An Update on the Mechanisms of Phenytoin Induced Gingival Overgrowth

Drug-Induced Gingival Enlargement: A Comparative Study on the Effect of Phenytoin, Gabapentin, and Cyclosporin on Gingival Fibroblast Cells

Drug-induced gingival enlargement (DIGE) is an abnormal overgrowth that may occur as a side effect in some patients when calcium channel blockers, immunosuppressants, or anticonvulsants are taken. The prevalence of DIGE was shown to be 70% for phenytoin (30% for other anticonvulsant medicines) and 50-80% for cyclosporine. The usage of these medications is increasing as new indications emerge. These drugs act through a common mechanism of action at the cellular level by inhibiting intracellular calcium influx. DIGE is characterized by the presence of varied quantities of inflammatory infiltrates, primarily plasma cells, and an excessive build-up of extracellular matrix like-collagen. Fibroblasts, the cells responsible for collagen synthesis, may become hyperactive, leading to the excessive production of collagen fibers. This increased collagen content can result in the enlargement of gingival tissues. As collagen deposits increase, it hinders normal oral care routines, masticatory processes, and esthetics. In this study, we compared the cytotoxicity of phenytoin, gabapentin, and cyclosporine on gingival fibroblast cells using the methyl thiazolyl-tetrazolium assay to understand their effect on gingival fibroblast cells. Phenytoin had the greatest half-maximal inhibitory concentration (IC50) with a value of 305.78 µg/ml, followed by gabapentin with a value of 260.44 µg/ml and cyclosporin with a value of 243.79 µg/ml. Understanding the cytotoxic thresholds of these medications is essential for improving patient outcomes and minimizing the incidence of gingival enlargement in those requiring long-term therapy. According to the study, cytotoxicity increases along with medication concentration. These findings will assist medical professionals in selecting the drug that poses the least risk of adverse effects on gingival health, ultimately guiding more informed prescribing practices.

CCN2: A potential contributor to gingival overgrowth

BACKGROUND

Fibrotic responses in the gingiva are characterized by their hyperproliferative nature instead of scar tissue formation. Clinically, these conditions appear as "gingival overgrowth" (GO), which can be of drug-induced or genetic origin. Despite surgical removal, GO can recur. Therefore, non-invasive methods of treating GO are required. In other fibrotic systems, the matricellular protein CCN2 represents a potential therapeutic target. However, CCN2 has been relatively understudied in the context of GO.

HIGHLIGHT

Herein, we describe what is known regarding CCN2 expression in GO and gingival fibroblasts. Specifically, CCN2 is induced by agents that promote fibrogenesis in the oral cavity, such as transforming growth factor-β, and drugs that promote GO, such as cyclosporine, nifedipine, and phenytoin.

CONCLUSION

Although little is known regarding the possible function of CCN2 in GO, given the correlation between CCN2 expression and GO recurrence, we hope that this review will inspire further research on this topic.

Novel microfluidic development of pH-responsive hybrid liposomes: In vitro and in vivo assessment for enhanced wound Healing

Wound healing is a complex biological process crucial for tissue repair, especially in chronic wounds where healing is impaired. Liposomes have emerged as promising vehicles for delivering therapeutics to facilitate wound repair. Liposomes have been explored as effective carriers for therapeutic agents. However, traditional methods of liposome preparation face significant challenges, particularly in achieving consistent stability and precise control over drug encapsulation and release. This study addresses these challenges by pioneering the development of Hybrid Liposomes (HLPs) using microfluidic technology, which provides more controlled characteristics through precisely managed formulation parameters. Notably, the formation of Polydopamine (PDA) polymer within HLPs facilitates pH-responsive drug release, making them well-suited for acidic wound environments. Furthermore, surface modification with Folic Acid (FA) enhances cellular interaction with the HLPs. In vitro and in vivo studies demonstrate the efficacy of HLPs loaded with Hyaluronic Acid (HA) or Phenytoin (PHT) in promoting wound healing. Microfluidics optimizes the stability of HLPs over 90 days, underscoring their potential as a potent, antibiotic-free drug delivery system. In conclusion, this research advances the understanding of microfluidic optimization for HLPs, offering cutting-edge drug delivery systems. The transformative potential of targeted HLPs through microfluidics holds promise for revolutionizing wound healing and inspires optimism for effective therapeutic interventions.

Drug induced gingival enlargement - phenytoin: an overview and case report

Gingival enlargement is a side effect of several different medication, including immunosuppressants, anticonvulsants, and calcium channel blockers. It is an inflammatory response that starts when plaque and calculus build up on the tooth surface. The most prevalent long-term neurological condition affecting people is epilepsy. In affluent nations, the prevalence of epilepsy is ~ 1%, whereas in less developed countries, it may >2%. The preferred medication for the condition, phenytoin, has major side effects include gingival enlargement. In addition to being visually disfiguring, this enlargement frequently affects speech, chewing and eating. Furthermore, those with poor dental hygiene, causes disabilities with motor coordination and muscular limitations leading to mental disability and physical impairments are more prone to periodontal disease. This article enlightened the mechanism of drug induced gingival enlargement clinically, microbiologically, and surgically.

Histological evaluation of wound healing by topical phenytoin application on extraction socket: an in vivo study in albino Wistar rats

Objective: To investigate the effects of topical phenytoin application on wound healing of extraction socket of albino Wistar rats. Materials and methods: Thirty-six albino Wistar rats were randomly divided into Group A (control), B (1% phenytoin mucoadhesive paste), and C (mucoadhesive paste without phenytoin). All animals were anesthetized followed by first molar extraction. Group A did not receive any agent, whereas, Group B and C received daily application of their respective pastes. Four animals from each group were sacrificed on day 7, 14, and 21 and analyzed histologically. Results: No significant difference was found in blood vessel count among the groups. Statistical increase in percentage of fibroblast in Group B was found as compared with other groups at day 7, whereas, no significant difference was found among groups at day 14. Day 21 showed significant decrease in percentage of fibroblasts in Group B (p-value < 0.001) as compared with Group A and C. Increase in percentage of bone trabeculae in Group B was observed on day 7, 14, and 21 with a significant difference (p-value < 0.05) as compared to Group A and C. Conclusion: Topical application of phenytoin promoted fibroblast proliferation and bone trabeculae formation during healing of extraction socket in rats.

Dual-drug delivery of Ag-chitosan nanoparticles and phenytoin via core-shell PVA/PCL electrospun nanofibers

Dual-drug delivery systems were constructed through coaxial techniques, which were convenient for the model drugs used the present work. This study aimed to fabricate core-shell electrospun nanofibrous membranes displaying simultaneous cell proliferation and antibacterial activity. For that purpose, phenytoin (Ph), a well-known proliferative agent, was loaded into a polycaprolactone (PCL) shell membrane, and as-prepared silver-chitosan nanoparticles (Ag-CS NPs), as biocidal agents, were embedded in a polyvinyl alcohol (PVA) core layer. The morphology, chemical composition, mechanical and thermal properties of the nanofibrous membranes were characterized by FESEM/STEM, FTIR and DSC. The coaxial PVA-Ag CS NPs/PCL-Ph nanofibers (NFs) showed more controlled Ph release than PVA/PCL-Ph NFs. There was notable improvement in the morphology, thermal, mechanical, antibacterial properties and cytobiocompatibility of the fibers upon incorporation of Ph and Ag-CS NPs. The proposed core-shell PVA/PCL NFs represent promising scaffolds for tissue regeneration and wound healing by the effective dual delivery of phenytoin and Ag-CS NPs.

Gingival overgrowth induced by anticonvulsant drugs: A cross-sectional study on epileptic patients

OBJECTIVE

Our aim was to estimate the prevalence of gingival overgrowth (hyperplasia) and to determine whether active molecules affect the severity of overgrowth in a group of epileptic patients.

BACKGROUND

The effects of phenytoin on oral health have been explored in different studies, yet little information is available on other antiepileptic drugs.

METHODS

Data were collected from 213 subjects of both sexes, from 5 to 80 years. Patients taking the same antiepileptic therapy for at least 1 year and meeting the inclusion criteria of the study (n = 162) were subjected to measurement of gingival overgrowth according to the modified Harris and Ewalt classification and O'Leary's plaque control record (OLR). Descriptive statistics were calculated. Data were analyzed using Pearson's r correlation coefficient and chi-square test. Significance level was set at 5%.

RESULTS

The active drugs lamotrigine, oxcarbazepine, and phenobarbital were significantly associated with gingival overgrowth in 61%, 71%, and 53% of cases, respectively, and phenytoin, valproic acid, and carbamazepine in 50%, 44%, and 32% of cases, respectively.

CONCLUSION

Different antiepileptic molecules may be related to gingival overgrowth. In addition to phenytoin, also lamotrigine, oxcarbazepine, and phenobarbital were associated with increased prevalence of gingival overgrowth. In the management of epileptic patients, dentists should take into account different drugs as possible causes for gingival overgrowth and warn for possible alternatives.

Phenytoin - An anti-seizure drug: Overview of its chemistry, pharmacology and toxicology

Phenytoin is a long-standing, anti-seizure drug widely used in clinical practice. It has also been evaluated in the context of many other illnesses in addition to its original epilepsy indication. The narrow therapeutic index of phenytoin and its ubiquitous daily use pose a high risk of poisoning. This review article focuses on the chemistry, pharmacokinetics, and toxicology of phenytoin, with a special focus on its mutagenicity, carcinogenicity, and teratogenicity. The side effects on human health associated with phenytoin use are thoroughly described. In particular, DRESS syndrome and cerebellar atrophy are addressed. This review will help in further understanding the benefits phenytoin use in the treatment of epilepsy.

Phenytoin sodium-ameliorated gingival fibroblast aging is associated with autophagy

BACKGROUND AND OBJECTIVE

Human gingival fibrolasts aging is an important cause of periodontal disease. Phenytoin sodium (phenytoin) has a side effect of gingival hyperplasia and an effect on the autophagy progress. This study investigated whether the effect of phenytoin on aging gingival fibroblast is related to the autophagy pathway.

MATERIAL AND METHODS

The aging model of gingival fibroblast cell line HGF-1 was induced by hydrogen peroxide (H₂ O₂ ), and the treatment of phenytoin and 3-methyladenine (3-MA) was performed simultaneously. Cell viability, cell cycle, and intracellular calcium ion were measured by flow cytometry. Changes in expression of basic fibroblast growth factor (bFGF), P16^INK4A , P21^cip1 , and bFGF, P16^INK4A , P21^cip1 , LC3II, p62, and Beclin were tested by using reverse transcription polymerase chain reaction, western blot, and immunofluorescence staining.

RESULTS

The results showed that aging HGF-1 proliferation was inhibited by H₂ O₂ , gene, protein expression of bFGF, P16^INK4A , and P21^cip1 were decreased, autophagy-related proteins LC3II, p62, and Becline were decreased, and the proportion of G0/G1 phase and intracellular calcium ion of cell cycle was increased. Phenytoin treatment could recovery above changes, but the effect of phenytoin could be blocked by 3-MA.

CONCLUSION

We propose that phenytoin alleviates the aging of gingival fibroblasts induced by H₂ O₂ . This condition is related to the enhancement of autophagy pathway.