Phenytoin-induced gingival overgrowth is a well-known and frequently reported gingival lesion, which was first detected in 1939. However, there are conflicts in the literature about the agents which affect the severity of the lesion. Un-cooperative dental patients are one of the most unsuccessfully treated periodontal patient groups because of the difficulty in maintaining their oral hygiene. This case report consists of two cases with the same characteristics: phenytoin usage, comprehension and speech defects and poor oral hygiene, but each case differs in the duration of the phenytoin therapy. Both of the cases received scaling, root planning and a gingivectomy.
Adult ; Anticonvulsants/*adverse effects ; Epilepsy/*drug therapy ; Gingival Overgrowth/*chemically induced ; Human ; Male ; Oral Hygiene ; Patient Compliance ; Phenytoin/*adverse effects

OBJECTIVETo investigate the effect of cyclosporin A (CsA) and tumor necrosis factor-α (TNF-α) on cell proliferation of cultured human gingival fibroblasts (GF), and the relationship between gingival inflammation and drug-induced gingival overgrowth.

METHODSHuman GF were cultured in vitro using tissue culture method. then cells from the 4 - 8 th passage were used in the experiment. The cells were cultured and incubated with various concentrations of CsA and TNF-α (A: blank group, B1: 10 µg/L CsA, B2: 50 µg/L CsA, B3: 250 µg/L CsA, B4: 1250 µg/L CsA, C: 5 µg/L TNF-α, D1: 10 µg/L CsA + 5 µg/L TNF-α, D2: 50 µg/L CsA + 5 µg/L TNF-α, D3: 250 µg/L CsA + 5 µg/L TNF-α, D4: 1250 µg/L CsA + 5 µg/L TNF-α) solution for 3, 5 and 7 days. Methyl thiazolyl tetrazolium assay was used to evaluate the cell proliferation in the culture meidiun.

RESULTSThe proliferation of fibroblasts was inhibited when exposed to different concentration of CsA and A value decreased. There was no significant difference between group B1, B2, B3 and the control group, while the A value of group B4 was significantly higher than that of control group (P < 0.01). Fibroblast proliferation was significantly increased while cultured with 5 µg/L TNF-α. A value increased (P < 0.01). When exposed to CsA + TNF-α, A value of group D1, D2, D3 was much higher than that of group A, but was lower than that of group C (P < 0.05). Cell proliferation in group D4 was significantly increased, and significantly different with that in group C (P < 0.01).

CONCLUSIONSCsA did not stimulate the cell proliferation, and high concentration of CsA inhibited cell proliferation. TNF-α can stimulate the cell proliferation. High-concentration CsA + TNF-α can enhance the fibroblast proliferation, which suggests that CsA in certain concentration have amplification effect on TNF-α to stimulate fibroblast proliferation.

Adult ; Cell Proliferation ; drug effects ; Cells, Cultured ; Cyclosporine ; adverse effects ; pharmacology ; Dose-Response Relationship, Drug ; Fibroblasts ; cytology ; Gingiva ; cytology ; Gingival Overgrowth ; chemically induced ; Humans ; Immunosuppressive Agents ; adverse effects ; pharmacology ; Tumor Necrosis Factor-alpha ; adverse effects ; pharmacology

OBJECTIVETo investigate the prevalence and risk indicator of nifedipine-induced gingival overgrowth in a community population in Beijing.

METHODSA cross-sectional survey was conducted in 616 community subjects with hypertension or coronary vascular disease in Beijing, China. Among them 205 individuals took nifedipine for at least half year and 411 individuals who had never received calcium channel blocker (CCB) were recruited as controls. Smoking, oral hygienic habit, systemic health, pharmacological and demographic data for each subject were recorded by questionnaire. Sulcus bleeding index (SBI) was assessed in 12 anterior teeth per subject. Turesky modified Quigley-Hein plaque index (PI) and gingival overgrowth index in anterior teeth were scored on photograph. 38.6% was defined as threshold to identify individual with significant gingival overgrowth.

RESULTS7.3% of the subjects taking nifedipine were found to have significant gingival overgrowth in this population. The prevalence of gingival overgrowth in nifedipine group was statistically higher than that in the control group. By logistic regression analysis, SBI was found to be the only risk indicator (odds ratio = 5.92, P = 0.001).

CONCLUSIONSThe presence of gingival inflammation was an important cofactor for the occurrence of gingival overgrowth.

Adult ; Aged ; Aged, 80 and over ; Calcium Channel Blockers ; adverse effects ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Gingival Overgrowth ; chemically induced ; epidemiology ; Humans ; Logistic Models ; Male ; Middle Aged ; Nifedipine ; adverse effects ; Prevalence ; Risk Factors