Phenytoin Induced Hyperplasia Found in Edentulous Patients

Bredfeldt, Glenn W.

doi:10.14219/jada.archive.1992.0190

Cited by 13 publications

(11 citation statements)

References 10 publications

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“…These include hyperplasia induced by phenytoin medication 7,8 and one case of allergy to titanium abutments. 9 A few articles on peripheral giant cell granuloma associated with dental implants have also been published.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of a Pyogenic Granuloma in Relation to a Dental Implant

Dojcinovic¹,

Richter²,

Lombardi³

2010

Journal of Oral and Maxillofacial Surgery

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Pyogenic granuloma is an inflammatory vascular hyperplasia often occurring in the oral cavity. It appears in response to various stimuli such as low-grade local irritation, trauma, or female steroid hormones. A 32-year-old man sought care for a tender and bleeding lesion of the left posterior maxillary gingiva. The intraoral examination showed an exophytic ulcerated nodule measuring 1.0 cm, related to a dental implant placed in the upper left second premolar position. Radiographic examination showed an oversized healing cap. A provisional diagnosis of reactive inflammatory hyperplasia was made, and the lesion was excised and submitted for histologic examination. On microscopy, the surgical specimen showed an ulcerated nodule consisting of a delicate connective tissue stroma containing numerous blood vessels with plump endothelial cells, intermingled with abundant polymorphonuclear lymphocytes. A diagnosis of pyogenic granuloma associated with a dental implant was made. In this case it was the result of an inappropriate choice of a healing cap, thus allowing an accumulation of dental plaque and sustained chronic inflammation of the peri-implant tissue. A conservative excision and replacement of the healing cap were sufficient for definitive treatment.

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Section: Discussionmentioning

confidence: 99%

Occurrence of a Pyogenic Granuloma in Relation to a Dental Implant

Dojcinovic¹,

Richter²,

Lombardi³

2010

Journal of Oral and Maxillofacial Surgery

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“…They hypothesised that gingival hyperplasia in edentulous spaces within dentulous arch may occur after removal of the teeth in a segment of the arch or it may not resolve following tooth extraction. Another possible hypothesis for this observation of gingival overgrowth in edentulous ridge in our case could be the incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa 11 .…”

Section: Discussionmentioning

confidence: 63%

“…For the phenytoin‐influenced gingival overgrowth seen in edentulous ridges covered by complete dentures 7–11 , various aetiological reasons have been put forth like candidal infection 10 , bacterial plaque accumulation 11 and incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa 11 .…”

Section: Discussionmentioning

confidence: 99%

“…The edentulous spaces in the present case were never exposed to the denture wear thus, precluding any involvement of the denture-induced hyperplasia of the alveolar ridges which has been reported quite commonly in denture wearers on phenytoin intake [7][8][9][10][11] . Even after surgical excision of gingival overgrowth and full mouth extraction, gingival overgrowth was still present in the edentulous arches especially in the upper arch, which could be termed as a remnant of gingival overgrowth after tooth extraction.…”

Section: Have Hypothes-mentioning

confidence: 98%

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Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report

Dhingra¹,

Prakash

2012

Gerodontology

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Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report Background: Drug-influenced gingival overgrowth is an unaesthetic overgrowth of gingiva principally associated with intake of drugs like phenytoin, cyclosporin A and nifedipine. Its occurrence in both dentate and edentulous regions of oral cavity is poorly understood. Objectives: This report highlights clinical and histological description, aetiology and management of gingival overgrowth in a partially edentulous (non-denture wearer) 60-year-old female patient with epilepsy on phenytoin and phenobarbital drugs from past 7 years. Materials and methods: Patient's intraoral examination revealed lobulated and fibrotic consistency gingival overgrowth around teeth and on partially edentulous ridges of upper and lower arches along with generalised tooth mobility. Under medical consultation, full mouth extraction, surgical excision of overgrowth followed by complete denture rehabilitation and replacement of combination drugs with sodium valproate were accomplished. Results: Histologically, the lesion showed fibro-epithelial hyperplasia. Clinical results after 6 months demonstrated almost complete resolution of gingival overgrowth. Conclusion:The findings of present case suggest that gingival overgrowth can occur even in partially edentulous ridges (not exposed to denture wear) that could be due to persistence of gingival overgrowth, which may not resolve completely following tooth extraction or occurs because of incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa.

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“…24 Similarly, gingival enlargement has been reported in edentulous patients. [25][26][27][28][29][30] This observation does not rule out a role for mucosal inflammation in this process because in these cases there appeared to be an association of the hyperplasia with denture trauma or fungal infection. These conditions may have enhanced the adverse drug effect.…”

mentioning

confidence: 99%

Metabolism of phenytoin by the gingiva of normal humans: The possible role of reactive metabolities of phenytoin in the initiation of gingival hyperplasia*

Zhou¹,

Pihlstrom²,

Hardwick³

et al. 1996

Clin Pharmacol Ther

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Gingival hyperplasia is a well-known complication of therapy with cyclosporine, calcium channel blockers, and phenytoin. It is characterized by the presence of inflammation and a marked fibrotic response. The mechanism of this adverse reaction is unknown. We propose that it may be initiated by the metabolic activation of these drugs to form reactive metabolites. These then cause cellular injury and lead to the gingival hyperplasia. To evaluate this hypothesis we examined phenytoin metabolism and the cytochrome P450 contents of gingival tissues from 10 patients undergoing surgery for various periodontal conditions. We found that microsomes obtained from the gingiva show significant phenytoin hydroxylase activity as determined by the production of 5-(4'-hydroxyphenyl)-5-phenylhydantoin (HPPH) (range, 12.8 pmol HPPH/min.mg microsomal protein to 276.9 pmol HPPH/min.mg microsomal protein; rat control, 133.7 +/- 11.5 pmol HPPH/min.mg microsomal protein). We also found that CYP1A1, CYP1A2, CYP2C9, CYP2E1, and CYP3A4 were present in these microsomes. We detected no CYP2B6 or CYP2D6. We believe that these data support our hypothesis that the proliferative inflammation observed with drugs such as phenytoin, nifedipine, and cyclosporine may be initiated by the formation of reactive metabolites and that the formation of these metabolites may be catalyzed by one or more CYPs found in the gingiva. These metabolites may then cause cellular injury and induce a reactive inflammatory response, followed by fibroblastic proliferation. This proliferation leads to the excess collagen deposition observed with gingival hyperplasia.

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Phenytoin Induced Hyperplasia Found in Edentulous Patients

Cited by 13 publications

References 10 publications

Occurrence of a Pyogenic Granuloma in Relation to a Dental Implant

Occurrence of a Pyogenic Granuloma in Relation to a Dental Implant

Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report

Metabolism of phenytoin by the gingiva of normal humans: The possible role of reactive metabolities of phenytoin in the initiation of gingival hyperplasia*

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