RESUMO
BACKGROUND: Children and adolescents undergoing kidney transplantation may present oral conditions after the procedure, but a few studies have recently described them. AIM: To describe the oral conditions of post-renal transplant children and adolescents. DESIGN: Two calibrated dentists examined all the participants by assessing caries experience, enamel defects, periodontal condition and soft tissue lesions. RESULTS: A total of 120 participants were included in the study, in which 63 (52.5%) were male and 57 (47.5%) were female, with a mean age of 12.78 ± 3.9 years. Among the participants, 104 (86.7%) showed at least one oral change directly related to kidney disease. The most frequent oral findings were enamel defect (49/120; 40.8%) and drug-induced gingival overgrowth (DIGO) (20/120; 16.7%). Gingival bleeding was observed on probing in 115 (95.8%) participants, whereas 69 (57.5%) presented dental calculus and 51 (42.5%) had caries experience. CONCLUSION: Gingival bleeding, enamel defects and DIGO were the most frequent oral findings in kidney transplant children and adolescents. The use of amlodipine and anticonvulsants was associated with DIGO, and there was a positive correlation between oral ulcers and use of everolimus.
Assuntos
Cárie Dentária , Crescimento Excessivo da Gengiva , Transplante de Rim , Doenças Dentárias , Adolescente , Anlodipino/efeitos adversos , Anticonvulsivantes/efeitos adversos , Criança , Everolimo/efeitos adversos , Feminino , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Humanos , Transplante de Rim/efeitos adversos , Masculino , Saúde BucalRESUMO
Abstract Objective: Myofibroblasts have been associated with the development of several pathologic fibrotic conditions. This longitudinal study aims to assess the proliferative and antiapoptotic effects of cyclosporin, nifedipine and phenytoin on gingival connective tissue cells of nonhuman primate, as well as to analyze a possible role of myofibroblasts in gingival overgrowth. Materials and Methods: Gingival samples from the right superior canine area were obtained from 12 male monkeys ( Sapajus spp ) to comprise the control group. After one week, the animals were randomly assigned to three groups, which received daily oral doses of cyclosporin, nifedipine or phenytoin for 120 days. Gingival samples were collected from the left superior canine area of two animals of each group at 52 and 120 days. Histological sections were stained with hematoxylin and eosin, and immunoreacted against α-SMA, Ki- 67 and bcl-2. Results: α-SMA immunoreaction was negative in the control and experimental groups. Similarly, no difference between groups concerning immunostaining against Ki-67 and bcl-2 was observed in connective tissue cells. Conclusion: Based on this methodology, it may be concluded that gingival overgrowths induced by cyclosporin, nifedipine and phenytoin are not associated with neither myofibroblast transdifferentiation, proliferation nor apoptosis of gingival connective cells in monkeys.
Assuntos
Animais , Masculino , Fenitoína/farmacologia , Nifedipino/farmacologia , Ciclosporina/farmacologia , Transdiferenciação Celular/efeitos dos fármacos , Miofibroblastos/efeitos dos fármacos , Gengiva/citologia , Biópsia , Imuno-Histoquímica , Distribuição Aleatória , Estudos Longitudinais , Actinas/análise , Haplorrinos , Apoptose/efeitos dos fármacos , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Antígeno Ki-67/análise , Antígeno Ki-67/efeitos dos fármacos , Genes bcl-2/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Miofibroblastos/citologia , Gengiva/efeitos dos fármacosRESUMO
OBJECTIVE: Myofibroblasts have been associated with the development of several pathologic fibrotic conditions. This longitudinal study aims to assess the proliferative and antiapoptotic effects of cyclosporin, nifedipine and phenytoin on gingival connective tissue cells of nonhuman primate, as well as to analyze a possible role of myofibroblasts in gingival overgrowth. MATERIALS AND METHODS: Gingival samples from the right superior canine area were obtained from 12 male monkeys ( Sapajus spp ) to comprise the control group. After one week, the animals were randomly assigned to three groups, which received daily oral doses of cyclosporin, nifedipine or phenytoin for 120 days. Gingival samples were collected from the left superior canine area of two animals of each group at 52 and 120 days. Histological sections were stained with hematoxylin and eosin, and immunoreacted against α-SMA, Ki- 67 and bcl-2. RESULTS: α-SMA immunoreaction was negative in the control and experimental groups. Similarly, no difference between groups concerning immunostaining against Ki-67 and bcl-2 was observed in connective tissue cells. CONCLUSION: Based on this methodology, it may be concluded that gingival overgrowths induced by cyclosporin, nifedipine and phenytoin are not associated with neither myofibroblast transdifferentiation, proliferation nor apoptosis of gingival connective cells in monkeys.
Assuntos
Transdiferenciação Celular/efeitos dos fármacos , Ciclosporina/farmacologia , Gengiva/citologia , Miofibroblastos/efeitos dos fármacos , Nifedipino/farmacologia , Fenitoína/farmacologia , Actinas/análise , Animais , Apoptose/efeitos dos fármacos , Biópsia , Proliferação de Células/efeitos dos fármacos , Genes bcl-2/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Haplorrinos , Imuno-Histoquímica , Antígeno Ki-67/análise , Antígeno Ki-67/efeitos dos fármacos , Estudos Longitudinais , Masculino , Miofibroblastos/citologia , Distribuição AleatóriaRESUMO
Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10-year-old female patient presented with a 1-month history of an asymptomatic, firm, and pinkish-red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.
Assuntos
Crescimento Excessivo da Gengiva/patologia , Leucemia Mieloide Aguda/diagnóstico , Infiltração Leucêmica/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Criança , Feminino , Crescimento Excessivo da Gengiva/diagnóstico por imagem , Crescimento Excessivo da Gengiva/tratamento farmacológico , Humanos , Leucemia Mieloide Aguda/diagnóstico por imagem , Leucemia Mieloide Aguda/tratamento farmacológico , Infiltração Leucêmica/diagnóstico por imagem , Infiltração Leucêmica/tratamento farmacológico , Radiografia PanorâmicaRESUMO
Focal reactive overgrowths are among the most common oral mucosal lesions. The gingiva is a significant site affected by these lesions, when triggered by chronic inflammation in response to microorganisms in dental plaque. Myofibroblasts are differentiated fibroblasts that actively participate in diseases characterized by tissue fibrosis. The objective of this study was to evaluate the presence of stromal myofibroblasts in the main focal reactive overgrowths of the gingiva: focal fibrous hyperplasia (FFH), peripheral ossifying fibroma (POF), pyogenic granuloma (PG), and peripheral giant cell granuloma (PGCG). A total of 10 FFHs, 10 POFs, 10 PGs, and 10 PGCGs from archival specimens were evaluated. Samples of gingival mucosa were used as negative controls for stromal myofibroblasts. Oral squamous cell carcinoma samples, in which stromal myofibroblasts have been previously detected, were used as positive controls. Myofibroblasts were identified by immunohistochemical detection of alpha smooth muscle actin (α-sma). Myofibroblast immunostaining was qualitatively classified as negative, scanty, or dense. Differences in the presence of myofibroblasts among FFH, POF, PG, and PGCG were analyzed using the Kruskal-Wallis test. Stromal myofibroblasts were not detected in FFH, POF, PG, or PGCG. Consequently, no differences were observed in the presence of myofibroblasts among FFH, POF, PG, or PGCG (p > 0.05). In conclusion, stromal myofibroblasts were not detected in the focal reactive overgrowths of the gingiva that were evaluated, suggesting that these cells do not play a significant role in their pathogenesis.
Assuntos
Humanos , Crescimento Excessivo da Gengiva/patologia , Miofibroblastos/patologia , Carcinoma de Células Escamosas/patologia , Gengiva/patologia , Neoplasias Gengivais/patologia , Imuno-Histoquímica , Inclusão em Parafina , Estatísticas não Paramétricas , Células Estromais/patologiaRESUMO
This paper presents a method for measuring gingival volume through the analysis of the tooth crown area of anterior teeth using digital photographs and computer analysis. Three photographs were taken and manipulated to simulate gingival overgrowth to perform a numeric correlation of change in gingival volume. The proposed method is easy, noninvasive, and provides rich data for statistical analysis or clinical classification of the gingival condition.
Assuntos
Gengiva/anatomia & histologia , Processamento de Imagem Assistida por Computador/métodos , Odontometria/métodos , Fotografia Dentária/métodos , Coroa do Dente/anatomia & histologia , Adulto , Dente Pré-Molar/anatomia & histologia , Calibragem , Dente Canino/anatomia & histologia , Crescimento Excessivo da Gengiva/patologia , Humanos , Incisivo/anatomia & histologia , Masculino , SoftwareRESUMO
Focal reactive overgrowths are among the most common oral mucosal lesions. The gingiva is a significant site affected by these lesions, when triggered by chronic inflammation in response to microorganisms in dental plaque. Myofibroblasts are differentiated fibroblasts that actively participate in diseases characterized by tissue fibrosis. The objective of this study was to evaluate the presence of stromal myofibroblasts in the main focal reactive overgrowths of the gingiva: focal fibrous hyperplasia (FFH), peripheral ossifying fibroma (POF), pyogenic granuloma (PG), and peripheral giant cell granuloma (PGCG). A total of 10 FFHs, 10 POFs, 10 PGs, and 10 PGCGs from archival specimens were evaluated. Samples of gingival mucosa were used as negative controls for stromal myofibroblasts. Oral squamous cell carcinoma samples, in which stromal myofibroblasts have been previously detected, were used as positive controls. Myofibroblasts were identified by immunohistochemical detection of alpha smooth muscle actin (α-sma). Myofibroblast immunostaining was qualitatively classified as negative, scanty, or dense. Differences in the presence of myofibroblasts among FFH, POF, PG, and PGCG were analyzed using the Kruskal-Wallis test. Stromal myofibroblasts were not detected in FFH, POF, PG, or PGCG. Consequently, no differences were observed in the presence of myofibroblasts among FFH, POF, PG, or PGCG (p > 0.05). In conclusion, stromal myofibroblasts were not detected in the focal reactive overgrowths of the gingiva that were evaluated, suggesting that these cells do not play a significant role in their pathogenesis.
Assuntos
Crescimento Excessivo da Gengiva/patologia , Miofibroblastos/patologia , Carcinoma de Células Escamosas/patologia , Gengiva/patologia , Neoplasias Gengivais/patologia , Humanos , Imuno-Histoquímica , Inclusão em Parafina , Estatísticas não Paramétricas , Células Estromais/patologiaRESUMO
Cowden syndrome, also known as multiple hamartoma syndrome, is a rare autosomal dominant disorder characterized by multiple hamartomas and a high risk of development of malignancy. Oral findings, such as papillomatous lesions and fibromas, are common features; however, a periodontal phenotype has not been reported previously. Therefore, this report presents a case of gingival overgrowth associated with Cowden syndrome, its successful surgical management, and the 12-month follow-up results. Additionally, we discuss the implications for clinicians. A 23-year-old woman was referred to the Department of Periodontics, Piracicaba Dental School, presenting with generalized gingival overgrowth. A detailed dental and medical history and clinical examination confirmed the systemic diagnosis of Cowden syndrome. Histology, radiographs, and clinical data document the entire clinical approach and follow-up. Clinically, there were minor signs of recurrence of gingival overgrowth in a 12-month period after gingivectomy; however, papular lesions reappeared in keratinized gingiva immediately after healing. No signs of bone loss related to the systemic condition were observed radiographically. Histologically, a dense connective tissue with a moderate chronic inflammatory infiltrate and epithelial acanthosis, which is characteristic of gingival hyperplasia, were demonstrated. Gingival overgrowth may occur as an oral phenotype related to Cowden syndrome and can be successfully treated by means of external bevel gingivectomy, followed by regular maintenance therapy, contributing to the patient's well-being, both functionally and esthetically.
Assuntos
Crescimento Excessivo da Gengiva/cirurgia , Síndrome do Hamartoma Múltiplo/complicações , Feminino , Seguimentos , Hiperplasia Gengival/patologia , Crescimento Excessivo da Gengiva/etiologia , Crescimento Excessivo da Gengiva/patologia , Gengivectomia , Humanos , Recidiva , Cicatrização , Adulto JovemRESUMO
The chronic usage of nifedipine is associated with the appearance of gingival overgrowth (GO). The frequency of GO associated with chronic nifedipine therapy remains controversial and the possible subclinical effects of this drug on the gingival epithelium should be investigated. We investigated the epithelial proliferation index and apoptosis rate, and their association with epithelial enlargement. Proliferation (Ki67 and Cyclin B1) and apoptosis (BCL2, Bax and p53) markers were identified by immunohistochemistry in twenty-one samples of gingival tissue from patients undergoing chronic treatment with nifedipine and in eleven samples of gingival tissue from healthy patients who did not use drugs associated with GO (control). Our results show that the epithelial tissue of nifedipine users has considerably longer rete pegs compared to control (P = 0.01). However, the density of Ki67(+) and Cyclin B1(+) cells was similar in both groups. Regarding apoptosis, we found more BCL2(+) cells in the nifedipine group when compared to controls (P = 0.12). An increase in Bax(+) cells in the nifedipine group compared to control (P = 0.003) was also seen, and slightly lower levels of p53(+) expression were observed (P = 0.51). Our results suggest that the chronic use of nifedipine is not associated with subclinical changes in gingival tissue.
Assuntos
Bloqueadores dos Canais de Cálcio/efeitos adversos , Células Epiteliais/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Crescimento Excessivo da Gengiva/induzido quimicamente , Nifedipino/efeitos adversos , Adulto , Idoso , Apoptose/efeitos dos fármacos , Estudos de Casos e Controles , Proliferação de Células/efeitos dos fármacos , Ciclina B1/análise , Células Epiteliais/patologia , Feminino , Gengiva/citologia , Crescimento Excessivo da Gengiva/patologia , Humanos , Imuno-Histoquímica , Antígeno Ki-67/análise , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-bcl-2/análise , Estatísticas não Paramétricas , Proteína Supressora de Tumor p53/análise , Proteína X Associada a bcl-2/análiseRESUMO
The aim of this study was to evaluate the influence of diltiazem in combination with a sucrose-rich diet on gingival alterations in rats. One hundred and twenty male Holtzman rats were randomly assigned to 10 groups (n = 12), being 2 control groups treated with saline and 8 test groups treated with diltiazem in daily doses of 5, 25, 50 and 100 mg/kg during 40 or 60 days. Afterwards, the mandibles were removed for macroscopic, histologic and histometric analyses of the buccal gingiva of the mandibular right first molar. No macroscopic characteristic of gingival overgrowth was observed in any of the groups. The microscopic analysis showed characteristics of normality with inflammatory cells only adjacent to the crevicular epithelium in all groups for both periods. The histometric analysis showed significant differences only for the epithelial tissue area in the 40-day period (Kruskal-Wallis; P = 0.032). Comparing the periods, significant differences regarding the connective and epithelial tissue areas were observed only in the group treated with a 25 mg/kg dose (Mann-Whitney; P = 0.004 and P = 0.007, respectively). Oral administration of diltiazem in combination with a sucrose-rich diet did not induce gingival alterations in rats.
Assuntos
Bloqueadores dos Canais de Cálcio/farmacologia , Sacarose Alimentar/efeitos adversos , Diltiazem/farmacologia , Crescimento Excessivo da Gengiva/induzido quimicamente , Animais , Crescimento Excessivo da Gengiva/patologia , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fatores de TempoRESUMO
The aim of this study was to evaluate the influence of diltiazem in combination with a sucrose-rich diet on gingival alterations in rats. One hundred and twenty male Holtzman rats were randomly assigned to 10 groups (n = 12), being 2 control groups treated with saline and 8 test groups treated with diltiazem in daily doses of 5, 25, 50 and 100 mg/kg during 40 or 60 days. Afterwards, the mandibles were removed for macroscopic, histologic and histometric analyses of the buccal gingiva of the mandibular right first molar. No macroscopic characteristic of gingival overgrowth was observed in any of the groups. The microscopic analysis showed characteristics of normality with inflammatory cells only adjacent to the crevicular epithelium in all groups for both periods. The histometric analysis showed significant differences only for the epithelial tissue area in the 40-day period (Kruskal-Wallis; P = 0.032). Comparing the periods, significant differences regarding the connective and epithelial tissue areas were observed only in the group treated with a 25 mg/kg dose (Mann-Whitney; P = 0.004 and P = 0.007, respectively). Oral administration of diltiazem in combination with a sucrose-rich diet did not induce gingival alterations in rats.
Assuntos
Animais , Masculino , Ratos , Bloqueadores dos Canais de Cálcio/farmacologia , Sacarose Alimentar/efeitos adversos , Diltiazem/farmacologia , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Distribuição Aleatória , Ratos Sprague-Dawley , Fatores de TempoRESUMO
BACKGROUND: The purpose of this experimental study was to evaluate the collagen fiber distribution histologically after phenytoin, cyclosporin, or nifedipine therapy and to correlate it with collagen I and matrix metalloproteinase (MMP)-1 and -2 gene expression levels. METHODS: Gingival samples from the canine area were obtained from 12 male monkeys (Cebus apella). The mesial part of each sample was assessed by reverse transcription-polymerase chain reaction, whereas the distal part was processed histologically for picrosirius red and hematoxylin and eosin stainings, as well as for collagen IV immunostaining. One week after the first biopsy, the animals were assigned to three groups that received daily oral dosages of cyclosporin, phenytoin, or nifedipine for 120 days. Additional gingival samples were obtained on days 52 and 120 of treatment from two animals from each group on the opposite sides from the first biopsies. RESULTS: Picrosirius red staining showed a predominance of mature collagen fibers in the control group. Conversely, there was an enlargement of areas occupied by immature collagen fibers in all groups at days 52 and 120, which was not uniform over each section. There was a general trend to lower levels of MMP-1 gene expression on day 52 and increased levels on day 120. Phenytoin led to increased levels of MMP-2 and collagen I gene expression on day 120, whereas the opposite was observed in the nifedipine group. CONCLUSION: Cyclosporin, phenytoin, and nifedipine led to phased and drug-related gene expression patterns, resulting in impaired collagen metabolism, despite the lack of prominent clinical signs.
Assuntos
Anticonvulsivantes/farmacologia , Bloqueadores dos Canais de Cálcio/farmacologia , Colágeno/efeitos dos fármacos , Ciclosporina/farmacologia , Inibidores Enzimáticos/farmacologia , Gengiva/efeitos dos fármacos , Nifedipino/farmacologia , Fenitoína/farmacologia , Animais , Compostos Azo , Biópsia , Cebus , Colágeno/análise , Colágeno Tipo I/análise , Colágeno Tipo I/efeitos dos fármacos , Colágeno Tipo IV/análise , Colágeno Tipo IV/efeitos dos fármacos , Corantes , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Gengiva/enzimologia , Gengiva/patologia , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/enzimologia , Crescimento Excessivo da Gengiva/patologia , Gengivite/induzido quimicamente , Gengivite/enzimologia , Gengivite/patologia , Histocitoquímica , Masculino , Metaloproteinase 1 da Matriz/efeitos dos fármacos , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 2 da Matriz/efeitos dos fármacos , Metaloproteinase 2 da Matriz/genética , Distribuição Aleatória , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: Tacrolimus, an immunosuppressive drug used in organ transplantation, has been reported not to induce gingival overgrowth. However, prevalence studies are limited, and the methods used for assessing gingival overgrowth varies among studies. OBJECTIVE: The purpose of this study was to evaluate the effects of up to 240 days of tacrolimus therapy on gingival tissues of rats. MATERIALS AND METHODS: Rats were treated for 60, 120, 180 and 240 days with daily subcutaneous injections of 1 mg/kg body weight of tacrolimus. After histological processing, the oral and connective tissue, volume densities of fibroblasts (Vf), collagen fibers (Vcf) and other structures (Vo) were assessed in the region of the lower first molar. RESULTS: After 60 and 120 days of treatment with tacrolimus, gingival overgrowth was not observed. The gingival epithelium, connective tissue, as well as the values for Vf, Vcf, and Vo were similar to those of the control rats (P>0.05). After 180 and 240 days of the treatment, gingival overgrowth was associated with a significant increase in the gingival epithelium and connective tissue as well as an increase in the Vf and Vcf (P<0.05). CONCLUSIONS: Within the limits of the experimental study, it may be concluded that the deleterious side effects of tacrolimus on the gingival tissues of rats may be time-related.
Assuntos
Gengiva/efeitos dos fármacos , Imunossupressores/uso terapêutico , Tacrolimo/uso terapêutico , Animais , Contagem de Células , Colágeno/efeitos dos fármacos , Tecido Conjuntivo/efeitos dos fármacos , Tecido Conjuntivo/patologia , Epitélio/efeitos dos fármacos , Epitélio/patologia , Fibroblastos/efeitos dos fármacos , Gengiva/patologia , Hiperplasia Gengival/induzido quimicamente , Hiperplasia Gengival/patologia , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Imunossupressores/administração & dosagem , Injeções Subcutâneas , Masculino , Mucosa Bucal/efeitos dos fármacos , Mucosa Bucal/patologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Tacrolimo/administração & dosagem , Fatores de TempoRESUMO
OBJECTIVE: To evaluate and compare the possible morphological and histopathological changes in gingival tissue of rats under the administration of cyclosporine and tacrolimus. The present study was motivated by the high prevalence of gingival overgrowth observed in subjects under cyclosporine regimens and by studies reporting a significant decrease in gingival overgrowth after the substitution of tacrolimus. METHODS: Five Sprague-Dawley rat groups were administered therapeutic and greater-than-therapeutic doses of cyclosporine and tacrolimus over 54 days. The control group of 10 animals received distilled water as a placebo. The cyclosporine group was divided into two subgroups of 10 animals each, one receiving 10 mg/kg/day (CsA1) and one receiving 30 mg/kg/day (CsA2). The tacrolimus group was also divided in two subgroups of 10 animals each, receiving 3.2 mg/kg/day (Tcr1) or 6.4 mg/kg/day (Tcr2). RESULTS: Gingival overgrowth was higher in the group that was administered the higher cyclosporine dosage (CsA2) than in the group that received the therapeutic dosage, showing a positive relation between dosage and severity of gingival overgrowth. Hypercellularity, vascular congestion and focal inflammatory exudation were observed in the CsA2 subgroup only. There were no morphological or histological alterations in gingival tissue in either tacrolimus subgroups. CONCLUSION: Cyclosporine can induce adverse morphological and histopathological changes in gingival tissue of rats, and these effects are dose-dependent. Tacrolimus induced no gingival alterations in this rat model.
Assuntos
Ciclosporina/administração & dosagem , Imunossupressores/administração & dosagem , Periodonto/efeitos dos fármacos , Tacrolimo/administração & dosagem , Animais , Tamanho Celular/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Exsudatos e Transudatos , Gengiva/efeitos dos fármacos , Gengiva/patologia , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Masculino , Periodonto/patologia , Placebos , Ratos , Ratos Sprague-Dawley , Fatores de TempoRESUMO
A fibromatose gengival herediária (FGH) é uma condição oral rara, benigna e clinicamente apresenta-se como um aumento gengival firme, difuso, de crescimento lento, porém progressivo, podendo causar alterações funcionais, estéticas e psicológicas. Este estudo procurou enfocar as características clínicas, histológicas, genéticas e o tratamento do aumento gengival em um portador da FGH.
Assuntos
Humanos , Feminino , Adolescente , Crescimento Excessivo da Gengiva/patologia , Fibromatose Gengival/genética , Gengivectomia , Gengivoplastia/psicologiaRESUMO
BACKGROUND: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. METHODS: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. RESULTS: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. CONCLUSIONS: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.
Assuntos
Fibroma/cirurgia , Neoplasias Gengivais/cirurgia , Crescimento Excessivo da Gengiva/cirurgia , Granuloma Piogênico/cirurgia , Tumores Odontogênicos/cirurgia , Adolescente , Adulto , Biópsia/efeitos adversos , Feminino , Crescimento Excessivo da Gengiva/patologia , Humanos , ReoperaçãoRESUMO
It has previously been shown that, while cyclosporin A (CsA) and nifedipine both cause gingival overgrowth in the rat, the combined use of these drugs increases the severity of overgrowth. The aim of this study was to describe the histometry and densities of fibroblasts, collagen fibers and vessels in the gingival tissue of rats that were treated with CsA and nifedipine, either alone or in combination. Rats were treated for 60 days with a daily subcutaneous injection of 10 mg/kg body weight of CsA and/or with 50 mg/kg body weight of nifedipine added to the chow. The results confirmed that CsA causes a more severe overgrowth than nifedipine, and that the combined use of these drugs increases the overgrowth severity. All the rat groups that were studied showed that, as the severity of overgrowth increased, there was a parallel increase in fibroblasts and collagen, and a decrease in vessel content. Therefore, independently of whether the gingival overgrowth was caused by CsA alone, nifedipine alone, or both treatments in combination, the fibroblast and collagen density increased in parallel with the severity of the overgrowth.
Assuntos
Bloqueadores dos Canais de Cálcio/toxicidade , Ciclosporina/toxicidade , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Imunossupressores/toxicidade , Nifedipino/toxicidade , Análise de Variância , Animais , Vasos Sanguíneos/efeitos dos fármacos , Sinergismo Farmacológico , Colágenos Fibrilares/efeitos dos fármacos , Fibroblastos/efeitos dos fármacos , Gengiva/irrigação sanguínea , Gengiva/efeitos dos fármacos , Masculino , Ratos , Ratos WistarRESUMO
BACKGROUND: Host immunity plays an important role in the development of human papillomavirus (HPV)-associated disease. The HPV infection in oral cyclosporin-induced gingival overgrowth in renal transplant recipients has not been investigated previously. The aim of this study was to establish the HPV infection of cyclosporin-induced gingival hyperplasia in renal transplant recipients through morphological changes and use of the in situ hybridization technique. METHODS: We examined 13 renal transplant recipient biopsies with gingival overgrowth lesions and 4 healthy mucosa samples of these patients. The histopathological diagnoses were established on the basis of widely accepted criteria, and the pathologist was not aware of the HPV result. An in situ molecular hybridization was carried out under low stringent conditions to detect HPV species with mixed biotin-labeled probes of HPV 6 and HPV 11, and under high stringent conditions with HPV 6, HPV 11, HPV 16, and HPV 18 probes for HPV typing. RESULTS: The HPV prevalence among the 13 samples studied was 92.31% (12/13), of which 4 tested positive for HPV 6-11 and 1 for HPV 16. The 4 biopsies of normal mucosa from gingival overgrowth patients were also reactive for HPV DNA. In 11/12 (91.7%) HPV-positive cases, koilocytotic atypia was found. CONCLUSIONS: The suppression of T-cell function by cyclosporin therapy can result in an increase of HPV infection, adding to the proliferative activity of cyclosporin in the oral mucosa.
Assuntos
Ciclosporina/efeitos adversos , Crescimento Excessivo da Gengiva/induzido quimicamente , Imunossupressores/efeitos adversos , Transplante de Rim , Papillomaviridae , Infecções por Papillomavirus/classificação , Infecções Tumorais por Vírus/classificação , Adolescente , Adulto , Núcleo Celular/ultraestrutura , Corantes , Citoplasma/ultraestrutura , DNA Viral/análise , Feminino , Gengiva/patologia , Gengiva/virologia , Crescimento Excessivo da Gengiva/patologia , Crescimento Excessivo da Gengiva/virologia , Humanos , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mucosa Bucal/virologia , Papillomaviridae/classificação , Papillomaviridae/genética , Transplante Homólogo , Vacúolos/ultraestruturaRESUMO
Cyclosporin A is a selective immunosuppressant, used in organ transplants to prevent graft rejection. Cyclosporin A can cause various side effects including gingival overgrowth. The aim of this work was to evaluate gingival overgrowth of rats treated daily with 10 mg/kg bodyweight of cyclosporin A for 60 days, as well as the regression after the interruption of treatment. All rats treated with cyclosporin A developed gingival overgrowth, with increased thickness of the epithelium, height and width of the connective tissue. The density of fibroblasts and collagen fibers also increased. Five to 90 days after the interruption of treatment with cyclosporin A, there was a progressive reduction of the gingival volume and of collagen fibers and fibroblast densities. The reduction was more pronounced in the initial periods and after 90 days did not return to the normal values.
Assuntos
Ciclosporina/toxicidade , Crescimento Excessivo da Gengiva/induzido quimicamente , Crescimento Excessivo da Gengiva/patologia , Imunossupressores/toxicidade , Animais , Masculino , Ratos , Ratos Wistar , Remissão EspontâneaRESUMO
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. Forty Holtzman rats were divided into four groups: 1) control; 2) cyclosporin A: a 10 mg/kg/day subcutaneous dose of CsA; 3) chlorhexidine: 0.12% chlorhexidine (CHX) was applied to the buccal surface of the right mandibular molars; and 4) cyclosporin A/chlorhexidine: a combination of the treatment described for cyclosporin A and chlorhexidine groups. The animals were fed a high sucrose diet during the experiment and were sacrificed after 14 and 21 days. The histometric analysis revealed a significant increase in buccal gingival area in the cyclosporin A group compared to other groups (P < 0.01) after 21 days. The epithelium thickness of the buccal gingiva was significantly increased in the cyclosporin A group, compared to the control group (P < 0.05). The cyclosporin A/chlorhexidine group exhibited statistically significantly lower gingival overgrowth than the cyclosporin A group. These findings, if replicated in human studies, suggest that topically applied 0.12% chlorhexidine may be a valuable measure in the management of cyclosporin-induced gingival overgrowth.