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PubMedDate not supplied

[Gingival hypertrophy in I-cell disease (mucolipidosis II). A report of 2 nonfamilial cases. II].

Two nonconsanguineous patients affected by I-cell disease (mucolipidosis II) are reported. I-cell disease, an oligosaccharidosis, is characterized by severe psychomotor retardation, marked shortness of stature, coarse facies, gingival enlargement, generalized bone demineralization, periosteal cloaking of long bones visible in early infancy, a rapid deteriorating course, and death from heart failure or bronchopneumonia, usually by the age of 5 years. This disorder is the result of a deficiency of glycoprotein N-acetylglucosaminylphosphotransferase activity, necessary for proper intracellular processing of lysosomal enzymes. Inheritance is autosomal recessive. It received the name I-cell disease because of several granular inclusions in the cytoplasm of cultured fibroblasts and amniotic fluid cells observed under phase contrast microscopy. These granules represent altered lysosomes. The two patients, reported here, had a very marked gingival hypertrophy and, for this reason, were referred to the Oral Pathology Service of Galliera Hospital. A gingivectomy was performed on patient 2 to improve the mastication, but few months later gingival hypertrophy reappeared.

Child, Preschool↗
PubMed1998

Effect of treatment on cyclosporine- and nifedipine-induced gingival enlargement: clinical and histologic results.

The clinical and histologic responses to periodontal treatment of gingival enlargements, induced when cyclosporine and nifedipine were administered singly or in combination, were evaluated. A significant correlation was noted between plaque, gingivitis, and gingival overgrowth. Severity of enlargement appeared to be greater in patients on combined therapy. All treatment approaches such as scaling, root planning, gingivectomy, and periodontal flaps, and a combination of therapies, were effective in the management of gingival overgrowth up to 1 year after completion of treatment. Adjunctive use of chlorhexidine was found to be beneficial.

Adult↗
PubMed1997

Prevention and treatment considerations in patients with drug-induced gingival enlargement.

Drug-induced gingival overgrowth is an iatrogenic disease caused by the use of phenytoin, cyclosporine, nifedipine, and other medications in the susceptible patient. The gingival overgrowth can be due to three causes: noninflammatory, hyperplastic reaction to the medication; chronic inflammatory hyperplasia; or a combined enlargement due to chronic inflammation and drug-induced hyperplasia. Drug-induced gingival enlargement can be minimized, but not prevented, by elimination of local irritants, meticulous oral hygiene, and regular periodontal recall. If gingival enlargement interferes with function, speech, esthetics, or oral hygiene, tissue reduction can be accomplished by gingivectomy or a flap procedure. Gingival enlargement may recur, especially in the patient with poor oral hygiene.

Anticonvulsants↗
PubMed1994

Nifedipine aggravates cyclosporine A-induced gingival hyperplasia.

Gingival hyperplasia is a common side-effect of immunosuppression with cyclosporine A. Nifedipine is often used to control hypertension in kidney graft recipients. Analysis of gingival status in 106 children transplanted at our centre, and treated either with azathioprine, cyclosporine A or both, revealed significantly higher degrees of gingival overgrowth in those children receiving a combination of cyclosporine A and nifedipine compared with those children treated with cyclosporine A or nifedipine alone. Seven children undergoing gingivectomy at our centre over the past few years had received this combination. After a change in the antihypertensive regimen, avoiding long-term nifedipine medication, and improved dental care with chlorhexidine gel, we noted a reduction in the degree of gingival hyperplasia. In the majority of patients, nifedipine could be replaced by a single drug, usually hydralazine. We therefore recommend avoiding calcium channel blockers in the long-term management of hypertension in patients receiving cyclosporine.

Adolescent↗
PubMed1976

Effects of lowered temperatures on rat pulp and gingivae.

The histologic appearance of pulp and interdental papilla was observed for 2 months after cryosurgery of dental tissues in the molar region of twelve Colworth-Wistar rats. The reduction in temperature achieved was also calculated from thermocouples in the pulp chamber of freshly killed animals. Reduction to -13 degrees C. in 1 1/2 minutes was followed by destruction of the odontoblast layer and fibrosis of the pulp. Destruction of the epithelium was followed by regeneration and was characterized by a sterile inflammatory reaction. Cryotherapy is suggested to be a useful alternative to standard gingivectomy, especially in patients with blood dyscrasias, and may also be used to treat internal resorption or "pink spot."

Animals↗
PubMed1998

Treatment of periodontal disease.

Periodontal surgery is used to control advanced lesions affecting the support for teeth. The choice between conservative treatment and surgical treatment is a technical issue, but client compliance plays an important role. Excision surgical techniques (e.g., gingivectomy) and incisional surgical techniques (e.g., flap surgery) are described in this article. Postoperative, recall, and retreatment programs are explored.

Animals↗
PubMed2003

Treatment of a patient with an impacted transmigrant mandibular canine and a palatally impacted maxillary canine.

Very few people have seen transmigrant mandibular canines and little has been presented in the literature about this rare phenomenon. In this case report, identification techniques and treatment options are presented along with the treatment results of a patient diagnosed with a transmigrant mandibular canine. This rare condition usually requires extraction of the involved tooth because orthodontic forces are seldom successful at erupting these teeth into their proper location. The treatment protocol for this patient involved a combination of orthodontic procedures, surgical extractions, gingivectomy and frenectomy, and implant replacement of the impacted transmigrant tooth. Through a collaborative effort of a team made up of an orthodontist, periodontist, prosthodontist, and oral surgeon, these techniques were used to achieve an excellent esthetic and functional outcome.

Child↗
PubMed2004

High prevalence of Chlamydia pneumoniae infection in cyclosporin A-induced post-transplant gingival overgrowth tissue and evidence for the possibility of persistent infection despite short-term treatment with azithromycin.

BACKGROUND: Cyclosporin A (CsA) induces gingival overgrowth (GO) in up to a quarter of CsA-treated renal transplant recipients. A short-term therapy with azithromycin effectively reduces GO, indicating a possible involvement of microorganisms in the pathogenesis of CsA-induced GO. We aimed to determine if there could be any relationship between infection with Chlamydia pneumoniae and GO pathogenesis. In addition, we determined the long-term persistence rate of C. pneumoniae infection in residual GO tissue when azithromycin treatment failed to eliminate GO. METHODS: Chlamydia pneumoniae IgG and IgM antibody titres were measured by microimmunofluorescence technique in sera of kidney recipients with (n = 11) and without (n = 89) GO. GOs were rated and gingivectomies were performed before treatment with 500 mg of azithromycin for 3 days and at months 6 and 12 post-treatment when C. pneumoniae titres were re-evaluated. Nested polymerase chain reaction was performed to identify C. pneumoniae-specific DNA in GO tissues. Results of C. pneumoniae antibody titres from patients with GO were compared with pair-matched controls without GO. RESULTS: Chlamydia pneumoniae IgM titres were elevated in five of 11 patients with GO and in none without GO, whereas the difference of C. pneumoniae IgG titres between patients with GO and pair-matched controls did not reach significance (P<0.57). Chlamydia pneumoniae-specific DNA was found in 10 of 11 GO tissue samples pre-treatment. Azithromycin therapy effectively reduced GO and C. pneumoniae IgM titres. In residual GO, C. pneumoniae-specific DNA remained detectable after 1 year in all GO tissue samples despite azithromycin treatment. The C.pneumoniae IgM titres correlated with GO scores. CONCLUSION: Chlamydia pneumoniae infection is highly prevalent in CsA-induced GO. The infection can persist over a long period in residual GO despite short-term azithromycin therapy. The results indicate that CsA immunosuppression enhances C. pneumoniae infection rates in non-cardiovascular tissue.

Adult↗
PubMed1996

Oral presentation of posttransplantation lymphoproliferative disorders. An unusual manifestation.

Cyclosporine, an immunosuppressive agent widely used in organ transplantation, has several undesirable side effects, including gingival hyperplasia, which occurs in up to 70% of patients. Another complication associated with use of cyclosporine and other immunosuppressants is an increased incidence of malignancies. Long-term use of cyclosporine also is associated with a spectrum of hyperproliferative disorders ranging from reactive lymphoid hyperplasia to aggressive malignant lymphomas. While cyclosporine-related lymphoproliferative disorders have been widely reported, they have not been described in the oral cavity as the first manifestation of this disease. We report on two cardiac transplantation patients with a history of cyclosporine use who presented initially with oral symptoms of lymphoproliferative disorder. Both had erythematous to cyanotic and hyperplastic gingiva. On gingivectomy, the fixed tissue was soft, glistening, and tan colored, in contrast to the usual firm, white, cyclosporine-associated, benign gingival fibrous hyperplasia. Histologically, a dense, diffuse infiltrate of lymphoplasmacytoid cells with vesicular nuclei, prominent nucleoli, a moderate amount of cytoplasm, and high mitotic activity was observed. Immunocytochemical studies confirmed that the cells were monoclonal for lambda light chains in one patient and kappa light chains in the other. The cells from one patient were positive for CD45, while both patients were negative for CD20 and all nonhematopoietic antigens tested. Both tissues were strongly positive for Epstein-Barr virus. Morphology and immunocytochemistry findings are consistent with a posttransplant lymphoproliferative disorder. These are the first two reported cases of cyclosporine-associated posttransplant lymphoproliferative disorders presenting as gingival hyperplasia.

Adult↗
PubMed2006

Hereditary gingival fibromatosis: aggressive 2-stage surgical resection in lieu of traditional therapy.

INTRODUCTION: Hereditary gingival fibromatosis (HGF) is a rare condition characterized by progressive enlargement of the gingiva. Most cases follow autosomal dominant genetics, with a reported incidence of 1 in 750,000. In addition to cosmetic concerns, the compromised oral cavity may cause difficulty with eating, speech, hygiene, and oral competence. In addition, social consequences can be dramatic, forcing patients to lead isolated, reclusive lives. Traditional therapy uses serial gingival resections ("quadrantectomies") with primary closure. However, this method is associated with frequent recurrence and additional resections. We report on a family of 12 siblings, 8 of whom, including monozygotic twins, are affected with HGF. We describe corrective surgery for 3 siblings, as well as their long-term follow-up. METHODS: Three sisters suffered from severe maxillary and mandibular gingival hyperplasia. All complained similarly of weight loss, difficulty with articulation, and social isolation. Physical examination revealed massive overgrowth of both maxillary and mandibular gingiva, as well as multiple ectopic teeth. Following diagnostic biopsy, all 3 patients underwent staged resections. The first stage involved resection of the maxillary component, followed by a planned second-stage resection of the mandibular component. All resections included gingivectomies, odontectomies, and alveolar ridge ostectomies. The oral cavity was allowed to heal by secondary intention. RESULTS: All 3 patients were female, and ages ranged from 34-48 years (mean: 43). Follow-up on the 3 patients ranged from 3-18 months (mean: 11 months). There has been no evidence of recurrence to date. The gingiva remucosalized uneventfully within several weeks, and all patients are tolerating solid food. All patients report dramatically improved speech, oral hygiene, and self-confidence. CONCLUSIONS: In an effort to address the high recurrence rate, we describe our aggressive surgical approach, including resection of the hypertrophied gingiva and alveolar processes. Two-staged gingival resection, as opposed to the more traditional 4-stage quadrantectomy approach, has resulted in no recurrence to date, suggesting an improved outcome over the traditional techniques.

Adult↗
PubMed1976

The healing potential of the periodontal tissues following different techniques of periodontal surgery in plaque-free dentitions. A 2-year clinical study.

A clinical trial was undertaken to study the healing capacity of the periodontal tissues following different modes of periodontal surgery in patients whose oral hygiene was professionally maintained at an optimal level. Fifty patients, distributed into five groups, participated in the study. Following an initial examination and presurgical treatment, the various patient groups were subjected to one of the following surgical procedures: 1) the apically repositioned flap operation including elimination of bony defects, 2) the apically repositioned flap operation including curettage of the bony defects but without removal of bone, 3) the "Widman flap" technique including elimination of bony defects, 4) the "Widman flap" technique including curettage of the bony defects but without removal of bone, 5) gingivectomy including curettage of the bony defects but without removal of bone. After surgery, all patients received oral hygiene instruction and professional cleaning of the teeth once every 2 weeks during a 2-year period. The results showed that periodontal disease can be cured and further destruction of the periodontal tissues avoided irrespective of the surgical technique utilized for pocket elimination. Different surgical techniques, however, promoted varying degrees of regeneration of the supporting tissues. The most favourable healing was obtained when resection of bone was avoided and when complete coverage of the alveolar bone was ensured.

Adult↗
PubMed1977

Periodontal surgery in plaque-infected dentitions.

A clinical trial was performed to study the result of periodontal treatment following different modes of periodontal surgery in patients not recalled for maintenance care. The material consisted of 25 patients distributed into 5 groups. Following an initial examination, all patients underwent presurgical treatment including case presentation and instruction in oral hygiene measures. This instruction was given once. The various patient groups were then subjected to one of the following surgical procedures: 1) the apically repositioned flap operation including elimination of bony defects 2) the apically repositioned flap operation including curettage of bony defects but without removal of bone 3) the "Widman flap" technique including elimination of bony defects 4) the "Widman flap" technique including curettage of bony defects but without removal of bone 5) gingivectomy including curettage of bony defects but without removal of bone. Six, 12 and 24 months after completion of the treatment, the patients were recalled for assessment of their oral hygiene standard and periodontal conditions. The results showed that case presentation and oral hygiene instruction given once, only temporarily improved the patient's oral hygiene habits. Renewed accumulation of plaque in the operated areas resulted in recurrence of periodontal disease including a significant further loss of attachment. All five different techniques for surgical pocket elimination were equally ineffective in preventing recurrence of destructive periodontitis.

Adult↗
PubMed1990

Variation in the composition of gingival inflammatory cell infiltrates.

Biopsy specimens were taken at gingivectomy from 18 adult patients undergoing treatment for chronic marginal periodontitis. They were embedded so that the cut surface of the gingiva was parallel to the top of the block to obtain a comprehensive view in a transversal plane of the inflammatory cell infiltrate near the bottom of the pocket. Sections were stained with HES or with toluidine blue for histological description, and acid alpha-naphthyl acetate esterase (ANAE) was used to differentially stain T lymphocytes, plasma cells and monocytes/macrophages. Sections stained with HES showed that the density and size of the cell infiltrates varied along the circumference of a tooth over very short distances and on various surfaces on neighbouring teeth. Differential counts of cells stained for ANAE demonstrated great variation in the composition of the cell infiltrates, particularly along the pocket epithelium. The predominating ANAE positive cell type in this area was T lymphocytes, while in the central connective tissue, plasma cells predominated. There was no systematic covariation between the localization of the gingiva (i.e. mesial, facial, etc.) and the composition of the cell infiltrates. The local variation in the composition of the cellular infiltrate most likely reflects local variability in the noxious substances (i.e. plaque composition) within the periodontal pocket, and in the resulting local inflammatory response.

Adult↗
PubMed2004

Post-transplant lymphoproliferative disorders presenting as gingival overgrowth in patients immunosuppressed with ciclosporin. A report of two cases.

BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) can occur in patients maintained on immunosuppressive therapy following transplantation. This paper describes two cases of PTLD occurring in gingival tissues, in patients receiving ciclosporin following cardiac transplantation. TREATMENT: The lesions were localised to gingival tissues, mimicking ciclosporin-induced gingival overgrowth. They were removed surgically and the ciclosporin dose reduced to help prevent recurrence. CONCLUSION: The importance of histopathological examination of all tissue removed during routine gingivectomy procedures for ciclosporin-induced gingival overgrowth is highlighted.

Cyclosporine↗
PubMed1989

Verapamil-induced gingival overgrowth: a clinical, histologic, and biochemic approach.

Verapamil-induced overgrowth was most prominent in the anterior regions and interproximal areas associated with plaque retention. Despite periodontal therapy, overgrowths recurred 1 month after gingivectomy. Discontinuation of the drug resulted in regression of the overgrowths. Histologic findings showed inflamed connective tissue covered by an acanthotic, thickened oral epithelium with long rete pegs containing dyskeratotic pearls. The proliferation rate and protein and collagen production of fibroblasts from the overgrowth sites were markedly lower than in the control cells cultured from healthy gingiva. Incubation of fibroblasts in the presence of verapamil reduced protein and collagen synthesis.

Adult↗
PubMed1980

Selective fluorescence of mast cells: comparison of effect of staining with acid and basic dyes.

A previously described method in which mature rat mast cells stained with acid dyes were demonstrated by their selective fluorescence, was further studied. The material consisted of tongues from rats and mice in addition to heads and tails from 1-d-old rats and embryos 19 d post gestations stage. Chronically inflamed human gingiva obtained from gingivectomies was also studied. Some basic dyes were used for control and comparison. With the acid dyes acid fuchsin, fast green FCF and azocarmine G a mast cell fluorescence equal to that in rats was also demonstrated in mice and humans. Immature rat mast cells stained with acid dyes disclosed a selective fluorescence, the intensity of which was, however, lower than that observed with the basic dye acridine orange. Immature mast cells in the chronically inflamed gingiva revealed a fluorescence of lower than that emitted by the mature cells. In mature mast cells from rats and mice the fluorescence color induced with acid dyes except for thiazine red R, was dependent on the dye concentration. No or insignificant change of fluorescence was observed with the basic dyes.

Acids↗
PubMed1990

Androgen metabolism in gingival hyperplasia induced by nifedipine and cyclosporin.

Three cases of gingival overgrowth induced by cyclosporin and/or nifedipine have been reported. Patient A was under medication with cyclosporin plus nifedipine, patient B with nifedipine only and patient C with cyclosporin only. The significance of androgen metabolism in gingival tissue with respect to hyperplastic changes has been studied by several workers. Hence, we have investigated whether gingival tissue from the above patients showed significant metabolism of the androgen, testosterone, to its biologically-active form, 5 alpha-dihydrotestosterone (5 alpha-DHT). Radical gingivectomy was carried out in all 3 cases to remove the hyperplastic tissue. The excised tissue was incubated with labelled testosterone in order to study the extent of androgen metabolism. Healthy gingivae from males and females produced 5 alpha-DHT (22.4 +/- 7.7, s.e.m., n = 8). Very significantly higher values (p less than 0.001) were recorded for patients A, B and C (1139, 542 and 994 fmol/mg, respectively). These represented increases of 51-, 24- and 44.4-fold, respectively over control values. Corresponding production of 4-androstenedione from testosterone was 28 +/- 8.3, s.e.m., n = 8, fmol/mg. In patients A, B and C, 4-androstenedione production was elevated: 85, 901 and 113 fmol/mg, respectively, representing increases of 3-, 32- and 4-fold. Even the lower values of 85 and 113 fmol/mg were very highly significant (p less than 0.001) compared with control values. Although healthy female gingival tissue does not metabolize testosterone significantly, in the presence of inflammation the extent of 5 alpha-DHT formation is comparable to that of male samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗