The role of salivary galectin-3 and galectin-9 levels in plaque-induced gingivitis and periodontitis.

Background: This study aimed to compare the salivary galectin-3 and galectin-9 levels in periodontitis, gingivitis, and periodontally healthy patients. Methods: This study included 75 non-smokers who were systemically healthy. The clinical periodontal parameters of each participant were recorded. Individuals with periodontal health, gingivitis, and Stage II or Stage III Grade B periodontitis were allocated to the corresponding study groups (n = 25 each). Saliva samples were obtained from all individuals after they abstained from drinking and eating 1 h before sample collection. The galectin-3 and galectin-9 levels in the saliva were analyzed using enzyme-linked immunosorbent assay. One-way analysis of variance, student's t-test, Spearman correlation, and logistic regression were used for statistical analyses. Results: The galectin-3 and galectin-9 levels were significantly higher in the periodontitis and gingivitis groups than in the healthy group (p < 0.001). The highest galectin-3 and galectin-9 levels were observed in the gingivitis group (p < 0.05). Overall, the galectin-3 levels were significantly higher than the galectin-9 levels in all the groups (p < 0.001). Conclusions: The salivary galectin-3 and galectin-9 levels were high in patients with periodontitis and gingivitis, suggesting that they could be potential biomarkers for periodontal diseases.

Assessment of gingival thickness in the maxillary anterior region using different techniques.

OBJECTIVES: Gingival phenotype is closely related to treatment success and aesthetic results in the maxillary anterior region. Several methods were proposed to measure the dimensions of the gingival tissue. This study aimed to evaluate the gingival thickness using clinical and radiographic techniques and to explore the association between gingival thickness and gingival phenotypes classified by color-coded phenotype probes. MATERIALS AND METHODS: The gingival thickness of 86 periodontally healthy maxillary anterior teeth was assessed using transgingival probing (TGP) and cone-beam computed tomography (CBCT). The gingival phenotype was classified as thin, medium, thick, or very thick by transparency of the color-coded probes through the gingival sulcus. The labial alveolar bone thickness was measured on CBCT images. The keratinized tissue width (KTW) was recorded. RESULTS: Good to excellent agreement was found between TGP and CBCT regarding the thickness of the gingiva (p<0.001). There was a very high correlation between the phenotypes determined by color-coded probes and the gingival thickness measured by TGP (r=0.953, p<0.001). KTW was significantly higher in thick and very thick phenotype groups compared with thin phenotype group. CONCLUSION: Cone-beam computed tomography images and the probe transparency method with color-coded probes are reliable for identifying the gingival phenotype in the maxillary anterior region, based on comparisons to direct transgingival probing. CLINICAL RELEVANCE: The assessment of the gingival phenotype is essential, especially in the aesthetic zone, to obtain predictable and favorable clinical outcomes in various dental procedures. The newly introduced color-coded probes comprise a non-invasive and reliable method for this.

Impact of stage-grade of periodontitis and self-reported symptoms on oral health-related quality of life.

OBJECTIVES: The aim of the study was to investigate the impact of stage-grade of periodontitis and self-reported signs and symptoms on oral health-related quality of life. METHODS: The diagnosis of periodontitis was based on the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The Turkish version of Oral Health Impact Profile-14 (OHIP-14) was used to assess oral health-related quality of life (OHRQoL) and the participants were requested to state their symptoms associated with periodontal diseases. RESULTS: One hundred and sixty-six patients were included in the study with a mean age of 46.54 ± 9.24 years. The participants with Stage IV and Grade C periodontitis had the highest total OHIP-14 scores (median 20.00 [min.-max, 3.00-35.00] and median 18.50 (min.-max, 0.00-36.00]; respectively). The OHIP-14 scores (mean ± SD) were significantly associated with the symptoms of bleeding gums (13.64 ± 9.39), sore gums (18.00 ± 10.47), swollen gums (17.42 ± 10.91), bad breath (15.82 ± 9.44), loose teeth (20.00 ± 8.66) and drifting teeth (24.56 ± 8.46). CONCLUSIONS: This study demonstrates a significant association between OHRQoL and periodontitis. Stage-grade of periodontitis and its symptoms were associated with poor quality of life.

Evaluation of the effect of periodontitis on quality of life using Oral-Dental Health-Related Quality of Life-United Kingdom scale.

OBJECTIVE: The aim of this study was to investigate the impact of periodontitis on oral health-related quality of life (OHQoL) using Oral-Dental Health-Related Quality of Life-United Kingdom (OHRQoL-UK) scale and evaluate the contributing factors. METHODS: 50 patients with untreated periodontitis and 50 individuals without periodontitis were enrolled in the study. All subjects received detailed periodontal examination. Plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL) measurements were examined. OHRQoL was assessed by the Oral Health Quality of Life-United Kingdom (OHRQoL-UK) scale. Symptoms of periodontitis were monitored by visual analogue scale (VAS). Socio-demographic characteristics, medical history, smoking status, hygiene habits of the participants were recorded. This study is registered at ClinicalTrials.gov as NCT04240014. RESULTS: Total OHRQoL-UK scores were 38.24±6.47 in periodontitis patients and 55.88±9.38 in non-periodontitis individuals (p < 0.001). The scores of all 4 parameters were significantly lower in patients with periodontitis compared to healthy individuals (p <0.001). Higher PI, GI, PD and CAL values were associated with extensive negative impacts of periodontitis on OHRQoL (p < 0.001). According to the results of linear regression analysis, only periodontitis was found to associate with OHRQoL. Periodontal disease reduces the total quality of life score by 15.087 (ß= -15.087; 95% CI = [(-18.934)-(-11.240)]. CONCLUSIONS: Individuals with periodontitis has diminished OHRQoL compared to healthy individuals.

Levels of High-Sensitivity C-Reactive Protein in Heart Transplant Patients With and Without Periodontitis.

OBJECTIVES: The outcomes of heart transplantation are very favorable, but inflammation still plays a critical role in deterioration of chronic transplants. Periodontal diseases are not limited to supporting the structures of the teeth, but they also cause systemic inflammation. Based on the importance of inflammation in heart transplant recipients and the association between periodontal disease and systemic inflammation, this study explored whether periodontitis may be a modifier of serum high-sensitivity C-reactive protein in heart transplant patients. MATERIALS AND METHODS: Our study included 33 patients who had heart transplant procedures at the Baskent University Hospital. Clinical periodontal parameters were recorded to assess the periodontal status. On the same day as clinical measurements, blood samples were collected to measure the serum levels of highsensitivity C-reactive protein. RESULTS: Of the 33 heart transplant patients, 9 patients (27.3%) were diagnosed with periodontitis, 4 (12.1%) were periodontally healthy, and 20 (60.6%) had gingivitis. In the group with periodontitis, serum highsensitivity C-reactive protein levels were significantly higher than the periodontally healthy and gingivitis groups (P = .006). In addition, Spearman correlation analyses showed that serum high-sensitivity C-reactive protein was positively correlated with probing depth (r = 0.358; P = .041), clinical attachment level (r = 0.352; P = .045), and gingival recession (r = 0.422; P = .014). CONCLUSIONS: We found that elevated levels of serum high-sensitivity C-reactive protein in heart transplant patients were associated with periodontitis. Thus, these findings reinforce the need for the inclusion of regular periodontal visits after transplant.

Evaluating the Effects of a Topical Preparation with Dexpanthenol, Silbiol, Undecylenic Acid, and Lidocaine on Palatal Mucosa Wound Healing in a Rat Model

Background: Postoperative complications occur after periodontal plastic surgeries, but an ideal treatment to overcome them has not been found yet. Aims: To evaluate the effects of topically applied Oral-norm gel on the healing of excisional wounds. Study Design: Animal experiment. Methods: Excisional wounds with a diameter of 3 mm were made in the center of the palatal mucosa of 63 Sprague Dawley rats. Seven animals were sacrificed at time 0. The remaining rats were divided into two groups: a test group in which the topical Oral-norm gel was applied three times a day and a control group in which nothing was applied. Seven animals in each group were sacrificed at 3, 7, 14, and 21 days. Mean wound surface area was measured photographically, while wound healing and width were evaluated microscopically. Results: The mean wound surface area decreased significantly after 3 days in both groups (p<0.001). Between days 3 and 7, the mean wound surface area decreased from 6.62 (2.85) to 0.83 (1.62) mm2 in the control group and 5.07 (0.88) to 1.42 (1.67) mm2 in the test group. The wound width decreased significantly on day 7 in both groups (p<0.001), with no further changes by day 14. Both groups had a significant increase in inflammation and vascularization on day 3 (p<0.001), with a reduction thereafter. No significant differences in macroscopic and microscopic measurements were observed between the groups at any time point (p>0.05). Conclusion: The Oral-norm gel has no positive healing effects in the palatal mucosa of rats.

The effects of smoking on the expression of gelatinases in chronic periodontitis: a cross-sectional study.

Smokers have a risk of developing periodontal disease. Matrix metalloproteinases (MMP) play a significant role in periodontal tissue destruction. In this study possible relationship between smoking and gingival tissue expression of gelatinases in chronic periodontitis patients relative to periodontally healthy subjects was investigated. Forty chronic periodontitis patients (20 smokers and 20 non-smokers) and forty periodontally healthy subjects (20 smokers and 20 non-smokers) were enrolled. The clinical periodontal measurements recorded, and gingival tissues harvested after that. After histologic evaluation, matrix metalloproteinases -2 and -9 expressions were analyzed immunohistochemically. In nonsmokers, higher expression of metalloproteinases -2 and -9 detected in chronic periodontitis group compared to the periodontally healthy group. In the smoker chronic periodontitis group, the expression of metalloproteinases-2 was lower than nonsmoker chronic periodontitis group. Statistically significant differences detected between smoker and nonsmoker periodontally healthy groups in metalloproteinases-2 expression. For metalloproteinases-9 expression, smoker chronic periodontitis group has lower values than nonsmoker chronic periodontitis group. In periodontally healthy group smokers showed higher metalloproteinases -9 expressions than non- smokers. Present findings support the role of gelatinases in chronic periodontitis pathogenesis. Based on the current results we conclude that smoking alters the expression of gelatinases in gingival tissues.

The effects of smoking on the expression of gelatinases in chronic periodontitis: a cross-sectional study

Abstract Smokers have a risk of developing periodontal disease. Matrix metalloproteinases (MMP) play a significant role in periodontal tissue destruction. In this study possible relationship between smoking and gingival tissue expression of gelatinases in chronic periodontitis patients relative to periodontally healthy subjects was investigated. Forty chronic periodontitis patients (20 smokers and 20 non-smokers) and forty periodontally healthy subjects (20 smokers and 20 non-smokers) were enrolled. The clinical periodontal measurements recorded, and gingival tissues harvested after that. After histologic evaluation, matrix metalloproteinases -2 and -9 expressions were analyzed immunohistochemically. In nonsmokers, higher expression of metalloproteinases -2 and -9 detected in chronic periodontitis group compared to the periodontally healthy group. In the smoker chronic periodontitis group, the expression of metalloproteinases-2 was lower than nonsmoker chronic periodontitis group. Statistically significant differences detected between smoker and nonsmoker periodontally healthy groups in metalloproteinases-2 expression. For metalloproteinases-9 expression, smoker chronic periodontitis group has lower values than nonsmoker chronic periodontitis group. In periodontally healthy group smokers showed higher metalloproteinases -9 expressions than non- smokers. Present findings support the role of gelatinases in chronic periodontitis pathogenesis. Based on the current results we conclude that smoking alters the expression of gelatinases in gingival tissues.

Dental anxiety and fear: relationship with oral health behavior in a Turkish population.

The aim of this study was to assess fear and anxiety in dental patients. Five hundred patients were evaluated using the Modified Dental Anxiety Scale and the Dental Fear Scale, along with a questionnaire. Oral health status was assessed using the Decayed, Missing, and Filled Teeth (DMFT)/Decayed, Missing, and Filled Surfaces (DMFS) index. Statistic al analysis was performed (P < .05). Sex significantly affected dental anxiety (P < .05), and sex, marital status, having children, and time elapsed since last visit to clinician affected dental fear (P < .05). DMFT/DMFS scores were not related to dental anxiety or fear (P > .05). Female sex alone was a significant predictor of dental anxiety; female sex, adulthood, marriage, having children, and time passed since last visit to a clinician are significant predictors of fear.

Proinflammatory and anti-inflammatory cytokines in gingival crevicular fluid and serum of patients with rheumatoid arthritis and patients with chronic periodontitis.

BACKGROUND: The aim of this study is to evaluate proinflammatory and anti-inflammatory cytokine levels in gingival crevicular fluid (GCF) and serum of rheumatoid arthritis (RA) and chronic periodontitis (CP) patients to assess whether cytokine profiles distinguish patients with RA and patients with CP while using healthy patients as background controls. METHODS: A total of 49 patients, 17 patients with RA (three males and 14 females; mean age: 47.82 ± 10.74 years), 16 patients with CP (10 males and six females; mean age: 44.00 ± 7.00 years), and 16 controls (eight males and eight females; mean age: 28.06 ± 6.18 years) were enrolled. Patients with RA were under the supervision of rheumatologists; 15 of the patients with RA were being treated with methotrexate-sulfasalazine combined therapy, and two of the patients were being treated with leflunomid therapy. Periodontal parameters (plaque index, gingival index, probing depth, and clinical attachment level) were recorded. Interleukin (IL)-1ß, IL-4, IL-10, and tumor necrosis factor-α (TNF-α) were determined in GCF and IL-1ß and IL-10 in serum by enzyme-linked immunosorbent assay. RESULTS: There were significant differences found among RA, CP, and control groups for all periodontal parameters (P <0.05). The total amount and concentration of GCF IL-1 ß, IL-4, IL-10, and TNF-α were similar in RA and CP patients (P >0.05). Although the total amount and concentration of serum IL-10 was not significantly different among the groups (P >0.05), serum IL-1ß was significantly lower in the RA group compared to CP patients and controls and was higher in GCF of the RA group compared to the CP group. CONCLUSIONS: Although clinical periodontal disease parameters indicated more severe periodontal disease in CP compared to RA patients, immunologic evaluation did not reveal consistent results regarding proinflammatory and anti-inflammatory cytokine levels. This might be a result of the use of non-steroidal anti-inflammatory drugs and rheumatoid agents by patients with RA.

Nitric oxide synthase in gingival tissues of patients with chronic periodontitis and with and without diabetes.

BACKGROUND: The purpose of this study was to evaluate the expression of inducible nitric oxide synthase (iNOS) in the gingival tissues of periodontitis patients with and without type 2 diabetes to assess whether NO plays a role in the severity of periodontitis in patients with diabetes. Patients with diabetes and healthy patients were used as controls. METHODS: A total of 80 patients were evaluated in four groups (with 20 subjects each): patients with chronic periodontitis and diabetes (12 males and eight females; mean age, 52.1 +/- 6.9 years), patients with chronic periodontitis who were otherwise healthy (12 males and eight females; mean age, 43.1 +/- 8.9 years), periodontally healthy patients with diabetes (12 males and eight females; mean age 50.9 +/- 6.3 years), and systemically and periodontally healthy control subjects (12 males and eight females; mean age 29.8 +/- 9.2 years). Periodontal parameters were recorded. Immunohistochemistry was used to detect inflammation and iNOS expression in gingival tissues. RESULTS: Although periodontal parameters were slightly higher in periodontitis compared to diabetic periodontitis, immunohistochemical parameters were higher in diabetic periodontitis compared to periodontitis. All periodontal parameters were higher in patients with periodontitis and with/without diabetes compared to controls and patients with diabetes. All immunohistochemical parameters were higher in patients with diabetes and periodontitis compared to patients with only diabetes or periodontitis, but there was no difference between the latter two groups. There was a correlation between the expression of iNOS and inflammatory cells in controls, patients with diabetes, and patients with periodontitis but not in patients with diabetes and periodontitis. CONCLUSIONS: Inflammation and iNOS expression were more prominent in the gingiva of the patients with both diabetes and periodontitis. However, iNOS expression did not seem to have an additional detrimental effect on the course of periodontitis in patients with diabetes compared to those with periodontitis alone.

Osteoprotegerin in gingival crevicular fluid under long-term continuous orthodontic force application.

OBJECTIVE: To investigate the level of osteoprotegerin (OPG) in gingival crevicular fluid (GCF) during tooth movement. MATERIALS AND METHODS: Twelve patients (13-17 years of age) requiring canine distalization participated in the study. GCF sampling was done at baseline, 1 hour, 24 hours, 168 hours, 1 month, and 3 months from the distal sites of the test and with control teeth after the application of mechanical stress. OPG concentration was detected by enzyme-linked immunosorbent assay. RESULTS: OPG concentrations in distal sites of the test teeth were decreased in a time-dependent manner. Decreasing is significant when compared with the baseline measurements (P = .038). Variability was detected in the levels of OPG concentration in the distal sites of the control tooth throughout the experimental period. CONCLUSION: OPG is one of the key mediators responsible for alveolar bone remodeling during tooth movement.

Apoptosis and expression of caspase-3 in cyclosporin-induced gingival overgrowth.

BACKGROUND: The pathogenesis of epithelial thickening in gingival overgrowth remains obscure. Apoptosis plays an important role in maintaining tissue hemostasis. The aim of the present study was to investigate apoptosis via immunohistochemical analyses in cyclosporin A-induced gingival overgrowth tissue samples to determine whether these processes play a role in the pathogenesis of gingival overgrowth. METHODS: Gingival biopsies (one per person) were harvested from 22 renal transplant recipients (eight men and 14 women; mean age, 36.4 +/- 13.3 years) who had been diagnosed with cyclosporin A-induced gingival enlargement and from 12 systemically healthy persons (seven men and five women; mean age, 27.0 +/- 16.0 years) with plaque-induced gingivitis. Distributions of caspase-3 and apoptosis were determined immunologically. RESULTS: Significant differences were found with regard to caspase-3 levels and the extent of apoptosis between the cyclosporin A group and the control group. Plaque index, gingival index, and probing depths were significantly lower in the control group. CONCLUSION: The extent of keratinocyte apoptosis and decreased levels of caspase-3 may be an important factor affecting the gingiva of kidney transplant recipients with cyclosporin A-induced gingival overgrowth.

Expression of caspase-3, p53 and Bcl-2 in generalized aggressive periodontitis.

BACKGROUND: Apoptosis, or programmed cell death is a form of physiological cell death. It is increased or decreased in the presence of infection, inflammation or tissue remodelling. Previous studies suggest that apoptosis is involved in the pathogenesis of inflammatory periodontal disease. The aim of the present study was to investigate the clinical features and known indicators of apoptosis (p53, Bcl-2, Caspase-3) in patients with generalized aggressive periodontitis (GAP) METHODS: Eight patients with GAP, who had sites with probing depths (PD) > 5 mm, and 10 periodontally-healthy persons were included in the study. Clinical examinations and PD were performed, and the plaque index and gingival index were recorded. Gingival tissues biopsies were obtained from active site of each patient and from healthy individuals. The expression of caspase-3, Bcl-2, and p53 was evaluated by immunohistochemistry RESULTS: There were no significant differences between GAP and control group with respect to levels of caspase-3 and p53 expression (P > 0.05). Contrary, the frequency of grade 3 expression of Bcl-2 was higher in GAP group than the control group. CONCLUSION: The higher frequency of Bcl-2 expression in GAP group indicates and delayed apoptosis can lead to increasing resident inflammatory cells in periodontal tissues and resulting in progressive periodontal destruction.

Analysis of proliferative activity in oral gingival epithelium in immunosuppressive medication induced gingival overgrowth.

BACKGROUND: Drug-induced gingival overgrowth is a frequent adverse effect associated principally with administration of the immunosuppressive drug cyclosporin A and also certain antiepileptic and antihypertensive drugs. It is characterized by a marked increase in the thickness of the epithelial layer and accumulation of excessive amounts of connective tissue. The mechanism by which the drugs cause gingival overgrowth is not yet understood. The purpose of this study was to compare proliferative activity of normal human gingiva and in cyclosporine A-induced gingival overgrowth. METHODS: Gingival samples were collected from 12 generally healthy individuals and 22 Cyclosporin A-medicated renal transplant recipients. Expression of proliferating cell nuclear antigen was evaluated in formalin-fixed, paraffin-embedded gingival samples using an immunoperoxidase technique and a monoclonal antibody for this antigen. RESULTS: There were differences between the Cyclosporin A group and control group in regard to proliferating cell nuclear antigen and epithelial thickness. In addition, the degree of stromal inflammation was higher in the Cyclosporin A group when compared with the control group. CONCLUSION: The results suggest that the increased epithelial thickness observed in Cyclosporin A-induced gingival overgrowth is associated with increased proliferative activity in keratinocytes.

Apoptosis in cyclosporin A-induced gingival overgrowth: a histological study.

BACKGROUND: Cyclosporin A (CsA) is known to induce gingival overgrowth. Apoptosis plays a critical role in the regulation of inflammation and the host immune response. The aim of this study was to investigate apoptosis in CsA-induced gingival enlargement using electron microscopy examination of keratinocytes. METHODS: Gingiva specimens were collected from 12 CsA-treated renal transplant patients with gingival overgrowth and eight healthy controls with gingivitis. Clinical findings (probing depth, gingival index, and plaque index) were compared in the two groups. Histological and ultrastructural features of the specimens were also compared, and extent of keratinocyte apoptosis was scored on a three-tier scale: 0 = no apoptotic cells; 1 = one or two apoptotic cells; 2 = more than two cells. RESULTS: There were no significant differences between groups with respect to gingiva-related clinical findings or extent of keratinocyte apoptosis. CONCLUSIONS: The results indicate that the extent of keratinocyte apoptosis in the gingiva of kidney recipients with CsA-induced gingival overgrowth is similar to that observed in inflamed gingiva of healthy individuals. Further studies on apoptosis of different cell types in the presence of CsA should clarify this agent's role in the pathogenesis of drug-induced gingival enlargement.

Effect of cyclosporin A on apoptosis and expression of p53 and bcl-2 proteins in the gingiva of renal transplant patients.

BACKGROUND: Gingival overgrowth (GO) is a common side effect of cyclosporin A (CsA) therapy, but the exact mechanism for this is unknown. Apoptosis plays an important role in the maintenance of tissue homeostasis and mediators of this process may be involved in the pathogenesis of drug-induced GO. This study compared p53 expression, bcl-2 expression, and apoptosis in gingival samples from CsA-treated renal transplant recipients to findings in controls with gingivitis. METHODS: Twenty-two kidney recipients with CsA-induced GO and 15 systemically healthy subjects with gingivitis were included in the study. The 15 systemically and periodontally healthy volunteer control group were immunohistochemically analyzed for grades of p53 and bcl-2 expression, and were processed using terminal TdT-mediated dUTP-biotin nick-end labeling (TUNEL) technique to identify and grade levels of apoptosis. RESULTS: There were no differences between the CsA group and the control group with respect to grades of p53 and bcl-2 expression (P >0.05 for both). However, the CsA group showed a lower apoptosis grade than the control group (P <0.05). None of the clinical parameters was significantly correlated with any of the immunohistochemical findings for p53 or bcl-2 (P >0.05 for all). Similarly, grade of apoptosis was not correlated with any of the clinical parameters (P >0.05). There was a significant positive correlation between serum CsA level and level of bcl-2 expression, but serum CsA was not significantly correlated with level of apoptosis or level of p53 expression. CONCLUSION: The results indicate that the pathogenesis of CsA-induced GO might involve inhibition of apoptosis, and overexpression of bcl-2 in the setting of high serum CsA.

Immunohistochemical study of cyclosporin-induced gingival overgrowth in renal transplant recipients.

BACKGROUND: Cyclosporin A (CsA) is an immunosuppressant widely used to treat transplant patients and various systemic diseases with immunological components. Gingival overgrowth (GO) is a common side effect of CsA administration; however, the pathogenesis of drug-induced GO is poorly understood. The aim of this study was to evaluate the expression of Ki-67, activation molecules (CD71, CD98), leukocytes activation antigens (CD45, CD45RA, CD50, CD11a, CD162, CD227, CD231), neurothelin (CD147), and novel endothelial cell antigens (B-F45, SCF87, B-D46, B-C44, VJ1/6) in gingival tissue in renal transplant recipients treated with CsA. METHODS: Tissues from 15 renal transplant patients with significant GO and 10 systemically healthy control subjects with gingivitis were studied. Frozen-section biopsies were stained with monoclonal antibodies specific for the above-mentioned antigens using an indirect immunoperoxidase technique. RESULTS: Comparison of the CsA-treated and control groups revealed no significant differences with respect to expression of Ki-67; CD50; activation molecules; neurothelin; or novel endothelial cell antigens B-D46, B-C44, and VJ1/6. However, expression patterns of CD45, CD45RA, CD11a, CD162, CD227, CD231, B-F45, and SCF87 were significantly different in CsA and control groups. CONCLUSION: Leukocyte activation antigens play an important role in CsA-induced gingival overgrowth.

Immunohistochemical analysis of lymphocyte subpopulations in cyclosporin A-induced gingival overgrowth.

BACKGROUND: Cyclosporin A (CsA) is an immunosuppressive agent that is known to induce gingival overgrowth (GO). Pharmacological, genetic, immunologic, and inflammatory factors seem to be involved in the complex pathogenesis of drug-induced GO. Lymphocyte subpopulations in human gingival connective tissue have been implicated in the pathogenesis of inflammatory periodontal diseases. One purpose of this study was to quantify CD4, CD8-, CD57-, and epithelial membrane antigen (EMA)-positive cells in the gingiva of renal transplant recipients treated with CsA, and compare them to findings in healthy controls. A second aim was to correlate cell numbers with clinical findings. METHODS: The study included 19 kidney recipients who were taking CsA and had significant GO (CsAGO+), 13 recipients who were taking CsA but showed no GO (CsAGO-), and 14 systemically healthy individuals with gingivitis (C). Sections from gingival biopsies were incubated with monoclonal antibodies for CD4, CD8, EMA, and CD57, and then analyzed using the avidin-biotin complex method. In each specimen, the mononuclear cell types were quantified and their distribution was evaluated in 3 separate tissue zones: S = subepithelial connective tissue beneath the sulcular epithelium; O = subepithelial connective tissue beneath the oral epithelium; and M = middle connective tissue. RESULTS: There were no significant differences among the groups with respect to the numbers of CD4+ and CD8+ cells in each of the 3 zones (P >0.05). In zone S, the CsAGO+ group had significantly more EMA-positive cells than either the C or CsAGO- groups (P <0.05). There were significant differences among the groups regarding numbers of CD57+ (natural killer) cells in zone M, with the lowest cell numbers in the CsAGO+ patients (P<0.05). CONCLUSIONS: The results showed that low numbers of natural killer cells are important in the expression of plaque-induced inflammatory changes in CsA-associated GO. It appears that these cells may influence the drug's ability to induce proliferative activity.