete regeneration of the epithelium was observed in control gingivectomy specimens (P <0.05). The length of the newly formed epithelium showed a negative correlation with inflammation in the taurine group (P = -0.712; P <0.05). Immunoreactivity for both laminin 5 and Type IV collagen did not show any significant difference between groups.

CONCLUSION

The local application of taurine-hydrated collagen membrane on human gingival wounds demonstrated the histologic evidence of rapid reepithelization with taurine.

Gingival status of Brazilian renal transplant recipients under sirolimus-based regimens

BACKGROUND

Although the prevalence of gingival overgrowth (GO) in calcineurin-inhibitor (CNI) immunosuppressive regimens has been well documented, to the best of our knowledge data from sirolimus (SIR) regimens have not been described. We sought to investigate the gingival status of renal transplant recipients under SIR-based regimens with regard to the prevalence and potential risk variables associated with GO.

METHODS

A cross-sectional study was conducted at a public hospital in Belo Horizonte, MG, Brazil. Of 886 transplant recipients, an eligible sample of 144 subjects was selected. Medical, pharmacologic, and periodontal variables were recorded for each subject. GO was assessed through visual inspection and was evaluated in relation to variables of interest by univariate and multivariate analyses.

RESULTS

Although not clinically significant, 20.8% of the samples had GO, with a mean GO score of 5.0% +/- 3.98% (range, 0% to 19%) and mean GO score per papilla of 0.378 +/- 0.361 (range, 0.1 to 1.9); the percentage of papilla affected by GO was 14.35% +/- 9.86% (range, 5% to 45%). The multivariate final model, excluding periodontal variables, showed that the concomitant use of calcium channel blockers (P = 0.033) and the interaction between time since transplant and previous CNI use (P <0.001) were associated with GO. Adding periodontal variables to the model improved its accuracy and retained papillary bleeding index as being strongly associated with GO (P <0.001).

CONCLUSIONS

GO was observed in a considerable number of subjects under SIR-based immunosuppressive regimens, although the relationship was not clinically significant. Findings point to the importance of cooperation between medical and dental health care personnel in the maintenance of renal transplant recipients under SIR-based immunosuppressive regimens.

Gingival inflammation assessment by image analysis: measurement and validation

AIM

Gingival inflammation may be caused by injury or plaque-related diseases and reduction in inflammation can be a useful indicator of gingival recovery. There has been little research on development of non-index methods to measure gingival condition. The aims of the study were to investigate the reliability of the measurement of changes in gingival redness and swelling, using image analysis, and to compare this approach with an established method for assessing gingival overgrowth [J Clin Periodontol 28 (2001) 81].

METHOD

Twenty volunteers with gingival inflammation were recruited and digital images were taken. Duplicate measurements were made on the first visit by two examiners. At a subsequent visit following periodontal treatment, second images were taken. Gingival changes were determined by assessing redness and tooth surface area visible between the level of the inter-proximal papillae and the gingival margin. Tooth area measurements were compared with the established gingival overgrowth method.

RESULTS

The method showed excellent reliability for both intra- and inter-examiner measurements of 0.968-0.998 and 0.769-0.947, respectively, according to the classification by Donner and Eliasziw of the Fleiss coefficient of reliability (repeat measures taken during the patients' first attendance). High correlation was found for gingival encroachment when compared with the established gingival overgrowth method.

CONCLUSION

This technique proved a reliable method for investigating changes in gingival redness. High correlation was found for gingival encroachment when compared with an established method.

Correlation between finger-prick and venous ciclosporin levels: association with gingival overgrowth and hypertrichosis

The aims of this study were (1) to ascertain ciclosporin C(2) levels currently being achieved in children with steroid-sensitive nephrotic syndrome (SSNS) and renal transplants (RTs), (2) to determine the feasibility of the use of finger-prick samples for the measurement of ciclosporin levels, and (3) to identify any correlation between hypertrichosis or gingival overgrowth (GO) and level of ciclosporin 2 h post-dose (C(2)). Seventy-two children (39 with SSNS, 33 with RT) participated. Ciclosporin 12 h trough (C(12)) and C(2) levels were measured in venous and finger-prick samples by high-performance liquid chromatography tandem mass spectroscopy. Photographs of the teeth and back were taken for assessment of GO and hypertrichosis. Mean (+/-SD) C(2) levels in the SSNS and RT groups were 512 (+/-181) microg/l and 471 (+/-229) microg/l. There was a highly significant relationship between venous and finger-prick ciclosporin levels (r(2) = 0.96, P < 0.0001). Fourteen children had severe GO. There was a small, though statistically significant, impact of ciclosporin level on GO (C(2) r(2) = 0.12, P = 0.003 and C(12) r(2) = 0.06, P = 0.038) but no correlation with dose (milligrammes per kilogramme per day or milligrammes per square metre per day) or duration. Seventeen children had moderate or severe hypertrichosis, this being more common in children of South Asian ethnicity (P < 0.0001). There was no correlation between ciclosporin exposure or duration and hypertrichosis. Finger-prick blood sampling may serve as a practical alternative to venepuncture in children receiving ciclosporin.

Analysis of changes in gingival contour from three-dimensional co-ordinate data in subjects with drug-induced gingival overgrowth

OBJECTIVES

This aim of this study was to develop and assess a technique that could be used to assess accurately the gingival volume changes seen in drug-induced gingival overgrowth by the analysis of data obtained from an entire gingival surface by means of three-dimensional imaging.

MATERIAL AND METHODS

Stone dental models of patients before and after gingivectomy procedures were digitized with a laser scanner and then regenerated as computer models constructed from the acquired three-dimensional co-ordinate data. A comparison of superposed "before" and "after" surfaces was undertaken to assess and accurately quantify changes in gingival contour.

RESULTS

The mean vertical tissue reduction varied from 1.58 to 2.56 mm in the four study subjects and individual differences are shown. The maximum thickness of removed buccal gingival overgrowth was found to range between 1.20 and 3.40 mm. The volume of tissue removed from each inter-dental papilla ranged from 4.2 to 46.1 mm3 and the mean volume of the papilla removed from each subject+/-SD values was 24.8+/-13.1 mm3.

CONCLUSION

This method will measure changes in gingival tissues to within 60 microm in one plane, making it ideal for the assessment of longitudinal changes in gingival contour as seen in the development of gingival overgrowth, its recurrence after surgery or the changes in volume brought about by surgery.

Conversion from Cyclosporin A to Tacrolimus as a Non-Surgical Alternative to Reduce Gingival Enlargement: A Preliminary Case Series

BACKGROUND

Gingival enlargement (GE) is a frequent side effect that occurs in organ transplant recipients (OTR) after the administration of cyclosporin A (CsA). The availability of new drugs used to suppress graft rejection in OTR offers an opportunity to manage GE non-surgically. This preliminary case series aimed to analyze the effect of CsA withdrawal and its substitution by another immunosuppressant in OTR with severe GE.

METHODS

Four organ transplant recipients who had received a liver or renal allograft were recruited for this study. All OTR had developed clinically severe CsA-induced GE. GE scores were assessed for each patient at baseline and at weeks 2, 4, 8, 12, 16, and 54 following conversion to tacrolimus. Scaling and root planing were initially performed and repeated monthly during the first 6 months. Careful polishing of the teeth was carried out once every 2 weeks until month 6 and then monthly until month 12. Hygiene instructions and reinforcement to optimize oral hygiene were maintained throughout the study.

RESULTS

The four patients showed a rapid decrease in their gingival symptoms and in the size of the gingivae. This change was clinically evident 8 weeks after conversion to tacrolimus. One year later, all the patients experienced GE regression, although some anatomic irregularities persisted in the interdental papillae of one of the patients. No adverse effects from tacrolimus were observed during the study except in one patient who presented headaches.

CONCLUSION

It seems that CsA withdrawal and its conversion to tacrolimus in organ transplant recipients who develop severe gingival enlargement, together with an extensive plaque control program, provide an effective means to control/eliminate gingival hyperplasia, with minimal risk of graft dysfunction.

Antibiotic treatment of incipient drug-induced gingival overgrowth in adult renal transplant patients

BACKGROUND

Drug-induced gingival overgrowth (GO) remains a challenge in periodontics. Partial and total regressions of this GO have been reported after a short course of antibiotics.

METHODS

We conducted a double-blinded controlled randomised study to determine the effect of metronidazole (MNZ) or azithromycin (AZM) on the regression of incipient cyclosporin A-induced GO in 40 adult renal transplanted patients. The quantitation of the GO was performed with Image Digital Analysis.

RESULTS

None of the patients with GO showed complete remission after 30 days. The pretreatment GO index was 0.895 +/- 0.16 in the metronidazole treatment group (MNZ group, n = 13), 0.932 +/- 0.11 in the azithromycin treatment group (AZM group, n = 14), and 1.073 +/- 0.32 in the controls (placebo group, n = 13). At the end of the study (30 days), the GO index score was lower in 54.4% and 62.3% of the MNZ and AZM groups, respectively, and the mean score differences were statistically significant between the groups (0.897 +/- 0.28, MNZ group vs. 0.909 +/- 0.15, AZM group vs. 1.130 +/- 0.3, placebo group, P < 0.05 ANOVA).

CONCLUSIONS

A 7-day course of MNZ or AZM does not induce remission of CsA-induced GO, although it acts on concomitant bacterial over-infection and gingival inflammation.