Despite the popularity and wide acceptance of the calcium channel blockers (CCBs) by the medical community, their oral impact is rarely recognized or discussed. CCBs, as a group, have been frequently implicated as an etiologic factor for a common oral condition seen among patients seeking dental care: drug-induced gingival enlargement or overgrowth. This enlargement can be localized or generalized, and can range from mild to extremely severe, affecting patient's appearance and function. Treatment options for these patients include cessation of the offending drug and substitution with another class of antihypertensive medication to prevent recurrence of the lesions. In addition, depending on the severity of the gingival overgrowth, nonsurgical and surgical periodontal therapy may be required. The overall objective of this article is to review the etiology and known risk factors of these lesions, their clinical manifestations and periodontal management.
The importance of vitamin D in maintaining skeletal health via the regulation of calcium has long been recognized as a critical function of this secosteroid. An abundance of literature shows an association between oral bone mineral density and some measure of systemic osteoporosis and suggests that osteoporosis/low bone mass may be a risk factor for periodontal disease. Recently, nonskeletal functions of vitamin D have gained notoriety for several reasons. Many cells that are not associated with calcium homeostasis have been demonstrated to possess membrane receptors for vitamin D. These include activated T and B lymphocytes, and skin, placenta, pancreas, prostate and colon cancer cells. In addition, vitamin D "insufficiency" is a worldwide epidemic and epidemiologic evidence has linked this condition to multiple chronic health problems, including cardiovascular and autoimmune diseases, hypertension and a variety of cancers. Interestingly, there is mounting evidence connecting diminished serum levels of vitamin D with increased gingival inflammation and supporting the concept of "continual vitamin D sufficiency" in maintaining periodontal health. The ability of vitamin D to regulate both the innate and the adaptive components of the host response may play an important role in this process. This review will examine the skeletal and nonskeletal functions of vitamin D, and explore its potential role in protecting the periodontium as well as in regulating periodontal wound healing.
Reduction of the activation of NF-κB and AP-1 alone is not able to inhibit strongly the IL-1β stimulated IL-6 and IL-8 gene expression. 1,25D3 but not 20D3 may affect some of the many other factors/processes/pathways that in turn regulate the expression of these genes. However, the results suggest that topical application of ligands of the vitamin D receptor may be useful in the local treatment of periodontitis while reducing adverse systemic effects.
Introduction The presence of keratinized mucosa (KM) around natural teeth is believed to be beneficial in certain restorative, prosthetic, and orthodontic situations. Lack of adequate KM is common and predictably treated by autogenous gingival grafts (AGGs); however, AGGs have the disadvantages of harvest site morbidity, limited donor site availability, and compromised esthetics. Case Presentation This case series presents the use of the xenogeneic porcine bilayer collagen matrix (BCM) in increasing the width of attached KM around natural teeth. Patients with a limited amount of KM, shallow vestibule, and aberrant frenum attachment were treated using this graft material. The patients were followed up to 4.5 years postoperatively and were evaluated regarding the amount of KM, gingival margin stability, and tissue esthetics. Conclusions Within the limitations of the sample size of patients in this report, the BCM appears to be a viable alternative option to AGG for increasing the width of KM gingiva around teeth. This method resulted in gain of KM, gingival margin stability, vestibular deepening, aberrant frenum elimination, and favorable esthetics in terms of color matching, texture, and contour blending. This xenogeneic graft material could be used in cases where the autogenous graft supply is limited or in highly esthetically demanding cases. Additionally, it could be an alternative option when a second surgical site is not desired by the patient or a less invasive procedure is preferred by the clinician in certain medical conditions. Well‐controlled long‐term studies are required to validate our limited clinical observations.
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