1). Alternative medications phenytoin -carbamezipine. Found inside – Page 4761.1 Localized, fibrotic, tumor-like gingival enlargement on a female ... with nifedipine.16 LEARNING BOX 61.2 The prescribing of a substitute drug can help ... No data exist on any association between combined cyclosporine A (Cy A) and dihydropyridine (DHP) medication and the effect of periodontal treatment on the occurrence of gingival overgrowth (GO) among renal transplant recipients. The concomitant administration of Cy A and DHP resulted in a significantly increased percentage of score 2 overgrown gingival units as compared with Cy A alone (P < 0.03). Found insideEdited by Carl Misch and Randolph Resnik — both well-known names in dental implantology and prosthodontics — and with a team of expert contributors, this authoritative guide helps you handle the implant-related complications that can ... Quintessence international (Berlin, Germany: 1985). 1991;11:107–109. Management of DIGO is always, Gingival hyperplasia modified by medications are commonly seen in dental practice.The increased use of drugs systemically induce several alterations in micro and macroscopic tissues and may create speech, mastication, periodontal, and aesthetic problems.Many systemic diseases have limited therapeutic options and such drugs have an adverse influence on different systems, and one of these is that, Cyclosporine A, a drug that inhibits the immune response, has been widely used for over 30 years in immu‑ nosuppressive therapy protocols for patient‑recipients of the transplanted organs. The effect of cyclosporine with and without nifedipine on gingival overgrowth in renal transplant patients. Editor-In-Chief: C. Michael Gibson, M.S., M.D. Cyclosporine (CsA) has been used as an immunosuppressant to prevent graft rejection. Amlodipine is less commonly associated with gingival enlargement compared to nifedipine [5]. Age showed a statistical negative correlation with HI at baseline (P < .05), while PD > 3 mm was positively correlated to the baseline HI (P < .001). We collected all relevant studies about interventions for cyclosporine A (CsA)-induced renal cell apoptosis in Medline (1966 to July 2010), Embase (1980 to July 2010) and ISI (1986 to July 2010), evaluated their quality, extracted data following PICOS principles and synthesized the data. ©2020 NPS MedicineWise. Diltiazem and verapamil exhibit lower prevalence of gingival enlargement compared to nifedipine. - If you are suffering from gingivitis there . We searched electronic databases and bibliographies up to April 2010. Patients in use of cyclosporine are at risk to develop oral lesions, such as MRFH. Henry Quach and Arijit Ray-Chaudhuri declare that they have no competing interests. Endometrial cancer and breast cancer . - This occurs due to abnormal multiplication of gingival tissues due to various factors. Medication-induced gingival hyperplasia (MIGH) has been linked to several medications, with a reported prevalence ranging between 0.5% and 85%. Data were extracted from eligible studies and analyzed. Gingival enlargement, defined as an increase in the growth of the gingival tissue, raises the risk of infection, caries, and periodontal diseases, and negatively affects the esthetics of the smile. tacrolimus and nifedipine was changed to captopril. Such increased volume of gingiva may compromise normal oral functions, aesthetics in addition . Found inside – Page 483Nifedipine 3. As an alternative drug for premature labour Ans. Q. 2. Name of drugs causing gingival hyperplasia. Ans. ○ Nifedipine is dihydropyridine, ... J Periodontol. Gingival enlargement is one of the side effects associated with the administration of several drugs. The influence of chemical plaque control, using topically applied 0.12% chlorhexidine, on the severity of cyclosporin A (CsA)-induced gingival overgrowth (GO) was evaluated. Patients with more severe disease, those with no response to treatment, or those who experience relapse may require surgical resection of the fibrotic enlarged gingival tissue. It is concluded that combined treatment with Cy A and DHP is a significant risk factor for progression or recurrence of GO after periodontal treatment among susceptible patients. Nonsurgical periodontal treatment itself represents an efficacious therapy in transplant patients treated with CsA and Tcr. Vekaria, et al. Gingival Hyperplasia. Read our full disclaimer. Non-surgical treatment ; professional scaling and debridement. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval for the recorded variables according to PRISMA guidelines. Cleaning plaque from between the teeth can also be carried out if the patient is shown how to gently slide dental floss or tape along the tooth surfaces and under the edge of the gum. Periodontitis was labeled positive by clinical attachment loss (CAL) of at least 2mm and probing depth (PD) of at least 3 mm. Percentages of plaque index (PI), bleeding on probing (BoP), sites with probing depth (PD) > 3 mm, and hypertrophy index (HI) were registered at baseline, 90 days, 180 days, and at 1 year after nonsurgical periodontal therapy. Recurrence risk of cyclosporine and nifedipine-induced Oral Maxillofac Surg Clin North Am. Thorough cleaning by brushing and flossing should be carried out at least once daily. In cyclosporine A-treated renal transplant fibroblasts, azithromycin blocked the accumulation of total collagen in culture media and the increase in type I collagen mRNA level, but recovered the reduced MMP-2 mRNA level to the control. Gingival overgrowth leads to inflammation within the gums and periodontium and can amplify . There were three kinds of intervention, include anti-oxidant (sulfated polysaccharides, tea polyphenols, apigenin, curcumin, spirulina, etc), biologics (recombinant human erythropoietin (rhEPO), a murine pan-specific transforming growth factor (TGF)-beta-neutralizing monoclonal antibody1D11, cartilage oligomeric matrix protein (COMP)-angiopoietin-1 and hepatocyte growth factor (HGF) gene), and other drugs (spironolactone, rosiglitazone, pirfenidone and colchicine). revised guidelines from the American Heart. The epithelium thickness of the buccal gingiva was significantly increased in the cyclosporin A group, compared to the control group (P < 0.05). PMC Unsightly gingival overgrowth affects many individuals immunosuppressed with cyclosporin A (CsA). These results suggest that azithromycin may improve CIGO by blocking cyclosporine A-induced cell proliferation and collagen synthesis, and by activating MMP-2 in gingival fibroblasts of persons with cyclosporine A-induced gingival overgrowth. (2,3) Of the above drugs, phenytoin is the most studied, its association with gingival enlargement dating back to 1939. Calcium channel blockers are known to cause gingival overgrowth. Gingival overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs. Peri-implant diseases are prevalent, with numerous therapies studied in an attempt to combat this condition. Asthma in adults and adolescents: what’s new for mild asthma management? To explain its mechanism in alleviating the clinical symptoms of these individuals, we examined the effect of azithromycin on cell proliferation and collagen turnover modified by cyclosporin A in human gingival fibroblasts from healthy persons and from persons who had undergone renal transplant. This concise clinical companion to the thirteenth edition of Brunner and Suddarth's Textbook of Medical-Surgical Nursing presents nearly 200 diseases and disorders in alphabetical format, allowing rapid access to need-to-know information on ... The clinical presentation of the gingiva was similar to that of hereditary gingival hyperplasia but did not have a contributory medical or family history [1-3].General histological findings include normal overlying epithelium, rete pegs extending deep into underlying connective tissues with some areas of hyperplasia . 6 No. Objective Attempts at improving oral hygiene are of limited benefit in severe gingival enlargement - surgical gingival resection is indicated. Surgical reduction of the overgrown gingival tissue associated with an intensive biofilm control, Objective: The treatment for the condition is determined based on the cause . However, there is no direct relationship and these factors do not fully explain the incidence or the characteristics of the lesion. Khoori AH, Einollahi B, Ansari G, Moozeh MB. Clinicians should be aware of the risk of gingival enlargement in hypertensive patients taking calcium channel blockers prior to implant placement. Journal of Clinical and Diagnostic Research. FOIA In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. cyclosporine) and calcium channel blockers (e.g. Treatment planning becomes more complex where there is periodontitis plus gingival enlargement that is a cosmetic or functional problem. commonly reported with Nifedipine. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. enlargement due to nifedipine. Periodontol 2000 1999;21:176-96. Areas that are not included in the surgery can be cleaned as usual. Conclusion: Gingival enlargement is one of the side effects associated with the administration of several drugs. and nifedipine and other calcium channel blockers. Surgical periodontal therapy consisted of the flap technique with a 90 degrees gingivectomy incision. Found inside – Page 1142... nifedipine, which has a reported prevalence of gingival enlargement of up ... alternatives; their reported prevalences of inducing gingival enlargement ... Healthy gums are pale pink or pigmented, and wrap tightly around the neck of the teeth. Timely, independent, evidence-based information on new drugs and medical tests, and changes to the PBS and MBS. The dose of cyclosporin may be reduced in the course of medical treatment, and can also be reduced in some cases where patients are on a maintenance dose, with no adverse effects. Found inside – Page 174Felodipine Nicardipine Nifedipine Noninflammatory fibrous gingival overgrowth is beNimodipine lieved to be the result of genetic predisposition or an ... To reveal interventions for chronic cyclosporine A nephrotoxicity (CCN) and provide new targets for further studies, we analyzed all relevant studies about interventions in renal cell apoptosis. Background: . A collective review of current concepts. Found inside... the antihypertensive drug nifedipine may cause gingival hyperplasia and delayed eruption of teeth Consider tacrolimus as an alternative to cyclosporine ... Immunosuppressive drugs may induce an increase of the gingival connective tissue in the extracellular matrix. Currently, more than 20 drugs are associated with gingival enlargement. Drug-induced gingival enlargement is rarely seen in edentulous patients. Gingival hyperplasia: a side effect of nifedipine and diltiazem. Surgical treatment ; external bevel gingivectomy and the alternative option is by internal gingivectomy. Periodontitis can be treated using conventional clinical care, but the gingival enlargement may require changes to the medication regimen, periodontal surgery to remove excess tissue, or a combination of the two. In the oral cavity, gingival bleeding is the common complaint. Drugs having side effect of gingival enlargement can be broadly divided into three categories: anticonvulsants, calcium channel blockers and immunosuppressants. Generally, a higher dose and poorer plaque control - or more plaque retentive sites - are more likely to be associated with gingival enlargement. The book presents actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in periodontics. doi: 10.14219/jada.archive.1987.0050. For patients who are taking nifedipine, which has a reported prevalence of gingival enlargement of up to 44%, other calcium channel blockers such as diltiazem or verapamil may be viable alternatives; their reported prevalences of inducing gingival enlargement are 20% and 4%, respectively. Some of the variation in incidence of gingival enlargement can be attributed to differences between study populations and methods of classifying its severity. Gingival enlargement is usually caused by local conditions such as poor oral hygiene, food impaction, or mouth breathing. -. A closely Found inside – Page 67Gingival overgrowth can precede eruption or occur in childhood. ... Calcium channel blockers: • nifedipine; • diltiazem; • amlodipine. Plaque index (PI), papilla bleeding index (PBI) and DGO scores in the treated segments were recorded at each recall appointment. The medications that Americans take daily, both over the counter and prescription, have a major impact on dental health. Epub 2019 Jun 1. Drug-induced gingival hyperplasia: phenytoin, cyclosporine, and nifedipine. At five months postoperative, the gingival enlargements relapsed and diode laser-assisted surgery was repeated. Found inside – Page 262Among the most frequently prescribed drugs in 1995 , nifedipine was ranked seventh ... The CCB - induced gingival hyperplasia can develop within 1 month ... Since 1984 these drugs have been reported to be associated with gingival enlargement. Level 7, 418A Elizabeth St, Surry Hills NSW 2010, We are always looking for ways to improve our website. Large number of drugs and genetic disorders are associated with occurance of gingival over growth in susceptible individuals. Nifedipine are most frequently implicated in gingival enlargement with a prevalence ranging between 14.7% and 83% [1]. Found insideThe new second edition of the Handbook of Psoriasis remains an easy-to-read but detailed text on a common skin disease which affects 2% of the world's population. Key words: Diltiazem, drug induced, gingival enlargement, nifedipine induced Accepted June 02 2009 Introduction Gingival enlargement is a clinical condition which has been widely studied and is directly associated with specific local or systemic conditions. It is a common feature of gingival disease. gingival overgrowth is high, thus, there is a great need for prolonged care of patients following treatment and prosthetic restoration. Editor-In-Chief: C. Michael Gibson, M.S., M.D. Drug-induced gingival enlargement consists of soft tissue growth that begins between the teeth and increases in all directions. It is a common feature of gingival disease . As the tissue enlarges it develops a characteristically thickened and lobulated appearance. The patient had a history of Journal of Clinical and Diagnostic Research, Management of medication-induced gingival hyperplasia: a systematic review, Post-Transplant Gingival Hyperplasia: A Brief Review, Association between Prediabetes and Periodontitis- A Case control Study, Medication‐related fibrovascular hyperplasia lesion in tongue: Case report, Gingival Overgrowth as a complication of kidney transplantation – Nepali perspective. Ongoing education for Aboriginal and Torres Strait Islander health workers and practitioners on quality use of medicines and medical tests, Practical information, tools and resources for health professionals and staff to help improve the quality of health care and safety for patients. Gingival enlargement associated with Nifedipine was first reported in 1980's and is very rarely reported to be associated with Amlodipine and Felodipine. Found insideThis book is an ideal reference guide for clinicians seeking to improve their decision making and treatment outcomes when placing dental implants in medically compromised patients, in whom conditions for osseointegration and soft tissue ... The correct diagnosis is important, so the adequate treatment and follow‐up are instituted even considering the immunosuppression protocol. Application of topical anti-fungal agents. Amlodipine, like nifedipine, can be detected in gingival crevicular fluid, and gingival sequestration of amlodipine associated with gingival hyperplasia has also been reported. Assistant Professor, Department of Periodontology, 2. An alternative to phenytoin includes carbamazepine and valproic acid, which have shown a lower impact in gingival enlargement. This case illustrates that gingival enlargement can occur around dental implants, most notably in rehabilitation cases in patients who have had head and neck cancer. Individuals that were smokers, using alcohol, ketoacidosis, acute infection, and history of inflammatory or rheumatic diseases were excluded. The frequency of periodontitis was higher in Prediabetic cases (n=24, 80%) than controls (n=8, 20%) and these results were very highly statistically significant (P<0.001). Furthermore, HI at baseline and after 1 year was investigated by multiple linear regression. The mechanism through which these medications trigger a connective tissue response are still poorly understood. The cyclosporin A/chlorhexidine group exhibited statistically significantly lower gingival overgrowth than the cyclosporin A group.
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