Dihidropridine Bağlı Dişeti Büyümesinde Farklı İlaç Rejimlerinde Periodontal Tedavi Yaklaşımı

Year 2022, Volume: 6 Issue: 1, 1 - 7, 22.06.2022

Onur Eroğlu Ece Yetiş Hafize Öztürk Özener Leyla Kuru

https://doi.org/10.29228/erd.18

Abstract

Dihidropiridine Bağlı Dişeti Büyümesinde Farklı İlaç Rejimlerinde Periodontal Tedavi Yaklaşımı

Amaç: Bu çalışmanın amacı, ilaca bağlı dişeti büyümesi (İBDB) gösteren ve ilaç değişimi yapılan ve yapılmayan hastalarda cerrahi olmayan periodontal tedavinin (COPT) klinik etkinliğini değerlendirmek ve enflamatuvar dişeti büyümesi (EDB) gösteren hastalarla karşılaştırmaktır.

Gereç ve Yöntemler: Ağızda generalize dişeti büyümesi görülen toplam 17 hasta araştırmaya dahil edildi. Dihidropiridine bağlı dişeti büyümesi olan hastalardan hekim konsültasyon sonucu ilacına devam edenler Grup 1 (n=6), ilaç değişimi yapılan hastalar ise Grup 2 (n=5) olarak ayrıldı. EDB görülen hastalar Grup 3’e (n=6) dahil edildi. Tüm çalışma gruplarına 4 seans COPT uygulandı. Başlangıçta ve COPT'den 6 hafta sonra plak indeks, gingival indeks, sondalamada kanama , sondalama derinliği (SD) ile alçı model ve fotoğrafik dişeti büyümesi skorları ölçüldü.

Bulgular: Tüm hasta gruplarında COPT sonrası tüm klinik parametrelerde azalma gözlendi (p<0.05). Başlangıç ölçümlerinin gruplar arası karşılaştırmasında, Grup 1'de Grup 2'ye göre daha yüksek olan SD değeri (p<0.05) dışında anlamlı bir fark görülmedi (p>0.05). COPT sonrası verilerin gruplar arasında karşılaştırılmasında, yalnızca Grup 1 ve 2 arasında model ve fotoğrafik dişeti büyümesi değerlerinde istatistiksel olarak anlamlı fark bulundu (p<0.05).

Sonuçlar: COPT’nin İBDB ve EDB görülen hastalarda 6 haftalık süreçte enflamasyonun şiddetinin ve büyümüş dişeti dokularının boyutlarının azaltmasında etkili bir yöntem olduğu sonucuna varıldı. Dişeti büyümesini indükleyen ilacın değişimi, İBDB hastalarında büyümüş dişetinin boyutlarının azaltılmasında COPT'ye ek katkıda bulunduğu belirlendi.

Keywords

Diş eti aşırı büyümesi, hipertansiyon, antihipertansifler, kökü düzleştirme, ilaç ikamesi

Supporting Institution

Marmara Üniversitesi Bilimsel Araştırma Projeleri Birimi

Project Number

SAG-C-DRP-241018-0576

Periodontal treatment approach for dihydropyridine induced gingival overgrowth with or without drug substitution

Abstract

Periodontal treatment approach for dihydropyridine induced gingival overgrowth with or without drug substitution

Objectives: The aim of this study is to evaluate clinical effectiveness of nonsurgical periodontal treatment (NSPT) in patients with drug induced gingival overgrowth (DİGO) with or without drug substitution in comparison with patients presenting inflammatory GO.

Material and Methods: A total of 17 patients with generalized GO were included in this clinical trial. Based on the medical physicians consultation, DIGO patients who continued to use dihydropyridine were allocated to the Group 1 (n=6), whereas patients whose drug substitution was carried out were allocated to the Group 2 (n=5). Group 3 (n=6) subjects had inflammatory GO. All study groups received NSPT for 4 sessions. At baseline and 6 weeks after NSPT, plaque index, gingival index, bleeding on probing (BOP), probing depth (PD) and, plaster model and photographic GO scores were measured.

Results: NSPT resulted in significant decreases in periodontal clinical parameters in all groups (p<0.05). Intergroup comparisons of baseline measurements revealed no statistically significant differences (p>0.05) except PD value which was higher in the Group 1 compared to the Group 2 (p<0.05). Comparisons of post-NSPT data among groups exhibited statistically significant difference only between Groups 1 and 2 in the model and photographic GO scores (p<0.05).

Conclusions: After the 6-week evaluation period, NSPT was found to be an effective method in reducing the severity of inflammation and size of overgrown gingival tissues in patients with DIGO and inflamatory GO. Substitution of drug causing GO provided further contribution to NSPT regarding the size of overgrown gingiva in the patients with DIGO.

Keywords

Gingival overgrowth, Hypertension, antihypertension agents, root planing, drug substitution

Project Number

SAG-C-DRP-241018-0576

References

• 1. Kantarci A, Carranza F, Hogan E. Gingival Enlargement. Newman M, Takei H, Klokkevold P, Carranza F, editors. Newman and Carranza's Clinical Periodontology 13th Edition. Philadelphia, PA: Elsevier;2019 p. 256-67.
• 2. Kimball O. The treatment of epilepsy with sodium diphenyl hydantoinate. J Am Med Assoc 1939;112(13):1244-45.
• 3. Ramon Y, Behar S, Kishon Y, Engelberg IS. Gingival hyperplasia caused by nifedipine-a preliminary report. Int J Cardiol 1984;5(2):195-206.
• 4. Rateitschak-Plüss EM, Hefti A, Lörtscher R, Thiel G. Initial observation that cyclosporin-A induces gingival enlargement in man. J Clin Periodontol 1983;10(3):237-46.
• 5. Pieper JA. Evolving role of calcium channel blockers in heart failure. Pharmacotherapy 1996;16(2):43-9.
• 6. Livada R, Shiloah J. Calcium channel blocker-induced gingival enlargement. J Hum Hypertens 2014;28(1):10-4.
• 7. Ellis JS, Seymour RA, Steele JG, Robertson P, Butler TJ, Thomason JM. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. J Periodontol 1999;70(1):63-7.
• 8. Jorgensen MG. Prevalence of amlodipine-related gingival hyperplasia. J Periodontol 1997;68(7):676-68.
• 9. Dongari-Bagtzoglou A. Research S, Therapy Committee AAoP. Drug-associated gingival enlargement. J Periodontol 2004;75(10):1424-31.
• 10. Sanz M, Hall’s Critical Decisions in Periodontology and Dental Implantology 5th edition. Harpenau LA, Kao RT, Lundergan WP, Sanz M, editors. Gingival Enlargement. Shelton,CT:People’s Medical Publishing House; 2013 p. 57-8.
• 11. Brown RS, Beaver WT, Bottomley WK. On the mechanism of drug-induced gingival hyperplasia. J Oral Pathol Med 1991;20(5):201-9.
• 12. Nyska A, Shemesh M, Tal H, Dayan D. Gingival hyperplasia induced by calcium channel blockers: mode of action. Med Hypotheses 1994;43(2):115-18.
• 13. Das SJ, Olsen I. Keratinocyte growth factor is upregulated by the hyperplasia-inducing drug nifedipine. Cytokine 2000;12(10):1566-69.
• 14. Becerik S, Celec P, Gurkan A, Ozturk VO, Kamodyova N, Atilla G. Gingival crevicular fluid and plasma levels of transglutaminase-2 and oxidative stress markers in cyclosporin a-induced gingival overgrowth. J Periodontol 2016;87(12):1508-16.
• 15. Kose KN, Yilmaz S, Noyan U, Kuru B, Yildirim HS, Agrali OB. The gingival crevicular fluid levels of growth factors in patients with amlodipine-induced gingival overgrowth: A pilot study. Niger J Clin Pract 2020;23(4):561-67.
• 16. Pundir AJ, Pundir S, Yeltiwar RK, Farista S, Gopinath V, Srinivas TS. Treatment of drug-induced gingival overgrowth by full-mouth disinfection: A non-surgical approach. J Indian Soc Periodontol 2014;18(3):311-15.
• 17. Tavassoli S, Yamalik N, Caglayan F, Caglayan G, Eratalay K. The clinical effects of nifedipine on periodontal status. J Periodontol 1998;69(2):108-12.
• 18. Aimetti M, Romano F, Debernardi C. Effectiveness of periodontal therapy on the severity of cyclosporin A-induced gingival overgrowth. J Clin Periodontol. 2005;32(8):846-50.
• 19. Smith JM, Wong CS, Salamonik EB, Hacker BM, McDonald RA, Mancl LA, et al. Sonic tooth brushing reduces gingival overgrowth in renal transplant recipients. Pediatr Nephrol 2006;21(11):1753-59.
• 20. Kantarci A, Cebeci I, Tuncer O, Carin M, Firatli E. Clinical effects of periodontal therapy on the severity of cyclosporin A-induced gingival hyperplasia. J Periodontol 1999;70(6):587-93.
• 21. Somacarrera ML, Lucas M, Scully C, Barrios C. Effectiveness of periodontal treatments on cyclosporine-induced gingival overgrowth in transplant patients. Br Dent J 1997;183(3):89-94.
• 22. Seymour RA, Smith DG. The effect of a plaque control programme on the incidence and severity of cyclosporin-induced gingival changes. J Clin Periodontol 1991;18(2):107-10.
• 23. Pernu HE, Pernu LM, Knuuttila ML. Effect of periodontal treatment on gingival overgrowth among cyclosporine A-treated renal transplant recipients. J Periodontol 1993;64(11):1098-100.
• 24. Carranza FA, Hogan EL. Gingival Enlargement In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Carranza's Clinical Periodontology 12th Ed.;2015 St. Louis, Missouri: Elsevier. p. 232-33.
• 25. Nakib N, Ashrafi SS. Drug-induced gingival overgrowth. Dis Mon 2011;57(4):225-30.
• 26. Silness J, Loe H. Periodontal Disease in Pregnancy. Ii. Correlation between Oral Hygiene and Periodontal Condtion. Acta Odontol Scand 1964;22:121-35.
• 27.Loe H, Silness J. Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand 1963;21:533-51.
• 28. Seymour, R. A., Smith, D. G., & Turnbull, D. N. The effects of phenytoin and sodium valproate on the periodontal health of adult epileptic patients. J Clin Periodontol 1985;12(6), 413-19.
• 29. Barclay S, Thomason JM, Idle JR, Seymour RA. The incidence and severity of nifedipine-induced gingival overgrowth. J Clin Periodontol 1992;19(5):311-14.
• 30. Keglevich T, Benedek E, Gera I. Clinical experience with the treatment of gingival hyperplasia induced by calcium channel blocking agents. Fogorv Sz. 1999;92(12):363-72.
• 31. Harel-Raviv M, Eckler M, Lalani K, Raviv E, Gornitsky M. Nifedipine-induced gingival hyperplasia. A comprehensive review and analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79(6):715-22.
• 32. Hancock RH, Swan RH. Nifedipine-induced gingival overgrowth. Report of a case treated by controlling plaque. J Clin Periodontol 1992;19(1):12-14.
• 33. Mavrogiannis M, Ellis JS, Thomason JM, Seymour RA. The management of drug-induced gingival overgrowth. J Clin Periodontol 2006;33(6):434-39.
• 34. Montebugnoli L, Bernardi F, Magelli C. Cyclosporin-A-induced gingival overgrowth in heart transplant patients. A cross-sectional study. J Clin Periodontol 1996;23(9):868-72.
• 35. Naidoo LC, Stephen LX. Nifedipine-induced gingival hyperplasia: non-surgical management of a patient. Spec Care Dentist 1999;19(1):29-34.
• 36. Seymour RA. Effects of medications on the periodontal tissues in health and disease. Periodontol 2000 2006;40:120-29.
• 37. Seymour RA, Ellis JS, Thomason JM. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol. 2000;27(4):217-23.
• 38. Modeer T, Wondimu B, Larsson E, Jonzon B. Levels of cyclosporin-A (CsA) in saliva in children after oral administration of the drug in mixture or in capsule form. Scand J Dent Res. 1992;100(6):366-70.
• 39. Ellis JS, Seymour RA, Monkman S, Idle JR. Disposition of nifedipine in plasma and gingival crevicular fluid in relation to drug-induced gingival overgrowth. J Periodontal Res 1993;28(5):373-78.
• 40. Thomason JM, Seymour RA, Ellis JS, Kelly PJ, Parry G, Dark J. Iatrogenic gingival overgrowth in cardiac transplantation. J Periodontol 1995;66(8):742-46.
• 41. Segelnick SL, Weinberg MA. Reevaluation of initial therapy: when is the appropriate time? J Periodontol 2006;77(9):1598-1601.
• 42 Carvalho FB, Cabral PA, Gusmao ES, Jamelli SR, Cimoes R. Non-surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient. Gerodontology; 2010 27(1):76-80.
• 43. Camargo PM, Melnick PR, Pirih FQ, Lagos R, Takei HH. Treatment of drug-induced gingival enlargement: aesthetic and functional considerations. Periodontol 2000 2001;27:131-138.
• 44. Kato T, Takiuchi H, Yamaguchi M, Naito T. Ca-channel blocker-induced gingival overgrowth that improved with non-surgical therapy during visiting care: a case report. Gerodontology 32(4):318-20.
• 45. Morisaki I, Dol S, Ueda K, Amano A, Hayashi M, Mihara J. Amlodipine-induced gingival overgrowth: periodontal responses to stopping and restarting the drug. Spec Care Dentist 2001;21(2):60-62.
• 46. Fang L, Tan BC. Clinical presentation and management of drug-induced gingival overgrowth: A case series. World J Clin Cases 2021;9(32):9926-34.