RESUMEN
Cardiovascular diseases including hypertension affect 40% of the adult population in Hungary. Calcium channel blockers are frequently prescribed for the treatment of hypertension either in monotherapy or in fixed-combination therapy. Their main effect is vasodilatation with gingival hyperplasia as a side effect. Our aim is to draw our colleagues' attention to the practical importance of the fact that calcium channel blocker-induced gingival hyperplasia correlates closely with the dental status and the quantity of plaque on the surface of teeth and dental implants. Once established, gingival hyperplasia makes it more difficult for the patient to maintain individual tooth cleaning and increases plaque formation. Thus proliferation of Gram-negative bacteria is enabled in the plaque which promotes gingival overgrowth and can pose a risk factor for further cardiovascular diseases. If proper individual oral hygiene and professional interventions are carried out, healthy and hyperplasia-free gingival state can be sustained in the long term in most cases, even with calcium channel blocker therapy. In order to protect patients' oral health, a closer cooperation of internists and dentists would be desirable. Orv Hetil. 2018; 159(29): 1183-1187.
Asunto(s)
Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Hiperplasia Gingival/inducido químicamente , Hiperplasia Gingival/prevención & control , Salud Bucal , Antihipertensivos/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Encía/efectos de los fármacos , Bolsa Gingival/inducido químicamente , Bolsa Gingival/prevención & control , Humanos , Hungría , Higiene Bucal , Inducción de RemisiónRESUMEN
BACKGROUND: Angiotensin-converting enzyme (ACE) downregulates the activity of bradykinin, a potent proinflammatory and immunostimulatory peptide liberated from an internal portion of kininogens. Here, we asked whether periodontitis is worsened in patients under antihypertensive treatment with ACE inhibitors. METHODS: Periodontal parameters were recorded from 30 individuals taking ACE inhibitors (case) and 35 taking a non-ACE inhibitor medication (control). Data were analyzed by nonparametric and parametric statistical tests. RESULTS: Most sociodemographic figures were similar in both groups. However, family income was statistically higher in the control group, and the percentage of sites with visible plaque (PL) was statistically higher in the case group (P = 0.043 and P = 0.005, respectively). The prevalence of individuals with chronic periodontitis varied from 31.5% in the control group to 63.4% in the case group (P = 0.001). Patients in the case group presented a 3.2-fold higher risk of having sites with pocket depth ≥5 mm and a 2.9-fold higher risk of having sites with clinical attachment loss ≥5 mm in comparison with those in the control group (P = 0.009 and P = 0.001, respectively; adjusted for family income and visible PL). CONCLUSION: Angiotensin-converting enzyme inhibitors may increase the prevalence and extent of chronic periodontitis in Brazilian patients.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Periodontitis Crónica/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Estudios de Casos y Controles , Periodontitis Crónica/patología , Femenino , Bolsa Gingival/inducido químicamente , Bolsa Gingival/patología , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
The ultimate goal of research was to make a comparative evaluation of efficiency of periodontitis treatment with alpha-lipoic acid in the short-term and long-term period in people which are under the influence of heavy metal salts of low intensity. 50 patients residing on the territory under the influence of heavy metal salts of low intensity, were under observation and they were given medical treatment to evaluate the efficiency of periodontitis treatment with the help of alpha-lipoic acid in short-term and long-term period. The patients were undergone clinical evaluation of periodontal status according to general indexes and data of laboratory examinations prior to treatment, in 14 days and in 12 months. After intaking of 600 mg of alpha-lipoic acid per day during 14 days the condition of periodontitis tissues in the reference group and in the basic group has no statistically significant differences. The basic group took alpha-lipoic acid during 2 months, that favored improving of clinical and laboratory indexes. In comparison with the reference group in the basic group PMA index decreased in 2.3 times, IIS in 1.4 times, BPI in 1.8 times, complex parodontal index improved in 1.3 times, leucocytes emigration decreased in 1.2 times and microbial contamination of epithelium in 1.22 times. Efficiency of anti-inflammatory therapy was 1.4 times higher. Depth of gingival pockets and level of oral hygiene had no statistical significant differences.
Asunto(s)
Bolsa Gingival/inducido químicamente , Bolsa Gingival/patología , Periodontitis/patología , Ácido Tióctico/administración & dosificación , Antibacterianos/administración & dosificación , Bolsa Gingival/tratamiento farmacológico , Humanos , Metales Pesados/toxicidad , Higiene Bucal , Periodontitis/inducido químicamente , Periodontitis/tratamiento farmacológico , Sales (Química)/toxicidadRESUMEN
A case history of a woman with gingival overgrowth (GO) induced by amlodipine is presented. A 49-year-old Japanese woman, who was taking amlodipine, had gingival overgrowth and swelling on examination. No specific periodontal treatment was provided to the patient for the GO; however, the amlodipine was replaced with an ACE inhibitor after consultation with her medical practitioner. Within two months, the suspension of amlodipine resulted in a significant improvement in her periodontal condition. Failure to control the hypertension caused the physician to re-prescribe amlodipine. After three months, the gingival overgrowth returned; however, its severity was less when compared with the original periodontal condition, due to reduction in drug dose and periodontal therapy. This experience suggests that temporary suspension of a drug which can induce GO can improve the periodontal condition without the aid of surgical treatment.
Asunto(s)
Amlodipino/efectos adversos , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Sobrecrecimiento Gingival/inducido químicamente , Antagonistas Adrenérgicos beta/uso terapéutico , Amlodipino/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/administración & dosificación , Femenino , Hemorragia Gingival/inducido químicamente , Hemorragia Gingival/prevención & control , Sobrecrecimiento Gingival/prevención & control , Bolsa Gingival/inducido químicamente , Bolsa Gingival/prevención & control , Humanos , Persona de Mediana Edad , RecurrenciaRESUMEN
Patients with nifedipine-induced gingival hyperplasia (GH) often require continued calcium channel blocker therapy. Switches to diltiazem and verapamil have been described; however, these drugs are of a different chemical class and present therapeutic limitations in some patients. The purpose of this study was to evaluate the effect on nifedipine-induced GH of a switch to a dihydropyridine derivative with a low incidence of GH. Fourteen patients with nifedipine-induced GH were given a medical exam and a periodontal exam. The following parameters were assessed: probing depth (PD), gingival margin (GM), gingival thickness (GT), plaque index (PI), and gingival index (GI). Intraoral photographs, study models, and a gingival biopsy for histological examination were taken. Following baseline measures, patients were randomized to continued treatment with nifedipine or an equivalent dose of isradipine in a single-blind fashion. Biweekly periodontal parameters were taken for 8 weeks. At the end of 8 weeks, some patients elected to receive 4 weeks of open label isradipine therapy, with biweekly examination continuing through the open label phase. The isradipine treatment arm showed a mean decrease in PD of 0.59 mm at week 8 (P < 0.05). No other measured parameter (GM, GT, PI, GI) was significantly changed, compared either to baseline or to the alternate treatment arm. Clinically, 60% of patients treated with isradipine exhibited a decrease in hyperplasia, while 66% of patients treated with nifedipine demonstrated an increase in hyperplasia, a significant difference (P < 0.05). When combined with open label data, patients switching therapy to isradipine exhibited an increase in GM (increase in recession) of 0.74 mm from baseline to week 12 (P < 0.05). No patients treated with isradipine exhibited an increase in gingival overgrowth. All patients exhibited adequate control of hypertension. We conclude that in hypertensive patients with nifedipine-induced GH, switching hypertensive therapy to isradipine may result in a regression of GH. When coupled with aggressive oral hygiene treatment, this drug may provide a reasonable option for patients requiring dihydropyridine treatment.
Asunto(s)
Bloqueadores de los Canales de Calcio/efectos adversos , Hiperplasia Gingival/inducido químicamente , Isradipino/uso terapéutico , Nifedipino/efectos adversos , Adulto , Anciano , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Biopsia , Bloqueadores de los Canales de Calcio/uso terapéutico , Índice de Placa Dental , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Encía/efectos de los fármacos , Encía/patología , Hiperplasia Gingival/patología , Hiperplasia Gingival/prevención & control , Bolsa Gingival/inducido químicamente , Bolsa Gingival/patología , Recesión Gingival/inducido químicamente , Humanos , Hipertensión/prevención & control , Incidencia , Masculino , Persona de Mediana Edad , Modelos Dentales , Higiene Bucal , Índice Periodontal , Fotograbar , Inducción de Remisión , Método Simple CiegoRESUMEN
Treatment with either cyclosporin A or nifedipine may induce gingival hyperplasia. A case report is presented which describes a patient medicated simultaneously with both drugs and who subsequently developed extreme hyperplasia. Could such a severe gingival pathology have resulted from an additive interaction between the two drugs?
Asunto(s)
Bloqueadores de los Canales de Calcio/efectos adversos , Ciclosporina/efectos adversos , Hiperplasia Gingival/inducido químicamente , Inmunosupresores/efectos adversos , Nifedipino/efectos adversos , Sinergismo Farmacológico , Femenino , Hiperplasia Gingival/cirugía , Bolsa Gingival/inducido químicamente , Bolsa Gingival/cirugía , Gingivectomía , Humanos , Persona de Mediana EdadRESUMEN
The incidence of gingival overgrowth secondary to the administration of cyclosporine A (CsA) is widely reported in renal transplant recipients, while there is no information about periodontal conditions in heart transplant patients. In the present cross-sectional investigation the relationship between clinical periodontal conditions and pharmacological profiles of CsA was determined in 39 patients (31 male and 8 female, aged 18-63 years, mean 45.6 +/- 15.2 years) who possessed their 6 upper and 6 lower anterior teeth. All patients had been on a CsA-based immunosoppression regimen for at least 6 months (6-101, mean 39.3 +/- 30.1). 2 periodontal parameters (recorded on the 12 anterior teeth only) relating to gingival overgrowth were considered: hyperplastic index and % of sites with probing depth > 3 mm. These parameters were always recorded by the same observer at first appointment and 2 months after an oral hygiene programme. Both non parametric statistical analysis (Kruskal-Wallis one-way analysis by rank, Wicoxon signed rank-test and Mann Whitney U-test) and parametric analysis (stepwise multiple regression analysis, one-sample and two-sample t-test) were used to investigate the relationship between the periodontal parameters (dependent variables) and a series of independent variables: age, sex, plaque index (PI), gingival index (GI), CsA dose, CsA blood level, duration of therapy (months since allograft). Results failed to demonstrate any significant correlation between gingival overgrowth and age, sex, CsA dose or CsA blood level, PI. A positive significant correlation was found between periodontal conditions and GI and a significant inverse correlation between periodontal conditions and duration of therapy, suggesting that the relation between CsA therapy and gingival overgrowth in heart-transplant patients could be time-related and the negative influence of the drug on the periodontal status could spontaneously decrease over time.
Asunto(s)
Ciclosporina/efectos adversos , Sobrecrecimiento Gingival/inducido químicamente , Trasplante de Corazón , Inmunosupresores/efectos adversos , Adolescente , Adulto , Factores de Edad , Análisis de Varianza , Estudios Transversales , Ciclosporina/sangre , Índice de Placa Dental , Femenino , Estudios de Seguimiento , Hiperplasia Gingival/inducido químicamente , Hiperplasia Gingival/patología , Sobrecrecimiento Gingival/patología , Bolsa Gingival/inducido químicamente , Bolsa Gingival/patología , Humanos , Inmunosupresores/sangre , Incidencia , Masculino , Persona de Mediana Edad , Higiene Bucal , Índice Periodontal , Análisis de Regresión , Factores Sexuales , Factores de TiempoRESUMEN
The clinical and histological aspects of gingival hypertrophy due to cyclosporine-A in 10 heart-transplanted patients are studied. The behaviour to avoid or to limit gingival overgrowth is suggested.
Asunto(s)
Ciclosporinas/efectos adversos , Hipertrofia Gingival/inducido químicamente , Trasplante de Corazón , Adulto , Encía/efectos de los fármacos , Encía/patología , Hipertrofia Gingival/patología , Bolsa Gingival/inducido químicamente , Bolsa Gingival/patología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Amalgama Dental/normas , Filtración Dental/etiología , Restauración Dental Permanente/normas , Enfermedades Periodontales/inducido químicamente , Adulto , Amalgama Dental/efectos adversos , Restauración Dental Permanente/efectos adversos , Femenino , Bolsa Gingival/inducido químicamente , Humanos , Hungría , Masculino , Persona de Mediana Edad , Control de CalidadRESUMEN
Two days after polysulphide rubber impressions had been taken of gold inlay cavities in 6 and 7, a 22-year-old female dental student developed a painful swelling between 5 and 6. A radiograph revealed the presence of an irregular radiopaque body within the cancellous bone of the interdental septum between 5 and 6. At operation, 1 month later, the interdental septum was seen to have been destroyed and its position occupied by impression material and inflammatory tissue. When the lesion was reopened 2 years later to correct slight recurrent pocketing, significant regeneration of bone was found to have occurred.