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Casu C, Murgia MS, Orrù G, Scano A. Photodynamic therapy for the successful management of cyclosporine-related gum hypertrophy: A novel therapeutic option. J Public Health Res 2022; 11:22799036221116177. [PMID: 36226306 PMCID: PMC9549190 DOI: 10.1177/22799036221116177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Drug-induced gingival overgrowth is associated with the intake of three classes of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. It is clinically characterized by hyperplasia of the gingival connective tissue which appears edematous, bloody, and purplish-red in color. In more severe cases, drug-induced gingival hyperplasia negatively affects the patient's quality of life, making it difficult to eat and practice good oral hygiene. Drug-induced gingival overgrowth therapy is controversial and, in fact, no studies in the literature highlight a well-defined therapeutic protocol. The therapies that are described provide primarily for non-surgical periodontal treatment and second-line surgical treatment. The aim of this work is to highlight a case of drug-induced gingival hyperplasia which was completely resolved thanks to photodynamic therapy which is completely free from side effects. Design and Methods Photodynamic therapy was performed on an 18 year-old female patient with LEDs at a power of 450-470 nm and 5500 mW/cm2 + 7500 mW/cm2, combined with a Curcuma longa-based photosensitizer. A single session was performed, with applications of approximately 30 s for each interdental papilla. Results The patient improved markedly after only one cycle of PDT. There was an absence of clinically detectable inflammation, edema, and rubor of the involved dental papillae. At the 4, 6, and 12 week follow-ups there were no recurrences. Conclusions This case report highlights the first case of drug-induced gingival hypertrophy entirely treated with photodynamic therapy to be described in the literature. Therefore, although it is only a case report, this therapy which is free from side effects should be investigated as an alternative to current therapies.
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Affiliation(s)
- Cinzia Casu
- International Ph.D. in Innovation
Sciences and Technologies, University of Cagliari, Cagliari, Italy,Department of Surgical Science, Oral
Biotechnology Laboratory, University of Cagliari, Cagliari, Italy,Cinzia Casu, International Ph.D. in
Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy,
Cagliari 09124 Emails: ;
| | | | - Germano Orrù
- Department of Surgical Science, Oral
Biotechnology Laboratory, University of Cagliari, Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Science, Oral
Biotechnology Laboratory, University of Cagliari, Cagliari, Italy
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Sabarudin MA, Taib H, Wan Mohamad WM. Refining the Mechanism of Drug-Influenced Gingival Enlargement and Its Management. Cureus 2022; 14:e25009. [PMID: 35712334 PMCID: PMC9195644 DOI: 10.7759/cureus.25009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
Drug-influenced gingival enlargement (DIGE) or overgrowth manifests as abnormal enlargement of the gingiva due to an adverse effect of certain drug reactions in patients treated with anticonvulsants, immunosuppressants, or calcium channel blockers (CCBs). As the gingival enlargement became significant, it may interfere with the normal oral hygiene measures, aesthetics, as well as masticatory functions of the patients. The exact mechanism of how this undesirable condition develops is yet unknown, and complicated, with non-inflammatory and inflammatory pathways involved. This review illuminates these putative pathways of DIGE and highlights various treatment approaches based on existing research and current observations.
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Fang L, Tan BC. Clinical presentation and management of drug-induced gingival overgrowth: A case series. World J Clin Cases 2021; 9:9926-9934. [PMID: 34877332 PMCID: PMC8610926 DOI: 10.12998/wjcc.v9.i32.9926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/02/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report three patients with drug-induced gingiva overgrowth (DIGO) caused by nifedipine, a calcium channel blocker, who were treated and followed up for 1–3 years. We discussed their symptoms, treatment process, treatment prognosis, and follow-up results.
CASE SUMMARY All the patients had a history of nifedipine treatment to control hypertension. Besides nifedipine, Patient 1 was prescribed immunosuppressant cyclosporine A to control nephritis, which is also implicated in GO. Thus, we assumed that a synergistic effect between the drugs contributed to the severity of Patient 1’s condition. This condition has been reported to be more pronounced in patients with periodontitis. In the course of treatment, Patients 1 and 2 did not stop or change drugs. After initial periodontal treatment, periodontal surgery, and later periodontal support and better plaque control, their gingival hyperplasia was well managed and controlled. Under the guidance of a physician, Patient 3 replaced her calcium-channel blocker drug with losartan potassium and hydrochlorothiazide tablets. She received initial treatment without surgery, obtaining a good curative effect.
CONCLUSION Patients’ compliance, self-plaque control, and professional periodontal therapy have a vital role in treating and preventing the recurrence of DIGO.
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Affiliation(s)
- Li Fang
- Department of Stomatology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian 223800, Jiangsu Province, China
| | - Bao-Chun Tan
- Departments of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China
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Teshome A, Girma B, Aniley Z. The efficacy of azithromycin on cyclosporine-induced gingival enlargement: Systematic review and meta-analysis. J Oral Biol Craniofac Res 2020; 10:214-219. [PMID: 32489824 PMCID: PMC7254476 DOI: 10.1016/j.jobcr.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cyclosporine is one of the powerful immunosuppressant drugs commonly used to avoid transplant rejection and autoimmune condition management. However, this drug has many side effects, such as nephrotoxicity, hepatotoxicity, hypertension, and gingival overgrowth. Gingival enlargement is one of the most commonly reported adverse drug outcome in patients with long term usage of the drug with the exclusion of other confounding factors. Hence, this systematic review and Meta-analysis was planned to investigate the effect of azithromycin on cyclosporine A-induced gingival enlargement. METHODS We used 4 electronic databases: MEDLINE (up to January 2018), EMBASE (up to January 2018), CINAHL (up to January 2018), Cochrane Library (up to January 2018) to search all the available literature between February 1, 2018, and January 1, 2019. All papers, published up to January 2018, on the efficacy of azithromycin on cyclosporine-induced gingival enlargement were included on this systematic review and meta-analysis. RevMan 5.3 software was used to make the quantitative analysis and the pooled effect presented in terms of the mean difference. Meanwhile, the presence of heterogeneity is presented in terms of I2. RESULTS Five Randomized controlled trials with a total of 167 participants were eligible for this study. The effect of azithromycin on cyclosporine-induced gingival growth, probing depth and plaque index was reported in 3 studies and the selected 5 studies reported its effect on bleeding on probing. The pooled effect revealed there was a significant reduction of gingival enlargement (MD, 1.58, 95%CI: 0.77-2.39) and bleeding on probing in the intervention group (MD, 1.32, 95%CI: 0.39-2.24). Statistically non-significant effects were observed on the effect of azithromycin on plaque index and probing depth in patients with cyclosporine-induced gingival enlargement. CONCLUSION Azithromycin has a clinically significant effect on the reduction of cyclosporine-induced gingival enlargement and bleeding on probing.
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Affiliation(s)
- Amare Teshome
- Department of Dentistry, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Biruk Girma
- Oral and Maxillofacial Surgery, Department of Dentistry, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
| | - Zelallem Aniley
- Oral and Maxillofacial Surgery, Department of Dentistry, School of Medicine, College of Medicine and Health Science, University of Gondar, Ethiopia
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Pundir AJ, Vishwanath A, Pundir S, Swati M, Banchhor S, Jabee S. One-stage Full Mouth Disinfection Using 20% Propolis Hydroalcoholic Solution: A Clinico-microbiologic Study. Contemp Clin Dent 2017; 8:416-420. [PMID: 29042728 PMCID: PMC5644000 DOI: 10.4103/ccd.ccd_544_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Propolis is a resinous substance produced by honeybees which has many therapeutic properties because of its unique composition. It has been widely used since many years for different medicinal purposes. Aim: The aim of this study was to investigate the effects of one-stage full mouth disinfection (OSFMD) using 20% propolis hydroalcoholic solution in chronic periodontitis patients. Materials and Methods: Thirty patients diagnosed with chronic periodontitis and presenting three or more nonadjacent teeth with deep pockets were selected for the study. Clinical parameters including gingival index, plaque index, bleeding on probing, probing pocket depth, and clinical attachment level were recorded at baseline in all the patients followed by subgingival plaque sampling. All the thirty patients were randomly allocated into two groups; 15 patients (control group) were subjected to scaling and root planning (SRP) alone, and in remaining 15 patients (test group), SRP was done followed by OSFMD using 20% propolis hydroalcoholic solution after 24 h. All the patients were kept at periodic recall, and clinical and microbiological parameters were again taken at 4 weeks and 12 weeks. Results: There was a significant improvement for all the clinical parameters, with higher probing depth reduction and attachment gain in the test group when compared to the control group. Furthermore, the microbiological counts of the periodontopathogens were found to decrease considerably more in the test group. Conclusion: SRP followed by OSFMD with propolis extract after 24 h was more effective than SRP alone in chronic periodontitis patients.
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Affiliation(s)
- Aena Jain Pundir
- Department of Periodontology, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
| | - Anju Vishwanath
- Department of Periodontology, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
| | - Siddharth Pundir
- Department of Oral Pathology, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
| | - M Swati
- Department of Periodontology, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
| | - Saket Banchhor
- Department of Periodontology, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
| | - Saba Jabee
- Department of Periodontology, Rungta College of Dental Science and Research, Bhilai, Chhattisgarh, India
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Gurgel BCDV, de Morais CRB, da Rocha-Neto PC, Dantas EM, Pinto LP, Costa ADLL. Phenytoin-induced gingival overgrowth management with periodontal treatment. Braz Dent J 2015; 26:39-43. [PMID: 25672382 DOI: 10.1590/0103-6440201300029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 11/24/2014] [Indexed: 01/18/2023] Open
Abstract
Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.
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Affiliation(s)
| | | | | | - Euler Maciel Dantas
- Department of Dentistry, UFRN - Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Leão Pereira Pinto
- Department of Dentistry, UFRN - Federal University of Rio Grande do Norte, Natal, RN, Brazil
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