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Nifedipine-induced gingival hypertrophy is a rare side effect reported by the producers of this drug but, surely, not well known in all its aspects. In the present case report this pathology is studied in a patient treated with nifedipine for 30 months for cardiac angina, analyzing the histologic features, the therapy plain conducted for the hypertrophy and the most important pathogenetic theories formulated till now.
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The clinical and histological aspects of gingival hypertrophy due to cyclosporine-A in 10 heart-transplanted patients are studied. The behaviour to avoid or to limit gingival overgrowth is suggested.
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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.
A 5-year-old boy was referred because of gross gingival hypertrophy which caused severe feeding difficulties in addition to obvious aesthetic concern. The patient also suffered from frequent upper respiratory tract infections and diarrhoea. In addition, he had pigmentation on bony prominences of his hands, elbows, knees and ankles, cutaneous nodules behind his ear and granulomatous tissue adjacent to his nose. Excess gingival tissue was removed under general anaesthesia. Histological features suggested a diagnosis of juvenile hyaline fibromatosis, which is considered to represent the same underlying pathological condition as infantile systemic hyalinosis. It is suggested that systemic hyalinosis should be preceded by 'infantile' or 'juvenile' depending on the clinical presentation.
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A female child with a terminal deletion on the long arm of chromosome 14, 46,XX,del(14)(q31.1), presented with microcephaly, narrow palate, gingival hypertrophy, protuberant ears, and a small haemangioma on the back. She was mildly mentally retarded. Only a few patients with a partial deletion of 14q (14q-) have been reported without consistent clinical findings. Although a clinical syndrome associated with ring chromosome 14, r(14), has been established, no distinct pattern has been so far reported in 14q-.
Two sisters born to consanguineous Lebanese parents had mental retardation and epilepsy, brachymetacarpalia, hirsutism, bulbous soft nose, thick floppy ears with abnormal configuration and gingival hypertrophy. One girl presented additionally with tetralogy of Fallot and the other with congenital hypothyroidism and bilateral ureteral stenosis. These manifestations resemble the syndrome of hypertrichosis-gingival fibromatosis-mental retardation and seizures of Anavi et al. [1989: Dev Med Child Neurol 31:538-542] but our two girls additionally have brachymetacarpia. The inheritance seems to be autosomal recessive. These two sisters may represent a hitherto undescribed syndrome. We discuss the findings in our patients in relation to the literature.
What is believed to be the first reported case of congenital generalized fibromatosis in an African infant is described. Features in our patient, which were not noted in previous reports of the disease, include gingival hypertrophy, ankylosis of joints, skeletal hyperostosis, and lymphatic dilation of the ileal villi. Corticosteroid therapy was tried in the patient, but did not produce any beneficial effect.
Eighty-two patients were observed at the Dental Department at Parma University. Seventy-six of them had renal transplant and 6 liver transplant. They were in immunosuppressive therapy with cyclosporina, 42 of them were also in calcium antagonist therapy. Gingival hypertrophy was observed in 52 subjects (63.4%) 25 (30%) patients underwent surgical operation, 6 of them (24%) showed a relapse about 3 months after the first operation. Clinical data were measured in accordance with 5 indicators: the level of oral hygiene, cyclosporinemia, contemporaneous use of calcium antagonist, the duration of therapy and the DMF index. By the results obtained, it's possible to suppose that the gravity of the disease is related to the contemporaneous use of calcioantagonist, but it wasn't highly significant (p < 0.05). The degree of oral hygiene was decidedly in relation to the most severe forms of gingival hyperplasia (grade 2-3), (p < 0.001). No relation was found for the duration of therapy, distribution of the DMF index and the level of drugs in the blood.
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Gingival overgrowth is defined as hyperplasia of gingival tissue due to local, systemic or drug-related causes. To see if the incidence and severity of this side-effect are related to cyclosporine A (CyA) dosage and/or blood levels BCyA), we analysed data from 24 renal transplanted outpatients, grouped as follows: controls (C, n = 3): patients on immunosuppressive therapy other than CyA; group 1 (G1, n = 10): patients with BCyA steadily 300 ng/mL (RIA); group 2 (G2, n = 11): patients with BCyA steadily between 301 and 650 ng/mL. BCyA averaged 290 +/- 21 in G1 and 481 +/- 100 in G2 (p less than 0.001): mean cyclosporine A dosage (mg/kg/die) was not significantly different: 4.1 +/- 1.4 in G1 and 4.97 +/- 2.4 in G2. However, six patients in G2 also received calcium antagonists known to increase CyA blood levels (diltiazem and nicardipine) for clinical purposes or deliberately to increase CyA bioavailability. Mean time from transplant was (in months) 19 +/- 11 in G1, 16 +/- 15 in G2 and 62 +/- 24 in C (G1 vs G2: NS; C vs G1 and 2: p less than 0.001). Mean GFR (mL/min) was 75 +/- 22 in C, 65 +/- 18 in G1 and 53 +/- 19 in G2 (NS). Dental hygiene, as assessed by scoring (0-3: absent, mild, moderate and severe) the bacterial plaque, was similar in all groups. Gingival overgrowth, was similarly scored (0-3) and was absent in C and in 20% of G1, mild in 40% of G1 and 33% of G2, moderate in 40% of G1 and 33% of G2 and severe in 0% of G1 and 33% of G2 (G1 vs G2: p less than 0.05). Our data suggest that the severity of gingival overgrowth in transplanted patients with similar oral hygiene is mainly related to CyA blood levels.
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