Gingival Hyperplasia during Pregnancy: Frequency and Clinical Presentation in a Tertiary Level Hospital in Yaoundé-Cameroon

Gingival hyperplasia or gingival overgrowth, which is a common trait of gingival disease, is characterized by an increase in the size of the gingiva. Gingival hyperplasia according to past reports has numerous etiological factors one of which is pregnancy due to increased hormone levels. Although pregnancy does not directly cause gingival hyperplasia, it may catalyze local etiological factors. Objectives: To determine the frequency and clinical aspects of gingival hyperplasia during pregnancy. Methodology: We conducted a cross sectional descriptive study from November 2021 to June 2022 at the Yaoundé Gyneco-Obstetrics and Pediatrics Hospital. Data were collected using a pretested questionnaire and clinical assessments done using dental consultation kits. Data were analyzed with the International Business Machine Statistical Package for Social Sciences (IBM SPSS) version 21.0 software. Results: We recruited 231 eligible participants for our study. Of 231, 101 (43.7%) had gingival hyperplasia. Most of our study population were between 20 - 40 years old and gingival hyperplasia was most commonly found in the 3rd trimester (60.7%). We reported that 31.3% of our population had a plaque score 2 and only 7.8% had consulted a dentist during pregnancy. We also observed that 93.3% of our population manifested a mild/moderate form of the disease while 6.9% had a severe form. Our study showed that 72.3% and 27.3% had a localized and generalized form of the disease, respectively. Conclusion: We concluded that gingival hyperplasia is a common pathology in pregnant women. It is most found in the third trimester. It presents more commonly as a localized form, and degree of severity is mostly moderate.

Drug-induced gingival overgrowth in cardiovascular patients

Drug-induced gingival overgrowth(DIGO)is a pathological growth of gingival tissue,primarily associated with calcium channel blockers and immunosuppressants.Consequently,it is mainly seen in cardiovascular and transplanted patients.Nifedipine remains the main calcium channel blocker related to the development of this unpleasant side-effect.As for immunosuppress-ants,cyclosporin is the leading causative agent,whereas other drugs from this druggroup,including tacrolimus,have better safety profiles.Accumulated collagen with inflammatory infiltrates is the histological hallmark of this condition.Several factors are involved in the pathogenesis and can increase the risk,such as male gender,younger age,pre-existing periodontal inflammation,and concomitant use of other DIGO-inducing medications.Patients with DIGO may experience severe discomfort,trouble with speech and mastication,pain,and teeth loss,aside from cosmetic implications.Furthermore,these patients also have an increased risk for cardiovascular diseases.The interdisciplinary approach and cooperation with dental care experts are necessary for patient management.Treatment includes discontinuing the drug and switching to one with a better profile,improving oral hygiene,and surgical removal of enlarged tissue.Recognizing the potential of commonly used medications to cause DIGO and its effect on patients'health is necessary for early detection and adequate management of this complication.

Gingival enlargements: Differential diagnosis and review of literature

Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated. Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the management of these lesions and prevention of their recurrence is completely dependent on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life. The purpose of this review article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them. A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized(isolated, discrete, regional) or generalized gingival enlargement.

The effect of Nifedipine on the expression of type I collagen in gingival fibroblasts

Objective：To investigate the effect of nifedipine（calciumchannel blocker） on the expression of collagen in gingival fibroblasts invitro. Methods：Primarily gingival fibroblasts were cultured and incubated with various concentrations of nifedipine（108 μg/L, 360 μg/L and 1200 μg/L）for 5 days. Gingival fibroblasts were primarily cultured derived from nifedipine responders and nonresponders in the presence of 360 μg/L nifedipine. Enzyme-linked immunosorbent assay was used to evaluate the amount of type I collagen. Cell proliferation was measured by cell counting with evaluating MTT value. Results：The expressions of collagen and cell proliferation were significantly different among the high concentration groups and the others on the fifth day, especially higher in 360 μg/L and 1200 μg/L groups and also different among nifedipine responders and non-responders. Conclusion：The expression of collagen and cell proliferation may be concerned with the biological mechanism for gingival overgrowth.

A Study on the Ultrastructure and Gene Location of Hereditary Gingival Fibromatosis

Objective\ To ascertain the histological characteristics of hereditary gingival fibromatosis and the location of HGF gene. Methods\ A pedigree analysis of HGF was made. The ultrastructure of gingival overgrown tissue was observed by electron microscopy (EMS) and the location of the HGF gene defined with microsatellite markers. Results\ The HGF consisted of coarse collagen bundles and fibrocytes, epithelial cells, smooth muscle cells, etc. were abnormally arranged; the HGF locus had been mapped to chromosome 5q13 q22. Conclusion\ The gingival pathological changes resemble 'hamartoma' and the findings have implications for identification of the underlying genetic basis of HGF.

青少年局限性海绵状牙龈增生1例

青少年局限性海绵状牙龈增生(LJSGH)是一种具有独特病理表现的牙龈过度增生性疾病,其临床表现不典型,病因和发病机制尚不明确,在国内尚未有病例报道。该病的诊断主要依靠病理检测,治疗后存在复发可能性,最佳治疗方法仍缺乏一定的循证医学证据。本文报道1例LJSGH,并结合文献复习,对其临床特点、病理学特征和治疗进行总结,为该病的诊治提供参考。

TRPA1与TRPV4在牙龈瘤组织中的表达及其与临床病理特征的相关性

目的探讨瞬时受体电位通道A1(TRPA1)和瞬时受体电位通道V4(TRPV4)在牙龈瘤组织中的表达及其与临床病理特征的相关性。方法选取牙龈瘤患者78例作为研究对象,所有患者均行手术治疗,术中切除牙龈瘤组织并切除少许正常牙龈组织送检。采用免疫组化SP法测定样本内TRPA1、TRPV4表达,比较牙龈瘤组织与正常牙龈组织内TRPA1、TRPV4表达情况;并分析TRPA1、TRPV4表达与临床特征间关系。随访1年,分析TRPA1、TRPV4表达与患者复发率间的关系。结果牙龈瘤组织内TRPA1、TRPV4阳性表达率高于正常组织,差异有统计学意义(P<0.05)。TRPA1、TRPV4表达阳性组年龄<50岁、非药物性牙龈增生的患者占比高于阴性组,差异有统计学意义(P<0.05);两者性别、BMI、病程、病理分型相比,差异无统计学意义(P>0.05)。78例患者随访1年,共30例复发,复发率为38.46%(30/78);复发患者TRPA1、TRPV4阳性表达率高于未复发患者,差异有统计学意义(P<0.05)。结论TRPA1、TRPV4在牙龈瘤组织中存在较高阳性表达,且高表达患者术后复发风险高。

P53蛋白和Bcl-2蛋白在环孢菌素和硝苯地平龈增生中的表达

目的 探讨凋亡相关蛋白P53、Bcl-2在药物性龈增生中的表达及意义。方法 用免疫组化SP法检测17例环孢菌素性龈增生、5例硝苯地平性龈增生牙龈中P53和Bcl-2蛋白的表达,8例正常人牙龈作对照。结果 17例环孢菌素性龈增生中有11例、5例硝苯地平性龈增生中有3例的牙龈上皮中有P53蛋白的阳性表达,而对照组均无P53蛋白的表达。Bcl-2蛋白在环孢菌素及硝苯地平性龈增生的牙龈上皮中,表达比较明显,而在对照组的牙龈上皮中,染色明显偏淡。结论 本研究结果中P53和Bcl-2蛋白表达增强,提示细胞凋亡抑制可能在药物性龈增生的发病中起作用。

硝苯地平对药物性牙龈增生患者牙龈成纤维细胞增殖的影响

目的研究硝苯地平致药物性牙龈增生患者牙龈成纤维细胞(NIFr-HGF)细胞周期增殖指数(PrI)的变化。方法以服用硝苯地平发生牙龈增生患者的牙龈组织为实验对象。龈切术获得组织样本,组织块培养法分离培养NIFr-HGF,在细胞培养液中分别添加10 ng/mL和1 000 ng/mL硝苯地平进行干预(低、高浓度药物干预组),分别于干预后18 h和30 h时间点收集细胞,流式细胞仪检测细胞周期并计算PrI。以不添加硝苯地平的NIFr-HGF作为空白对照。结果在药物作用时间相同条件下,两药物干预组NIFr-HGF细胞周期PrI明显高于空白对照组(P<0.05);低浓度与高浓度药物干预组间NIFr-HGF细胞周期PrI比较差异无统计学意义(P>0.05)。在低浓度和高浓度药物干预组,干预30 h细胞周期的PrI明显高于干预18 h,分别为(57.54±0.019)%vs(21.15±0.011)%和(59.36±0.031)%vs(19.01±0.012)%(P<0.05)。结论对于硝苯地平致药物性牙龈增生患者,NIFr-HGF细胞周期PrI随硝苯地平作用时间延长而增大,而与药物浓度无明显关系。

遗传性牙龈纤维瘤病一家族三代1例

遗传性牙龈纤维瘤病是一种罕见的家族遗传性疾病,以牙龈组织缓慢、渐进性增生为主要特征。本文对1例遗传性牙龈纤维瘤病家族进行报道及文献回顾。

非洛地平致牙龈增生3例报告及相关文献复习

本文报告了3例因服用非洛地平而致牙龈增生的病例,在停用(或减量)该药物及牙周治疗后,牙龈增生消退,形态恢复正常。作者复习了相关文献,并对药物性牙龈增生的发生机制和预防治疗进行了讨论。

硝苯地平导致药物性牙龈增生的临床研究

目的 :探讨服用硝本地平与牙龈增生关系和诊断标准。方法 :比较硝苯地平组与非硝苯地平组的 HI、CI、GI、PL I。结果 :对照组牙龈增生发生率为 91.1% ,明显高于硝苯地平组 ,硝苯吡啶组 HI>40 %者为 11/79,明显高于对照组。结论 :不容忽视非硝苯地平引起的牙龈增生 ,硝苯地平可导致牙龈增生 ,但与服药持续时间无相关关系 ;HI>40 %易确诊 ,30 % <HI≤ 40

肾移植术后环孢素A诱导牙龈增生的临床因素及血清亲环素浓度分析

目的分析服用环孢素A(CsA)的肾移植患者相关临床因素与牙龈增生(GO)程度的关系,初步探讨血清亲环素(CyPA)浓度与CsA诱导的牙龈增生(CUGO)的关系。方法本研究以65例用CsA为主要免疫抑制剂抗排斥患者为研究对象,经牙龈增生指数(GOI)评价后将患者分为牙龈增生组(GO^+)和牙龈无增生组(GO)。比较两组患者年龄、性别、服药时间、服药剂量、血清CsA和CyPA服药浓度、尿素、肌酐、牙龈评价之间的差异,观察血清CyPA浓度与CIGO发生及严重程度的关系。结果 GO(GOI≥30)发生率为21.54%(14/65)。GO^+组和GO^-组间年龄、性别、服药时间、尿素、肌酐、服药剂量和血清CsA浓度差异均无统计学意义。GO^+组血清CyPA浓度低于GO^-组[0.23(0.16～0.30)ng/mL vs 0.34(0.22～0.54)ng/mL,P=0.04)];血清CyPA浓度与GO严重程度呈负相关(r=-0.264,P=0.03),但与CsA服药剂量和其血清浓度无关(r=-0.014,P=0.91;r=0.012,P=0.9 3);牙龈评价结果:GO^+组的菌斑指数和龈乳头出血指数均高于GO^-组(1.41±0.27 vs 1.15±0.34,P=0.01;0.49±0.30 vs 0.25±0.11,P=0.01)。结论 CIGO的发生可能是局部因素与系统因素共同作用的结果;血清CyPA浓度可能是独立于CsA服药剂量和血药浓度之外的CIGO风险因素,对其进行检测有助于临床医师预判GO的发生。

钙离子拮抗剂致药物性牙龈增生的危险因素分析

目的:探讨高血压患者服用钙离子拮抗剂后出现牙龈增生的患病率。方法:对我院查体中心和心血管内科门诊服用钙离子拮抗剂抗高血压类药物的262和未服用钙离子拮抗剂的197例患者进行横断面调查。方法包括问卷调查和口腔牙周检查,其中牙龈增生的判定以牙龈增生指数(HI)为诊断标准。对调查结果进行统计学分析。结果:服用钙离子拮抗剂类药物患者的牙龈增生患病率为20.23%,显著高于对照组的2.54%(χ2=32.276,P<0.05)。随年龄增大,药物性牙龈增生的患病率降低(r=-0.155,P<0.05);单一用药者较联合用药者患病率高;服药时间越长患病率降低;随服药剂量的增加,患病率明显增长;口腔卫生状况差者可加重牙龈增生程度。结论:药物性牙龈增生是多方面作用的结果,其主要影响因素为患者年龄、服药方式、剂量、时间和牙周局部因素。

4种方法治疗不良烤瓷冠引起的牙龈增生性病变的疗效比较

目的:应用高频电刀、CO2激光、微波热凝及传统牙龈成形术治疗由不良烤瓷冠引起的牙龈增生性病变,观察治疗效果,探讨其临床应用价值。方法:将148例不良烤瓷冠引起的牙龈增生性病变患者随机分为高频电刀组、CO2激光组、微波热凝组及传统牙龈成形术组,每组各37例,分别应用上述4种方法进行治疗,恢复重建牙龈生理功能和外观,比较各组患者手术时间、术中失血量、创面愈合时间、临床疗效及美学效果。结果:①与传统牙龈成形术组比较,高频电刀组、CO2激光组及微波热凝组患者手术时间短、术中失血量少、愈合快、感染率低(P<0.01或P<0.05)。②4组患者术后牙龈指数(GI)、龈沟出血指数(SBI)及改良出血指数(mBI)与术前比较明显降低(P<0.01),且高频电刀组、CO2激光组及微波热凝组患者术后GI明显低于传统牙龈成形术组(P<0.05)。③高频电刀组、CO2激光组及微波热凝组患者1年后有效率分别为97.3%、94.6%及97.3%,组间比较差异无统计学意义(χ2=0.34,P>0.05),但均高于传统牙龈成形术组(89.2%)(P<0.05)。结论:采用高频电刀、CO2激光、微波热凝治疗不良烤瓷冠引起的牙龈增生性病变效果确切,效果优于传统牙龈成形术。

遗传性牙龈纤维瘤病1例

遗传性牙龈纤维瘤病是一种罕见的以牙龈组织缓慢、渐进性增生为主要特征的良性病变。本文对1例遗传性牙龈纤维瘤病的临床检查、病史进行报道,并结合文献对其进行讨论。

非硝苯地平钙离子拮抗剂与牙龈增生的关系研究

目的 :探讨服用非硝苯地平的钙离子拮抗剂 (除硝苯地平之外的其他钙离子拮抗剂 )与牙龈增生的关系。方法 :选择北京医院内科高血压门诊就诊的成年高血压病患者 ,进行问卷调查和口腔健康检查。分为服用非硝苯地平钙离子拮抗剂的患者 (简称服药组 )及从未服用过钙离子拮抗剂的患者 (简称对照组 )。问卷调查内容包括患者的一般状况 ,高血压患病史 ,服药史以及口腔卫生习惯等。口腔健康检查包括菌斑指数 (plaqueindexPLI)、简化牙石指数 (simplecalculusindexCI S)、以及牙龈增生指数 (gingivalhyperplasiaindexHI)的检查和记录。 结果 :对照组患者牙龈增生患病率 6 0 3% ,服药组患者牙龈增生患病率 31 2 5 % ,两者间的差异有显著性 (P <0 0 0 1) ,并且服药组患者中严重牙龈增生的患病率 19 2 3%也显著高于对照组 1 5 9% (P <0 0 0 1)。对照组平均HI值为 1 4 % ,服药组平均HI值为 10 % ,两者间的差异有显著性 (P <0 0 0 1)。结论 :服用非硝苯地平钙离子拮抗剂与高血压患者牙龈增生的患病间有显著相关性。

牙周基础治疗对药物性牙龈增生的疗效观察

目的:评价牙周基础治疗对钙拮抗剂导致的药物性牙龈增生的治疗效果。方法:钙拮抗剂导致的牙龈增生患者7例,在治疗前和牙周基础治疗后1、3、6个月各时点分别记录菌斑指数(plaque index,PLI),出血指数(bleedi ngindex,BI),探诊深度(probing depth,PD)和牙龈增生指数(gingi val hyper plasia index,GHI)。7例患者完成了至少6个月的观察。结果:在观察期间,牙龈炎症状态指标(PLI、BI、PD)持续减轻(P<0.01),牙龈增生状态(GHI)持续改善。结论:牙周基础治疗可改善钙拮抗剂药物引起牙龈增生的程度。

硝苯地平导致牙龈增生机制的研究

目的:在牙龈成纤维细胞(gingival fibroblasts(GFs))与牙龈角质形成细胞(gingival kerati-nocytes,GKs)共培养下,研究硝苯地平导致牙龈增生的可能机制。方法:用不同浓度(0、0.2、20μg/mL)硝苯地平处理GFs和GKs的共培养体系,3 d后用逆转录PCR、酶联免疫吸附实验以及流式细胞计数等方法观察角质细胞生长因子(keratinocyte growth factor,KGF)及其受体(keratinocyte growth factor receptor,KGFR)的表达。结果:在共培养条件下,硝苯地平导致GFs表达KGF显著增高,并呈浓度依赖性。同时硝苯地平能促进GKs中KGFR基因表达上调,膜KGFR蛋白表达水平在硝苯地平浓度为0.2μg/mL时上调。结论:间充质-上皮作用途径之一的角质细胞生长因子-受体间相互影响,在硝苯地平导致牙龈增生中起着一定的作用;体外GFs-GKs共培养模型能够在更接近体内环境的状态下进一步研究牙龈增生的机制。

服用硝苯地平后牙龈增生以及未增生患者牙龈成纤维细胞生物特性比较

目的:观察服用硝苯地平后牙龈增生和未增生患者牙龈成纤维细胞(nifedipine responders gingival fibro-blasts NIFr-HGF,nifedipine non-responders gingival fibroblasts NIFn-HGF)超微结构、细胞周期变化以及增殖能力的差异性,以探讨该药导致牙龈增生的可能作用机理。方法:采用透射电镜观察NIFr-HGF、NIFn-HGF的超微结构,利用流式细胞仪、MTT法检测和比较2种细胞经硝苯地平诱导后其细胞周期以及增殖能力的差异性。结果:与NIFn-HGF相比较,NIFr-HGF内粗面内质网扩张;受硝苯地平诱导后其增殖明显加强。结论:NIFr-HGF合成蛋白质的能力可能较NIFn-HGF强,且前者对于硝苯地平的反应也明显强于后者,这提示两类细胞的细胞生物学特性以及对钙离子拮抗剂的反应能力存在差异,药物性牙龈增生的发生可能存在细胞异质性。