Antiproliferative effect of low-level laser/ photobiomodulation on gingival fibroblasts derived from calcium channel blocker-induced gingival overgrowth.

The aim of this study was to evaluate the antiproliferative properties of low-level laser therapy (LLLT) on gingival fibroblasts obtained from calcium channel blocker-induced gingival overgrowth (GO). Gingival fibroblasts of patients with GO were compared to healthy gingival fibroblasts (H). Both cells were exposed to LLLT (685 nm wavelength, 25mW power, diode laser) and compared to those not treated with LLLT. Cell proliferation and viability were measured with MTT assay at baseline and after 24 and 72 h. TGF-ß1, CTGF, and collagen Type 1 levels were evaluated with Enzyme-Linked Immunosorbent Assay (ELISA). LLLT significantly decreased the proliferation of GO fibroblasts (p < 0.05) while leading to a significantly higher proliferation in H fibroblasts compared to the untreated cells (p < 0.05). GO cells showed significantly higher CTGF, TGF-ß, and collagen Type 1 expression than the H cells (p < 0.05). LLLT significantly reduced CTGF levels in GO cells compared to the control group (p < 0.05). In H cells, CTGF and TGF-ß levels were also significantly decreased in response to LLLT compared to the control group (p < 0.05). While LLLT significantly reduced collagen expression in the H group (p < 0.05), it did not significantly impact the GO cells. LLLT significantly reduced the synthesis of the growth factors and collagen in both groups with an antiproliferative effect on the gingival fibroblasts from calcium channel blocker-induced GO, suggesting that it can offer a therapeutic approach in the clinical management of drug-induced GO, reversing the fibrotic changes.

Oral Manifestations of Commonly Prescribed Drugs.

Drugs are being prescribed with more frequency and in higher quantities. A serious adverse drug event from prescribed medications constitutes 2.4% to 16.2% of all hospital admissions. Many of the adverse drug events present intraorally or periorally in isolation or as a clinical symptom of a systemic effect. Clinical recognition and treatment of adverse drug events are important to increase patient adherence, manage drug therapy, or detect early signs of potentially serious outcomes. Oral manifestations of commonly prescribed medications include gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and other oral or perioral conditions. To prevent dose-dependent adverse drug reactions, physicians should prescribe medications judiciously using the lowest effective dose with minimal duration. Alternatively, for oral hypersensitivity reactions that are not dose dependent, quick recognition of clinical symptoms associated with time-dependent drug onset can allow for immediate discontinuation of the medication without discontinuation of other medications. Physicians can manage oral adverse drug events in the office through oral hygiene instructions for gingival enlargement, medication discontinuation for oral pigmentation, and prescription of higher fluoride toothpastes for xerostomia.

Ca-channel blocker-induced gingival overgrowth that improved with non-surgical therapy during visiting care: a case report.

OBJECTIVES: To present a case of gingival overgrowth during visiting care. BACKGROUND: Ca-channel blocker-induced gingival overgrowth is a well-known adverse event. However, only limited information on the treatment of calcium-channel blocker-induced gingival overgrowth during visiting care has been reported. CLINICAL REPORT: The patient was an 88-year-old female living in a nursing home since dementia. She had been taking a calcium-channel blocker and observed gingival overgrowth. Initial therapy was performed and changed the antihypertensive medication from a calcium-channel blocker to an angiotensin converting enzyme inhibitor. After initial therapy, the gingival overgrowth improved significantly. In addition, the defecation rate was improved. CONCLUSION: This case indicated that periodontal therapy is useful even for dementia patients during visiting dental care.

Successful nonsurgical management of post-orthodontic gingival enlargement with intensive cause-related periodontal therapy.

Successful nonsurgical management of severe postorthodontic gingival enlargement and erythema in a 24-year-old male is presented. The patient received an intensive cause-related periodontal therapy, consisting of oral hygiene instruction, scaling and root planing, and weekly recall visits. At week five, complete resolution of the lesions was achieved. By targeting the primary etiologic factor, i.e., plaque, periodontal health was restored without needing surgical intervention. Reducing the bacterial load will give the biologic natural healing capacity of the body the opportunity to stabilize the periodontal condition and, thus, should be considered as the first line of intervention before a surgical approach is taken.

Non-drug induced gingival enlargement.

Gingival enlargement refers to an increase in the size of the gingival tissue. The etiology varies, and often is multifactorial; however, local and systemic conditions, disease, and idiopathic factors may contribute to gingival enlargement. Tissue consistency can vary from soft and spongy to dense, typically appearing darker in shade compared to the drug-induced gingival enlargement. Treatment modalities usually involve surgical removal of excess tissue, non-surgical debridement, use of chemotherapeutic agents, and/or elimination or mitigation of contributing factors and conditions.

Functional aesthetic treatment of patient with phenytoin-induced gingival overgrowth.

Gingival overgrowth (GO) may be related to the frequent use of certain medications, such as cyclosporin, phenytoin (PHT), and nifedipine, and is therefore denominated drug-induced GO. This article reports a case of a patient who with chronic periodontitis made use of PHT and presented generalized GO. A 30-year-old man with GO was referred to the clinic of the Universidade Estadual Paulista, Brazil. The complaint was poor aesthetics because of the GO. The patient had a medical history of a controlled epileptic state, and PHT was administered as an anticonvulsant medication. The clinical examination showed generalized edematous gingival tissues and presence of bacterial plaque and calculus on the surfaces of the teeth. The diagnosis was GO associated with PHT because no other risk factors were identified. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation, prophylaxis, and daily chlorhexidine mouth rinses. After this stage, periodontal surgery was performed, and histopathologic evaluation was made. The patient has been under control for 3 years after the periodontal surgery, and up to the present time, there has been no recurrence. It can be concluded that PHT associated with the presence of irritants favored gingival growth and that the association of nonsurgical and surgical periodontal therapies was effective in the treatment of GO. Besides, motivating the patient to maintain oral hygiene is a prerequisite for the maintenance of periodontal health.

Drug-induced gingival overgrowth: a case report.

A variety of systemic drugs can lead to adverse effects in the oral environment. This article reports the case of a 61-year-old man who had a severe drug-induced gingival overgrowth (DIGO) caused by nifedipine. DIGO is relevant due to severe gingival enlargement, which causes disfigurement and blocks physiological and social functions such as mastication and speaking. Management of DIGO is always a challenge due to the patient's systemic condition. This article shows, step-by-step, how the treatment was executed and how the DIGO was reversed.

Clinical case report of long-term follow-up in type-2 diabetes patient with severe chronic periodontitis and nifedipine-induced gingival overgrowth.

In this case report, we describe the clinical course over a 14-year follow-up in a 47-year-old diabetes patient with severe chronic periodontitis and nifedipine-induced gingival overgrowth. The patient had a history of hypertension for over 5 years and uncontrolled type 2 diabetes. Overgrown gingiva was observed in most of the teeth and was marked in the upper and lower anterior teeth. A probing pocket depth of ≥ 4 mm and bleeding on probing (BOP) were observed in 94 and 90% of sites examined, respectively. At baseline, his hemoglobin A1c (HbA1c) was 8.5%. The patient received periodontal and diabetic treatment simultaneously. Medication was changed from nifedipine chloride to an angiotensin-converting enzyme inhibitor. After initial therapy and subsequent periodontal surgery, gingival overgrowth disappeared and probing depth and BOP showed a significant improvement. No recurrence was observed during supportive periodontal therapy (SPT). The HbA1c level improved from 8.5 to 6.3% after periodontal treatment, subsequently remaining at a good level during SPT over 10 years. This study demonstrated that periodontal treatment, withdrawal of medication and control of diabetes can result in remarkable improvements in type 2 diabetes patients with chronic periodontitis and nifedipine-induced gingival overgrowth. These results suggest that comprehensive periodontal treatment in combination with treatment for diabetes mellitus can exert a positive influence on blood glucose levels and periodontal condition in diabetic patients.

Prevention and non-surgical periodontal therapy of calcium channel blockers induced severe gingival overgrowth. / A kalciumcsatorna-blokkoló gyógyszerek által indukált súlyos gingivahyperplasia konzervatív kezelése és megelozésének lehetoségei.

Összefoglaló. Bevezetés és célkituzés: A gingivahyperplasia a kalciumcsatorna-blokkoló gyógyszerek gyakori mellékhatása. Eredményeink közlésének célja, hogy bemutassuk, sebészi terápia nélkül, megfelelo egyéni szájhigiénia kialakításával és nem sebészi parodontalis terápiával milyen eredményt tudunk elérni az ínymegnagyobbodás kezelése során. Módszer: A Szegedi Tudományegyetem Fogorvostudományi Karának Parodontológiai Tanszékén 2015 és 2019 között 10 - 7 no és 3 férfi, átlagéletkoruk 56 év (50-69 év) volt -, kalciumcsatorna-blokkoló gyógyszer szedése során kialakuló, Grade III. ínyhyperplasiában szenvedo páciens kezelését végeztük konzervatív parodontalis módszerekkel, a gyógyszercsere mellozésével. A legfontosabb parodontalis értékeket rögzítettük, a tasakmélység, a vérzési index, a plakkindex és a fogmozgathatóság értékeit összegeztük vizsgálatunkban. A parodontium destrukciója mértékének megállapításához ortopantomogram és periapicalis röntgenfelvételeket értékeltünk. Eredmények: Minden parodontológiai paraméterben jelentos javulást tapasztaltunk. A nem sebészi parodontalis terápia eredményeként megszunt az elváltozás mind a 10 betegnél, és a szigorú fenntartó terápiának is köszönhetoen nem is újult ki. Következtetés: A nem sebészi terápia alkalmasnak bizonyult a súlyos gingivahyperplasia definitív kezelésére, ha az gingivitis vagy enyhe és középsúlyos parodontitis talaján alakult ki. Arra is következtethetünk az eredményeinkbol, hogy a gyógyszeres terápia megkezdése elott vagy azzal párhuzamosan parodontológiai terápiában részesülo páciensek nagy részénél a gingivahyperplasia - s ezzel a hosszú ideig tartó, drága kezelés - megelozheto lenne. Orv Hetil. 2022; 163(13): 506-512. INTRODUCTION AND OBJECTIVE: Gingival overgrowth is an adverse drug reaction in patients on long-term calcium channel blocker therapy. The aim of this study was to assess the efficacy of non-surgical pocket therapy in patients suffering from Grade III drug-related gingival overgrowth. METHOD: 10 (7 female and 3 male) patients (age between 50-69 years) diagnosed with severe, Grade III gingival overgrowth were treated in our department. Non-surgical periodontal therapy consists of improving of individual oral hygiene, scaling, polishing and subgingival mechanical debridement instrumentation. The main periodontal parameters (probing pocket depth, bleeding index, plaque index and mobility) were scored in this study. Bone loss was evaluated by orthopantomograms and periapical radiographs. Calcium channel blockers have not been replaced by any other medications during the whole course of periodontal treatment. RESULTS: Compared with baseline parameters, all scores improved after therapy. All patients showed decrease in the average probing pocket depth, deepest probing pocket depth, bleeding scores, plaque scores and tooth mobility. None of the patients needed further surgical treatment. In our followed-up patients, recurrence of gingival overgrowth has not been observed during the two-year meticulous supportive periodontal care in the patient group. CONCLUSION: Non-surgical periodontal treatment can be a potential definitive therapy in Grade III gingival overgrowth associated with gingivitis or moderate periodontitis. Periodontal screening and treatment before or simultaneously with the administration of calcium channel blockers can prevent the gingival enlargement in the majority of patient. These results outline the importance of the successful cause related periodontal therapy, started before or simultaneously with the administration of anithypertensive medications and in this way a series of further expensive therapies could be anticipated. Orv Hetil. 2022; 163(13): 506-512.

Clinical, microbiologic, and immunologic factors of orthodontic treatment-induced gingival enlargement.

INTRODUCTION: The aim of this study was to investigate the microbiologic and immunologic factors related to orthodontic treatment-induced gingival enlargement (GE). METHODS: Our study included 12 patients with GE undergoing fixed orthodontic treatment and 12 periodontally healthy controls. At baseline, periodontal variables, subgingival plaque samples, and gingival crevicular fluid (GCF) samples were taken from 2 preselected sites in both the GE and the control groups. The levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Treponema denticola and Tannerella forsythia were determined by real-time polymerase chain reaction. GCF interleukin (IL)-1ß and transforming growth factor-beta 1 (TGF-ß1) were detected by enzyme-linked immunosorbent assay (Invitrogen, Camarillo, Calif). Periodontal therapy was given to the GE group, and all parameters were reassessed after 4 weeks. RESULTS: At baseline, the GE group showed higher prevalences of the 5 periodontal pathogens than did the control group (P <0.05). IL-1ß and TGF-ß1 levels at the GE sites were also significantly higher than those at the control sites (P <0.05). Four weeks after periodontal therapy, the GE group showed significant improvements in the clinical parameters associated with significant reductions of P gingivalis, A actinomycetemcomitans, and T denticola. The levels of IL-1ß decreased significantly compared with the baseline (P <0.05), whereas there was no significant change in TGF-ß1 levels (P >0.05). CONCLUSIONS: Periodontal pathogens might have a relationship with the initiation and development of orthodontic treatment-induced GE. Inflammatory cytokines (IL-1ß and TGF-ß1) can also be considered as contributing factors.

Treatment of calcium channel blocker-induced gingival overgrowth without modifying medication.

Gingival overgrowth is a common side effect of calcium channel blockers used in the treatment of cardiovascular diseases. While controversial, management includes discontinuing the calcium channel blocker. We report the case of a 66-year-old Japanese man with hypertension and type 2 diabetes mellitus who was diagnosed with severe periodontitis covering almost all the teeth. The patient had been on nifedipine (40 mg/day) and amlodipine (10 mg/day) medication for 5 years. With his physician's consent, nifedipine was discontinued during his treatment for periodontitis, which consisted of oral hygiene instructions and scaling and root planing on all areas. Gingivectomy was performed on the areas of hard fibrous swelling. Nifedipine was resumed during periodontal treatment when the patient's hypertension worsened. His periodontal scores improved when he resumed treatment. We report that significant improvement in gingival overgrowth can occur with basic periodontal treatment, surgery and sustained intensive follow-up without adjusting calcium channel blockers.

[A woman with gingival enlargement]. / Een vrouw met gezwollen tandvlees.

A 65-year-old female complained of diffuse and rapidly progressive gingival enlargement. Gingival overgrowth can be caused by medication, infections or systemic diseases. In case of generalized, quickly progressive gingival enlargement, acute myeloid leukemia should be considered. Blood results showed an acute myelomonocytic leukemia. Treating the leukemia resolved the symptoms.

Non-surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient.

Drug-induced gingival overgrowth (DIGO) is a significant problem for periodontologists and this side effect is frequently associated with three particular drugs: phenytoin, cyclosporin A and nifedipine. A case report of gingival overgrowth induced by nifedipine in an elderly patient treated with non-surgical periodontal therapy is described. A 75-year-old male with generalised gingival overgrowth reported the problem of oral malodour and significant gingival bleeding. The medical history revealed a controlled hypertensive state and Cerebral Vascular Accident (CVA) 3 years prior to consultation. The diagnosis was gingival overgrowth associated with nifedipine, no other risk factors being identified. The patient had been taking nifedipine for 18 months, but after the consultation with the patient's doctor, nifedipine was suspended, as the hypertension was controlled. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation and prophylaxis. Six months after the first intervention, clinical parameters revealed a significant improvement with a considerable reduction in gingival overgrowth, demonstrating the effect of non-surgical periodontal therapy in severe cases of gingival overgrowth. Non-surgical treatment of DIGO is a far less invasive technique than surgical approaches and has demonstrated an impressively positive treatment response. It should therefore be considered as a first treatment option for DIGO.

Role of MDR1 gene polymorphisms in gingival overgrowth induced by cyclosporine in transplant patients.

BACKGROUND AND OBJECTIVE: The aim of the present study was to determine the association between genotypes of the MDR1 gene, encoding P-glycoprotein, and gingival overgrowth in transplant patients treated with cyclosporine, and to evaluate the effect of periodontal treatment in these patients. MATERIAL AND METHODS: Fifty transplant patients receiving therapy with cyclosporine and suffering from gingival overgrowth were subjected to nonsurgical periodontal treatment and received oral hygiene instructions. Hyperplastic index, periodontal probing depths, bleeding and plaque scores were recorded at baseline and after 3 and 6 mo. Patients were dichotomized into two groups: those with a hyperplastic index of < 30% (minimal gingival overgrowth) and those with a hyperplastic index of > or = 30% (clinically significant gingival overgrowth). MDR1 C3435T and G2677T polymorphisms were evaluated in all patients and in 100 controls. RESULTS: At baseline, 32 patients (64%) had minimal gingival overgrowth and 18 patients (36%) had clinically significant gingival overgrowth. The mutated C3435T genotype was significantly more frequent in the second group (p < 0.019). The significant association between gingival overgrowth and the 3435TT genotype was confirmed by logistic regression analysis (p < 0.031). The differences in hyperplastic index, observed at baseline between patients with the TT genotype and those with the CC/CT genotype disappeared in the second and third evaluation. The mean monthly change of the square root of the gingival overgrowth scores for all patients, assessed using linear models, was significantly different from baseline (-0.17 points per month, p < 0.00001); and this was particularly evident in subjects with renal transplant (-1.62, p < 0.01). CONCLUSION: Aetiological periodontal and self-performed maintenance therapy is effective in reducing gingival overgrowth, particularly in subjects with the 3435TT genotype and in patients with renal transplant.

Gingival enlargement as a manifestation of tuberous sclerosis: case report and periodontal management.

BACKGROUND: Tuberous sclerosis is an autosomal-dominant inherited disease involving many organs of the body. Oral manifestations include gingival enlargement, fibromas, and dental enamel pitting. The report presents a case of tuberous sclerosis with gingival enlargement histologically consistent with angiofibroma, describes its successful periodontal management, and reviews the literature associated with oral manifestations of tuberous sclerosis. METHODS: A 26-year-old white male presented to the Department of Periodontics and Implant Dentistry, New York University College of Dentistry, with a diagnosis of tuberous sclerosis and a chief complaint of gingival enlargement affecting mastication and esthetics. Following a complete medical history review, consultation with the patient's medical team at New York University Medical Center, and a thorough oral and periodontal examination, a treatment plan was developed that included oral hygiene instructions, mechanical debridement, and periodontal reevaluation. This was followed by gingivectomy, which provided improved function and esthetics. Excised tissue was submitted for histologic examination. The patient was followed every 2 months for assessment of the outcome of the surgical treatment. An extensive search of the dental and dermatologic literature was performed on MEDLINE. RESULTS: Histologic examination of the gingival tissue revealed features consistent with angiofibroma. Fifteen months following gingivectomy, the contours and gingival surface appearance remained normal. CONCLUSIONS: The gingival enlargement was histologically consistent with the characteristic angiofibromas of tuberous sclerosis. The gingival enlargement responded very well to gingivectomy and periodontal maintenance.

Non-surgical periodontal treatment of cyclosporin A-induced gingival overgrowth: immunohistochemical results.

AIM: The present study was planned to analyze the effects of a 12-month non-surgical periodontal treatment on histologic and immunohistochemical features of cyclosporin A (CsA)-induced gingival overgrowth (GO). MATERIALS AND METHODS: Gingival samples were collected from 21 liver transplant subjects exhibiting CsA-induced GO prior to, and 12 months after non-surgical periodontal therapy including oral hygiene instructions, scaling and 2-month recall appointments, and also from 18 healthy control subjects. Gingival biopsy specimens were stained with hematoxylin-eosin and monoclonal antibodies for vimentin, CD3 (T-lymphocytes), CD20 (B-lymphocytes), CD34 (endothelium) and Ki-67 (fibroblasts proliferation rate), using a streptavidin-biotin-peroxidase complex method. RESULTS: Total inflammatory cells, gingival vessels and fibroblast proliferation rate demonstrated significant reduction after non-surgical periodontal treatment (P < 0.0001) in overgrown gingiva, while B- and T-lymphocytes remained nearly unchanged (P = 0.61 and 0.33, respectively). At the 12-month evaluation no significant differences were found when comparing the gingival biopsies from CsA-treated patients and those from healthy controls (P > 0.05). CONCLUSIONS: Control of clinical inflammation by means of non-surgical periodontal treatment results both in lowering of inflammatory infiltrate and in changes in connective tissue composition. Thus, plaque-induced inflammation would seem to modulate the drug-gingival tissue interaction. CLINICAL RELEVANCE: A strict plaque control program play a pivotal role in the management of transplant patients exhibiting cyclosporin A-GO.

[Relationship of orthodontic treatment and periodontal soft tissue health].

With the increasing number of the orthodontic patients, the relationship between periodontal and orthodontic becomes increasingly close. Orthodontic treatment can improve periodontal status, but the adverse clinical problems of periodontal tissue during orthodontic treatment are relatively common. In this paper, we discuss the problems of soft tissue, including causes, prevention, and treatment of gingivitis, gingival enlargement, gingival recession, and gingival invagination in orthodontic treatment.

Clinical management of an unusual case of gingival enlargement.

AIM: The purpose of this article is to report a case of conditioned gingival enlargement managed by non-surgical periodontal therapy. BACKGROUND: Hormones are specific regulatory molecules that modulate a host of body functions. Hormonal effects reflect physiologic and pathologic changes in almost all tissues of the body with the periodontium being no exception. Physiologic changes like puberty, the menstrual cycle, and pregnancy cause hormonal variations that may cause inflammation of the gingiva. Oral contraceptives that contain estrogen and/or progesterone are associated with gingival enlargement. REPORT: A 28-year-old female presented with a complaint of swelling of the gingiva with spontaneous bleeding in the maxillary anterior region for a period of one year. The health history documented the use of contraceptives for one year, and a clinical examination revealed the existence of poor oral hygiene and enlarged painful gingival tissues that bled when touched. SUMMARY: This case reaffirms the fact plaque control is the most important procedure in any periodontal therapy. Another factor contributing to the excellent response to therapy is patient compliance. The patient followed home care instructions well and was effective in personal oral hygiene measures.

Gingival overgrowth: Part 2: management strategies.

The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in Part 1 (BDJ 2017; 222: 85-91). Initial management should involve cause-related therapy, which may resolve or reduce the lesion. If functional, aesthetic and maintenance complications persist following this phase; further treatment may be required in the form of surgery. This paper discusses management strategies, including management of aetiological factors and surgical techniques.