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PubMed1983

Malignant gingival and skin "infiltrates" in adult leukemia.

The clinicopathologic and histopathologic features of leukemic gingival and cutaneous "infiltrates" were studied in 1,076 adults hospitalized for cancer chemotherapy. Leukemic gingival hyperplasia was present in 3.6 percent and leukemia cutis in 3.1 percent of the patients. Only 7.6 percent of those with leukemic "infiltrates" had simultaneous gingival and skin involvement. Histologically, the lesions consisted of extravasated and proliferating monocytoid or myeloid cells. The infiltrative-proliferative tendency was most pronounced in patients with, in a sharply descending order, acute monocytic leukemia, acute myelomonocytic leukemia, and acute myelocytic leukemia. Formation of lesions in the skin and gingiva was unrelated to sex, age, and white blood cell count. Gingival lesions were particularly prone to infectious complications in patients with poor oral hygiene. Aside from the morphologic predisposition, the propensity for adults with leukemia to develop chemotherapeutically reversible malignant mucocutaneous lesions was highly individualistic and unpredictable.

Adolescent↗
PubMed2005

Oral manifestations of juvenile hyaline fibromatosis: a case report.

Hyaline fibromatosis is a rare autosomal recessive disease of connective tissue, characterised by an accumulation of hyaline in the skin as well as various organs. The clinical features include: multiple cutaneous nodules, joint contractures, osteolytic lesions and gingival hypertrophy. This paper reports the case of an 11-year-old boy, who was referred to our dental clinic complaining of pain in his mouth. On examination, the patient had gross maxillary and mandibular gingival hyperplasia, which caused severe feeding difficulties. He also had severe dental decay, mal-positioned teeth and limited mouth opening. Treatment was done under general anesthesia to remove excess gingival tissue and extract the severely decayed teeth. Histological examination confirmed the diagnosis of juvenile hyaline fibromatosis. It was concluded that patients with this condition have special dental needs. Early diagnosis of the affected children is important in order to start early preventive dental therapy.

Child↗
PubMed1997

[Dental and oral aspects in pediatric liver transplant patients. A comparison between the effects of cyclosporine A and FK 506].

The evolution and the improvement of the surgical techniques and pharmacological therapies brought to new patients categories, also in odontoiatric field for example patients who underwent organ transplantation. Among the patients, we wanted to dwell our attention on pediatric patients after liver transplantation, by light of the new therapeutic outlines modifications. In fact in these young patients it is possible to observe, besides the severe systemic consequences, also the involvement of the oral cavity. After the transplantation, the immunosuppressive therapy is set up and it is based on the use of cyclosporine with the possible azotiopine or steroid association. The cyclosporine side-effects are well known and, among these, the gingival hyperplasia. FK506 is a drug recently introduced, it is a strong immunosuppressor. Therefore we began to estimate patients who assumed FK 506, in order to compare the effect at the gingival level among patients who follow a cyclosporine therapy.

Child↗
PubMed2003

Gingival overgrowth in kidney transplant recipients treated with cyclosporine and its relationship with chronic graft nephropathy.

Our previous study of a group of renal transplant recipients treated with CsA showed a significantly faster development of chronic graft failure among patients with gingival hyperplasia (GH) compared to unaffected patients. The aim of the present research was to establish the impact of CsA dose and blood levels on the incidence of chronic graft nephropathy and gingival overgrowth as well as to assess risk factors for chronic graft nephropathy. The study included 64 renal graft recipients (32 patients with GH and 32 without GH) transplanted between 1989 and 1994. There were no significant differences between the pretransplant demographic and clinical data of the patients with and without GH. Patients with GH received a significantly higher total yearly dosages of CsA compared those without GH (P <.03). Serum creatinine in the first year posttransplant in patients with GH was 1.9 mg/dL versus 1.6 mg/dL in those without GH. During 9 to 14 years follow-up, end-stage renal failure due to chronic nephropathy occurred in 18 patients (56%) with GH and eight patients (25%) without GH. Ten-year renal graft survival was 35% in GH patients and 69% in patients without GH. Ten-year patient survival was 69% in the GH group and 91% in the group without GH. CsA dosage was a risk factor for GH and for graft loss, which implies a role of CsA toxic effects on the pathological mechanisms of GH and of chronic allograft nephropathy.

Adult↗
PubMedDate not supplied

Pyogenic granuloma in a renal transplant patient: case report.

This case report describes a 14-year-old female referred to Pediatric Dentistry for evaluation and treatment of cyclosporine-induced gingival hyperplasia. Examination of the anterior maxillary area showed a red, vascular, exophytic, soft-tissue mass which had been excised a few months earlier without a histopathologic examination being done. The mass did not appear consistent with gingival overgrowth induced by long-term use of medication, and thus an excisional biopsy was performed, which diagnosed the lesion as a pyogenic granuloma. A review of the literature and management recommendations are discussed.

Adolescent↗
PubMed2003

Effect of nifedipine on the expression of bcl-2 protein in rat gingiva.

Bcl-2 is a family of proteins involved in protecting the cell against death stimuli or in promoting cell death. The aim of the present study was to determine the effect of nifedipine treatment on the expression of bcl-2 protein in rat gingival tissues. Rats were given gastric intubation with various concentrations and durations of nifedipine. Nifedipine-untreated and dimethylsulfoxide (DMSO)-treated animals served as control groups. The gingival tissues were dissected and the expression of bcl-2 protein was determined immunohistochemically. The results showed that the numbers of bcl-2-positive cells in the gingiva of nifedipine-treated animals were significantly higher than in the control groups. These numbers increased parallel to increased concentration and duration of nifedipine treatment. The results suggest that nifedipine treatment may induce the expression of bcl-2 protein in rat gingival tissue in a dose- and duration-dependent fashion and that this proto-oncogenic protein may play a role in nifedipine-induced gingival hyperplasia.

Animals↗
PubMed1991

Fibrous hyperplasia of the gingiva in organ transplant patients.

Recent improvements in immunosuppressive therapy have improved the survival rate of post organ transplant patients. These developments have introduced a new group of medically compromised patients to the general dental practitioner. This paper reviews the medical and dental complications of organ transplant patients with special reference to heart transplant patients. A case report of the management of Cyclosporin A induced gingival hyperplasia in a post heart transplant patient is presented. Guidelines for dental management of heart transplant patients are suggested.

Adult↗
PubMed2000

Keratinocyte growth factor is upregulated by the hyperplasia-inducing drug nifedipine.

Keratinocyte growth factor (KGF) is the seventh member of the fibroblast growth factor (FGF) family. It is produced by mesenchymal cells and its activity is specific for epithelial cells, controlling epithelial homeostasis and wound repair in a paracrine manner. Although KGF has been implicated in a number of hyperplastic pathologies, it has not previously been investigated in gingival hyperplasia (GH), an adverse side-effect of three pharmacologically different types of drugs, including the anti-hypertensive drug nifedipine (NIF). The mechanism by which NIF causes GH is not yet known, but we have recently shown that KGF mRNA transcripts are elevated in drug-induced GH in vivo (manuscript submitted). It is therefore possible that the action of NIF is mediated via KGF and, in the present study, using the enzyme-linked immunosorbent assay (ELISA) and the semi-quantitative reverse transcribed-polymerase chain reaction (RT-PCR), we found that NIF upregulates KGF secretion and gene transcription by gingival fibroblasts in vitro. Our results thus suggest that KGF may have an important role in the molecular pathology of GH in vivo.

Antihypertensive Agents↗
PubMed2004

Impact of phenytoin therapy on the skin and skin disease.

Phenytoin (diphenylhydantoin; Dilantin), ALZA Corp.) is a highly effective and widely prescribed anticonvulsant agent used in the treatment of focal and tonic clonic generalised seizures. The side effects of phenytoin can occassionally engender significant morbidity. Phenytoin can induce generalised eruptions that include: a maculopapular exanthem, Stevens-Johnson syndrome, generalised exfoliative dermatitis, toxic epidermal necrolysis, vasculitis and fixed drug eruptions. Phenytoin is linked to a hypersensitivity syndrome that manifests with fever, rash and lymphadenopathy. Patients receiving phenytoin may develop pseudolymphoma or, rarely, malignant lymphoma and mycosis fungoides-like lesions. Rarer cutaneous side effects include drug-induced lupus, purple hand syndrome, pigmentary alterations and IgA bullous dermatosis. Phenytoin can effect clotting function and alter vitamin and mineral levels. Prenatal exposure to phenytoin may result in a spectrum of structural, developmental and behavioural changes, known as the fetal hydantoin syndrome. Patients who use phenytoin in the long-term commonly manifest with gingival hyperplasia, coarsening of the facies, and hirsutism.

Abnormalities, Drug-Induced↗
PubMed1984

Risk factors of dental caries in 9-10-year-old mentally retarded Finnish children.

Mentally retarded children from one age cohort and their randomly selected controls in one Finnish county were examined for standard of oral hygiene, and their parents and nurses interviewed for information on dental health habits and for other relevant background information. The mentally retarded consumed sugar containing products less frequently than the mentally normal controls. Toothbrushing and fluoride supply was also less common in the retarded than in the healthy. Among the retarded, the dental health habits were most favorable in registered outpatients and least favorable in administratively unknown retarded not included in special welfare. Differences in dental health habits between these subgroups of the retarded were large. In contrast to the findings in the healthy children, frequency of toothbrushing was not associated with the observed standard of oral hygiene in the mentally retarded. The toothbrushing subgroup of the mentally retarded consumed sugar more frequently than the toothbrushing healthy children and commonly used drugs which reduced saliva flow or promoted gingival hyperplasia.

Child↗
PubMed1981

Effect of phenytoin on mitotic activity of gingival tissue and cultured fibroblasts.

The effect of phenytoin on the mitotic activity of gingival tissue as well as cultured mammalian fibroblasts was studied. This was measured quantitatively using autoradiography utilizing tritiated thymidine. Hyperplastic gingiva removed from patients treated with phenytoin and subjected to autoradiography showed a marked increase in the mitotic activity of gingival cells. This was also the case with cultured fibroblasts. The mitotic index was higher in the treated fibroblasts than that of the control. Ascorbic acid added to the cultures markedly reduced the mitotic activity of these cells. These results agree with other studies that phenytoin may be a factor in direct stimulation of the mitotic activity and gingival hyperplasia seen in patients taking this medication.

Animals↗
PubMed1996

Evidence that cyclosporine inhibits periodontal prostaglandin I2 synthesis.

Cyclosporine (CsA) is a selective immunosuppressant widely used in clinical therapy. Like phenytoin and nifedipine, the drug is associated with gingival overgrowth. This study considers the interaction of CsA and prostaglandin I2 (PGI2), in particular the action of the drug on gingival tissue in vitro and in vivo. The PGI2-synthesis of rat, rabbit and human gingival tissue was examined by bioassay. In vivo CsA-therapy reduces gingival PGI2-synthesis. The results furthermore show a dose-dependent inhibition of PGI2-synthesis by CsA (1-100 micrograms/ml) in vitro. PGI2-synthesis from in vivo CsA-pretreated probes was further dose-dependently diminished by in vitro addition of CsA. As PGI2 exerts an antiproliferative activity via cAMP-elevation, the drug-induced inhibition of PGI2 production is claimed to be responsible for gingival hyperplasia in CsA-treated patients.

Adult↗
PubMedDate not supplied

Ultrastructural investigation of Zimmermann-Laband syndrome.

Zimmermann-Laband syndrome (ZLS) is a very rare autosomal dominant inherited condition characterized by 3 major clinical findings of which gingival hyperplasia are always present. The great heterogenicity of the syndrome is illustrated by the numerous variable clinical findings described in the literature. The purpose of the study was to examine a patient diagnosed with ZLS and to describe possible new characteristics of this rare syndrome, including the ultrastructural morphology using a transmission electron microscope (TEM) of the gingival and dermal fibroblasts. The ultrastrucutral morphology as has not previously been described in the literature. Tissue was collected from the alveolar ridge and skin of the forearm for TEM. TEM studies indicated the presence of prominent fibroblasts situated among numerous regular dense connective tissue bundles. Genetic analysis showed a new chromosomal insertion, ins(12;8)(p11.2;q11.2q24.3), suggesting that the gene responsible for the syndrome lies on chromosome 8.

Abnormalities, Multiple↗
PubMed1993

A clinical and histological comparative study of the effect of nifedipine and phenytion on human gingiva.

Ten patients manifesting gingival enlargement were chosen for this study. Five patients had been treated with 4 mg nifedipine per day as a treatment for angina pectoris, while the other five patients treated with phenytion as an anticonvulsant drug. Clinical and histological data showed that nefidipine induced gingival hyperplasia which is of close similarity to that induced by phenytion despite the differences in target tissue.

Anticonvulsants↗
PubMed1997

Familial broad terminal phalanges with one individual showing additional anomalies.

We describe a family with four relatives showing broad terminal phalanges (BTP) of the fingers and toes. One also had mental retardation, an unusual facial appearance, cleft palate with bifid uvula, and gingival hyperplasia. The BTP anomaly in this family seems to be transmitted as an autosomal dominant trait.

Abnormalities, Multiple↗
PubMed1978

Hereditary fibrous hyperplasia of the gingiva with varying penetrance and expressivity.

A kindred affected with hereditary fibrous hyperplasia of the gingiva with varying penetrance and expressivity is described. Most of the affected members were short in stature. The pedigree strongly suggested an autosomal dominant mode of inheritance. The penetrance of the trait varied, and three unaffected persons had transmitted the disease to their offspring. There were two modes of expression. The mild form showed only bilateral rugose thickening of the palate, whereas the severe form showed gingival hyperplasia in addition to changes in the palatal mucosa. The changes were already present at birth. Histological examination showed large amounts of alcian blue-positive extracellular material in the subepithelial connective tissue of the hyperplastic mucosa. Loose collagen-poor connective tissue with alcian blue-positive extracellular material and dense collagen-rich connective tissue in the rugose projections of the palatal mucosa were often segregated.

Adolescent↗
PubMed1991

The transmandibular implant: a 13-year survey of its use.

During the period from August 1976 until July 1989 the transmandibular implant was introduced in a total of 31 oral and maxillofacial surgery departments in the Netherlands and 1,466 patients were treated. This study includes 1,356 treated patients from 28 departments. The treatment course of 1,201 patients (89.6%) was uneventful. Of the 157 complications, 58 related to the anatomic contour of the mandible, 49 to the surgery, 25 to the prosthetic reconstruction, 8 to the psychosocial attitude of the patient, 8 to the use of medication, 5 to trauma, and 4 to the presence of a skin graft. Treatment of the complications included removal of the implant in 44 patients; in 106 patients the complication was treated satisfactorily. In the remaining 7 patients, hypesthesia was present. The reasons for the removal of the 44 implants were infection (11), operative error (5), premature loading of the implant (3), insufficient width of the mandible after a visor osteotomy (1), loss of osseointegration caused by the prosthesis (14), psychological problems (4), trauma (3), drug-related gingival hyperplasia (2), and inexplicable pain (1). The present survey shows a consistent success rate of 96.8%.

Adult↗