Successful management of phenytoin and phenobarbitone induced gingival enlargement: A multimodal approach

Priyadharshini, V; Belure, Vinita V; Triveni, MG; Kumar, Ashish; Mehta, Dhoom Singh

doi:10.4103/0976-237x.132365

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…[84] Cases of gingival enlargement after combination drug therapy have also been reported; a combination of cyclosporine and CCBs (11/119);[354685868788] phenytoin and phenobarbital (4/119);[54899091] and a combination of phenytoin, cyclosporine, and CCBs (1/119). [92]…”

Section: Resultsmentioning

confidence: 99%

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Samudrala

Chava

Chandana

et al. 2016

J Indian Soc Periodontol

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Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.

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Section: Resultsmentioning

confidence: 99%

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Samudrala

Chava

Chandana

et al. 2016

J Indian Soc Periodontol

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“…Gingival enlargement is associated with multiple factors, including inflammatory (acute and chronic), idiopathic, drug-induced, neoplasia (benign and malignant tumors), hormonal disturbances, ascorbic acid (vitamin C) deficiency, and with dental eruption. 3 Priyadharshini et al 12 reviewed the etiology, pathogenesis of AEDs associated with gingival overgrowth, in addition to its multidisciplinary management and prevention.…”

Section: Discussionmentioning

confidence: 99%

Phenytoin and gingival mucosa: A molecular investigation

Candotto

Pezzetti

Baj

et al. 2019

Int J Immunopathol Pharmacol

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Several distinct classes of drugs, such as anticonvulsants, immunosuppressants, and calcium channel blockers, caused gingival overgrowth. One of the main drugs associated with the gingival overgrowth is the anti-epileptic such as phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. In our study, we evaluate the effect of phenytoin, a drug whose active substance is phenytoin, on gingival fibroblasts of healthy volunteers. Gene expression of 29 genes was investigated in gingival fibroblasts’ cell culture treated with phenytoin compared with untreated cells. Among the studied genes, only 13 genes (CXCL5, CXCL10, CCR1, CCR3, CCR5, CCR6, IL-1A, IL-1B, IL-5, IL-7, IL-6R, BMP-2, and TNFSF-10) were statistically significant. All but one gene resulted downregulated after 24 h of treatment with phenytoin. BPM2 was the only, although weakly, up-expressed gene. Probably, we have not highlighted overexpression of the other inflammatory molecules because the study was performed on healthy people. Many studies show that phenytoin induces the overexpression of these cytokines but, probably, in our study, the drug does not have the same effect because we used gingival fibroblasts of healthy people.

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“…Thirtysix patients making use of PHE for at least 6 months without dosage alteration were selected. Out of these, 13 patients also made use of another medication such as CBZ (9), PB (3) and PMD (1). The age average of the patients was approximately 39.5 years for those taking only PHE and 38.8 for those associating It was observed that 35% of patients taking PHE developed GH grade 1, while only 10% of patients using CBZ showed GH grade 1.…”

Section: Majola Et Al (2000)mentioning

confidence: 99%

“…G ingival hyperplasia (GH) is a common condition to patients who take three different drug classes, anticonvulsants (phenytoin, phenobarbital, vigabatrin), immunosuppressors (cyclosporine A) and calcium channel blockers (nifedipine, amlodipine, diltiazem, verapamil) [1][2][3][4][5]. The pathogenesis of this condition is multifactorial, involving a number of factors, including the quality of plaque control, gingival inflammation, age, sex, duration of therapy, drug concentration, concomitant use of certain medications and genetic factors [4].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Gingival Hyperplasia Induced by Anticonvulsants: A Systematic Review

Cláudio

Rodrigues

Garcia³

et al. 2020

BDS

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Objective: Gingival hyperplasia (GH) is one of the side effects of anticonvulsant drugs. The aim of this study was to verify the prevalence of GH associated with the use of anticonvulsant, through a systematic review. Material and Methods: Systematic search was done at databases Pubmed and Embase between January 1984 and March of 2020 for identification of articles addressing the prevalence of GH associated with the use of anticonvulsant drugs. The methodological index for non-randomized studies (MINORS) was independently assessed for quality in the selected papers. Results: The search identified 4.471 references. Nine articles were selected and evaluated 632 participants. All of the studies included in the systematic review showed a low risk of bias. The anticonvulsants used by patients were carbamazepine, ethosuximide, phenytoin, primidone, phenobarbital, sodium valproate. The studies showed a correlation between different types of anticonvulsants and GH prevalence, with a range from 0% to 73%. Among the anticonvulsants used, phenytoin showed the greatest incidence of GH, varying between 15.61% and 73% in patients. Conclusion: In the analysis of the results obtained in the literature, it is possible to notice that the great majority of studies presented incidence of GH associated with anticonvulsant use. However, further studies are necessary to understand the anticonvulsant action mechanism inducing GH, as well as the prevention forms, given that GH is a significant side effect. KEYWORDS Anticonvulsants; Gingival hyperplasia; Prevalence.

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Successful management of phenytoin and phenobarbitone induced gingival enlargement: A multimodal approach

Cited by 6 publications

References 14 publications

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Phenytoin and gingival mucosa: A molecular investigation

Prevalence of Gingival Hyperplasia Induced by Anticonvulsants: A Systematic Review

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