Gingival hyperplasia treatment using diode laser gingivectomy in a child with cerebral palsy: case report

Gingival hyperplasia is associated with several factors, such as chronic inflammation due to the large accumulation of biofilm and medications including anticonvulsants. The aim of this study is to report a clinical case of a 4-year-old spastic quadriplegic cerebral palsy patient with gingival hyperplasia in the palatal region of the upper teeth induced by the use of high doses of anticonvulsant medications. The patient attended the Dental Assistance Center for People with Disabilities, with fibrotic gingival hyperplasia in the upper posterior region, covering the dental crowns on the palatal and occlusal surfaces. Oral hygiene instructions were previously carried out using chlorhexidine gluconate solution (0.12%) on the teeth with the aid of a cotton swab, twice a day for seven days, to reduce bacterial plaque levels and control periodontal inflammation. Gingivectomy was performed using a gallium aluminum arsenide diode laser (GaAlAs; 808±10 nm, 2.5 W output power, continuous mode). Following the surgical procedures, photobiomodulation therapy was performed with a low-level aluminum gallium indium phosphide diode laser (InGaAlP; 660±10 nm, 100 mW, 3 J) at three points (anterior, middle and posterior region of surgical wound). The patient returned at 7 and 30 days after surgery presenting accelerated wound healing. It was concluded that the high-level diode laser associated with photobiomodulation therapy were effective for performing a conservative and safe procedure in a patient with severe neurological disorder.

Amlodipine Induced Gum Hypertrophy – A Rare Case Report

Background: DIGO or drug-induced gingival overgrowth occurs as a side effect of certain drugs. Until now, the etiology of drug-induced gingival overgrowth is not clearly understood. Among the calcium channel blockers, nifedipine has been shown to be most frequently associated with drug-induced gingival hyperplasia. Amlodipine is a comparatively newer calcium channel blocker that witha longer duration of action and lesser side effects as compared to nifedipine. There are only certain case reports of amlodipine-induced gum hyperplasia. Case presentation: We report a case of amlodipine-induced gum hyperplasia in a 66-year-old hypertensive patient taking amlodipine at a dose of 5 mg once a day. There was significant regression of gum hypertrophy after substitution of amlodipine by Losartan. Conclusion: Amlodipine is one of the commonly prescribed antihypertensive drugs, and gingival hyperplasia is one overlooked side effect in patients taking amlodipine. Awareness of this potential side effect of amlodipine may be helpful to reduce the anxiety of patients and the cost of diagnostic procedures.

Oral reactive capillary hemangiomas induced by SHR-1210 in the treatment of non-small cell lung cancer: a case report and literature review

Background Antibodies to PD-1 and PD-L1 have remarkably improved the overall survival of many patients with advanced solid tumors. SHR-1210 is an anti-PD-1 monoclonal antibody. Dermatologic reactive capillary hemangiomas (RCH) were the most common and unique drug-related AEs of SHR-1210, but rare on oral mucosa and gastrointestinal mucosa. Herein we report a case of RCH occurred in oral mucosa during the clinical trials of SHR-1210 in the treatment of non-small cell lung cancer. Case presentation A male in his 60 s with a history of non-small cell lung cancer received injection of anti-PD-1 monoclonal antibodies SHR-1210. The patient developed drug-related RCH on skin after the first injection and began to have gingival hyperplasia one year after the first injection which gradually increased in size and affect eating and speaking. Anti-PD-1 treatments were continued. After periodontal treatment, two oral lesions and one skin lesion were surgically removed. Similar histological manifestation was found in all three lesions as reactive capillary hemangiomas. All lesions had a good prognosis without recurrence on oral mucosa within one year after surgery. Conclusions Oral reactive capillary hemangiomas could be induced by SHR-1210 in the treatment of non-small cell lung cancer. Surgical resection is an effective treatment with a good prognosis.

Seven-year follow-up of a patient with hereditary gingival fibromatosis treated with a multidisciplinary approach: case report

Background Hereditary gingival fibromatosis (HGF) is rare in clinical practice, and the long-term results of the combined orthodontic-periodontal treatment of HGF are rarely reported. Case presentation This study reports for the first time the results of seven years of follow-up in a seven-year-old girl with HGF. The diagnosis was confirmed by clinical signs, family history and histopathological examination. First, periodontal scaling and oral hygiene reinforcement were performed regularly in the mixed dentition stage. Next, gingivoplasty was performed on the permanent dentition. Two months after the surgery, treatment with fixed orthodontic appliances was conducted. The teeth were polished on a monthly basis, and oral hygiene was reinforced to control gingival enlargement. Gingival hypertrophy recurred slightly, and gingivectomies were performed in the months following the start of orthodontic treatment. Follow-up was performed for 24 months with orthodontic retention, and gingival enlargement remained stable after the combined treatment. Conclusions The risk of gingival hyperplasia recurrence during and after orthodontic treatment is high, but satisfying long-term outcomes can be achieved with gingivectomy, malocclusion correction, and regular follow-up maintenance.

Multiple Adverse Drug Reactions to Calcineurin Inhibitors in a Renal Transplant Patient

Calcineurin inhibitors (CNIs) are typically used to prevent organ rejection and their use has significantly improved allograft and survival rates with a marked reduction in rejection rates. However, CNIs have been associated with various side effects including nephrotoxicity, hypertension, gingival hyperplasia, hypertrichosis, hepatotoxicity, hyperkalemia, and neurotoxicity. Significant intra-patient and interpatient pharmacokinetic variability and narrow therapeutic indices make the therapy complicated. Although CNIs are essential in preventing organ rejection, higher doses could lead to toxicity, which can reduce patient tolerability and negatively affect long-term allograft survival and patient mortality. As individual patients respond differently to comparable drug levels, attaining the optimal drug level range does not ensure lack of drug toxicity or complete immunosuppressant viability. One to two adverse effects are commonly observed in patients using CNIs. However, no case about CNI-induced gingival hyperplasia, hypertrichosis, tremors, facial nerve palsy, and blepharospasm after kidney transplantation in a single patient has been reported. Our report describes the unusual case of a patient presenting with CNI-induced multiple adverse reactions.

Laser Therapy In Drug Induced Gingival Hyperplasia- A Case Report

Gingival excess is related with various components including innate infections, hormonal unsettling influences, helpless oral cleanliness condition, aggravation, neoplastic conditions, and unfavorable medication responses including anticonvulsants, calcium channel blockers, and immunosuppressants. This can have an inconvenient impact on the personal satisfaction and furthermore on high oral bacterial burden brought about by plaqueretentive regions. Different treatment modalities incorporate both careful (gingivectomy, periodontal fold, electrosurgery, and laser extraction) and nonsurgical methodologies. This case report reveals the treatment of drug induced gingival hyperplasia with laser

CLINICAL-STATISTICAL STUDY ON THE FREQUENCY AND ETIOLOGICAL FACTORS OF GINGIVAL HYPERPLASIA

Introduction. Gum hyperplasia is clinically translated by growth in gum size, edema and bleeding (over-normal bags). The gum may be thin or fibrous, firm (in pseudotumor forms). In the absence of proper treatment, it will be associated with the bone resorption of the alveolar process, leading to different degrees of dental mobility. Purpose. Through this clinical-statistical study, we aim to analyze patients diagnosed with gum hyperplasia by age, gender, type of gum hyperplasia, etiology and localization. Also, by observing in surgical practice more and more cases of gum hyperplasia in patients with orthodontic treatment, through this clinical-statistical study, we aim to quantify the incidence of gingival hyperplasia in orthodontic treatments carriers and its distribution by gender. Material and method. The study is retrospective type, performed on 172 patients with the diagnosis of gum hyperplasia (K06.1), treated in the Oro-maxillo-facial surgery Clinic in Targu Mures, during Jan.2015-march 2021. Hypocrate concept 3 was used to access patient observation sheets. Results and discussions. Analyzing the descriptive statistical data of this retrospective clinical-statistical study, it is observed that the average age of the subjects is 58 years, the distribution by sex favors the female gender (59%), generally occurs in adults, has affinity for the right hemimaxilla, approx. 25% of patients have gingival hyperplastic lesions caused by orthodontic appliances and mobile/mobilizable prostheses. These types of lesions represent a ratio of 2/1 in favor of females, which indicates that the aesthetic requirements for females are much higher compared to males. Also, interpreting, from a medical point of view, the statistical conclusions of this study, we find that the patient's gender does not influence the location and appearance of the hyperplasic lesion, instead the age of the patients influences the occurrence of the hyperplastic lesion. Conclusion. Orthodontic therapy should be indicated after a correct evaluation of periodontal tissues, quantification of periodontal indices and detection of risk factors.

Anesthetic Management of a Juvenile Hyaline Fibromatosis Patient With Trismus and Cervical Movement Limitation

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease characterized by the presence of tissue nodules, joint contractures, and gingival hyperplasia. With a 1-year-9-month-old female patient scheduled for a gingivectomy and excision of a lower lip mass under general anesthesia, it was anticipated that airway management would be difficult because of trismus and limited cervical movement. Intubation with video-laryngoscopic assistance could not be achieved because gingival hyperplasia and trismus prevented blade insertion and manipulation. Therefore, 2 endotracheal tubes were used: 1 used as a nasopharyngeal airway for assisted ventilation, and 1 used for intubation along with a flexible fiberoptic scope. This case demonstrated a useful method for managing ventilation and intubation in patients with JHF, particularly when the use of oral airway devices is difficult.