Severe phenytoin-induced gingival enlargement associated with periodontitis.

The potential of phenytoin to induce gingival hyperplasia has been well-established. High levels of dental plaque and calculus have been reported as a critical co-factor for the development and severity of phenytoin-induced gingival hyperplasia. This article documents a severe gingival enlargement associated with periodontitis (in a patient under combined anti-epileptic therapy) and provides a rational model for its clinical management. Initially, full-mouth scaling and root planing, oral hygiene instructions, and phenytoin withdrawal were performed; however, clinical results demonstrated partial resolution of maxillary gingival hyperplasia. Subsequently, surgical therapy was indicated for the maxillary teeth. Complete reduction of gingival enlargement and improvement of clinical periodontal parameters were observed after the surgical therapy. This case report clearly describes the challenges that oral and medical health practitioners face when developing appropriate prevention and treatment programs for epileptic patients, particularly those with periodontal disease.

Effects of glass ionomer and microfilled composite subgingival restorations on periodontal tissue and subgingival biofilm: a 6-month evaluation.

BACKGROUND: This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI) and microfilled composite (MC) subgingival restorations on periodontal tissues and subgingival biofilm. METHODS: Fifty-four periodontally healthy patients were assigned as follows: group 1 (N = 18), root exposure (RE) without non-carious cervical lesions (NCCL) treated with coronally positioned flap (CPF); group 2 (N = 18), RE with NCCL treated RMGI restorations plus CPF; group 3 (N = 18), RE with NCCL treated with MC restorations plus CPF. Probing depth (PD), visible local plaque score (PL), and local bleeding on probing (BOP) were assessed at baseline and 6 months after surgeries. Restored and non-restored root recoverage (RR) was assessed at 6 months. Each experimental tooth was subgingivally sampled (baseline and 6 months) and analyzed by checkerboard DNA-DNA hybridization. RESULTS: Clinical results showed no significant differences among the groups regarding PL, BOP, and PD at baseline and 6 months. The RR means were similar among the groups at 6 months. Intragroup analyses revealed that the proportions of 10 periodontopathogens decreased at 6 months for the control group. For the RMGI group, there was a significant decrease in the proportions of nine periodontopathogens. For the MC group, there was a significant increase in the proportions of Fusobacterium nucleatum polymorphum and Gemella morbillorum and a decrease in five periodontopathogens. Intergroup analyses showed an increase in the proportion of F. nucleatum polymorphum for the MC group. CONCLUSIONS: In a 6-month evaluation, well-finished RMGI or MC subgingival restorations did not negatively affect periodontal health. Furthermore, RMGI seems to exert more positive effects on the subgingival biofilm composition than MC.

Coronally positioned flap for treatment of restored root surfaces: a 6-month clinical evaluation.

BACKGROUND: The aim of this study was to evaluate clinically the treatment of gingival recession associated with non-carious cervical lesions (NCCLs) by resin modified glass ionomer cement (RMGI) or microfilled resin composite (MRC) and coronally positioned flap (CPF) at 6 months following surgery. METHODS: Fifty-nine patients were assigned to one of three treatments: root exposure without NCCL treated with CPF (group 1); root exposure with NCCL treated with RMGI restoration plus CPF (group 2); or root exposure with NCCL treated with MRC restoration plus CPF (group 3). Clinical measurements that were assessed at baseline and at 3 and 6 months after surgery included plaque index (PI), bleeding on probing (BOP); probing depth (PD), recession reduction (RR), clinical attachment level gain (CALG), keratinized tissue height (KTH), keratinized tissue thickness (KTT), percentage of root coverage (RC), and percentage of restored root coverage (RRC). RESULTS: Intra- and intergroup analyses demonstrated no significant differences in PI, BOP, PD, RR, CALG, KTH, or KTT (P >0.05) among the groups at any time. At 6 months, the mean RC was 80.83% +/- 21.08% for group 1; the mean RRCs were 71.99% +/- 18.69% and 74.18% +/- 15.02% for groups 2 and 3, respectively. There were no statistically significant differences in RRC between groups 2 and 3. CONCLUSION: All treatments showed root coverage improvement without damage to periodontal tissues, supporting the use of CPF for treatment of root surfaces restored with RMGI or MRC as being effective over the 6-month period.

Severe phenytoin-induced gingival enlargement associated with periodontitis: rational model for its clinical management

This case report documented a severe gingival enlargement associated with periodontitis in a patient under antiepileptic therapy and provided a rational model for its clinical management. Initially, full-mouth scaling and root planing, oral hygiene instructions and phenyto in with drawal were performed. However, clinical results demonstrated just partial resolution of upper jaw gingival hyperplasia after non-surgical therapy. Subsequently, surgical therapy was indicated for the upper jaw teeth. After the surgical therapy, complete reduction of gingival enlargement was observed. This report described the challenges faced by the oral and medical health practitioners in developing appropriate prevention and treatment for antiepileptic drug users, particularly for periodontal patients.

O presente relato documentou o aumento gengival induzido por fenitoína associado com periodontite apresentado por uma paciente sob terapia antiepiléptica, e propôs um modelo adequado para o manejamento clínico do caso. Inicialmente, realizou-se raspagem e aplainamento radicular completos, instruções de higiene bucal e substituição da fenitoína. Mas os resultados clínicos demonstraram resolução incompleta da hiperplasia do arco superior após a terapia não cirúrgica. Por isso, subseqüentemente, foi indicada para o arco superior a terapia periodontal cirúrgica, que acarretou em resolução completa do aumento gengival. Este relato de caso descreveu as dificuldades encontradas por profissionais médicos e odontológicos para o desenvolvimento de métodos preventivos e terapêuticos adequados para usuários de drogas antiepilépticas, particularmente pacientes com doença periodontal.