Gingival overgrowth and associated factors in a population of Nigerian hypertensives

Background: Gingival overgrowth may be idiopathic or secondary. Drug Induced Gingival Overgrowth (DIGO) occurs within 3 months of treatment and is more prevalent in younger age group with predilection for the anterior gingival tissue and usually not associated with attachment loss or tooth mobility unless there is an existing periodontal disease. Methodology: 170 hypertensive patients were recruited for the study; 85 calcium channel blocker (CCB) and 85 non-CCB users. Interviewer-administered questionnaires was used to obtain socio-demographic information as well as medical and drug history. GO was assessed using New Clinical Index for DIGO and data was analyzed with SPSS version 21 (Armonk, NY: IBM Corp). Continuous and nominal variables were described with means, standard deviations and frequencies. Statistical significance was set at P < 0.05. Results: Amlodipine was the most commonly used CCB. The prevalence of DIGO in CCB and non-CCB was the same (49.5%). Gingival enlargement was found equally among both sexes in the CCB and non-CCB groups. A third of the participants with GO were 70 years and above while those without were majorly in the fifth and sixth decade of life. Two-third of those with DIGO had fair oral hygiene status, two-fifth had gingival bleeding and three-fifth had mild gingival inflammation. Those without DIGO in both groups had a slight female predominance and majorly good oral hygiene. Associated factors with DIGO were female sex, 60-69 age group, 10mg drug dosage, been on medication less than 10 years, mild gingival inflammation and generalized gingivitis. Conclusion: There was no difference in the prevalence of DIGO between BBC and non-BBC users. However, there was mild gingival inflammation in all participants with DIGO and amlodipine users were three times more at risk of developing DIGO than nifedipine users. Thus, it is imperative to advise the hypertensives on the importance of maintaining adequate oral hygiene measures and incorporate periodontal care in their management so as to ameliorate the side effects of their medication.

Enamel Renal Syndrome: Protocol for a Scoping Review

Background Enamel renal syndrome (ERS) (OMIM 204690) is a rare autosomal recessive disorder characterized by hypoplastic amelogenesis imperfecta, failed tooth eruption, intrapulpal calcifications, gingival enlargement, and nephrocalcinosis. The rarity of the condition and the variability of the phenotype has led to ERS not being fully characterized. Objective This scoping review aims to account for the range and current state of knowledge on ERS and synthesize these findings into a comprehensive summary, focusing on the pathophysiology, genotype-phenotype correlations, and patient management from a dental perspective. Methods The authors will conduct a systematic search of PubMed (MEDLINE), BioMed Central, EbscoHost Web, Web of Science, and WorldCat. We will include all studies with human participants with a confirmed diagnosis of ERS. Articles will be screened in two stages (ie, initially by title and abstract screening and then full-text screening by two independent reviewers). Data extraction will be conducted using a customized electronic data extraction form. We will provide a narrative synthesis of the findings from the included studies. We will structure the results according to themes. Results This protocol is registered with the Open Science Framework. The electronic search was conducted in July 2020 and updated in April 2021. The research findings will be published in an open access journal. Conclusions Dentists should be able to identify patients with clinical features of ERS so that they receive appropriate referrals for renal evaluation, genetic counseling, and oral rehabilitation to increase the patient’s quality of life. A scoping review is the most appropriate method to conduct this comprehensive exploration of the current evidence, which may be sparse due to the rarity of the condition. It will also enable us to identify gaps in the research. Trial Registration Open Science Framework; https://osf.io/cghsa International Registered Report Identifier (IRRID) DERR1-10.2196/29702

Epulis gravidarum with histological features of plasma cell granuloma associated to herbal toothpaste: A case report

Hormonal imbalance during the pregnancy may predispose a localized gingival enlargement called epulis gravidarum. This paper aims to elaborate on a case of epulis gravidarum with histological features of plasma cell granuloma. Theoretically, they present in different histological features. However, in this case, the histological examinations showed both entities.

Clinopathological assessment of epulis lesions from Sindh Pakistan

BACKGROUND & OBJECTIVES: Gingival enlargement is a common characteristic of gums infection. Enlargement of the gums can possibly occur due to numerous factors, comprising of inflammatory disorders as well as certain meditational side effects. Pyogenic granuloma expresses as red, small erythematous papules on pedunculated or rather sessile base. The current study aims to evaluate the cases of epulis and to grade histological types of epulis. METHODOLOGY: This descriptive cross-sectional study was carried out at oral surgery OPD ISRA Dental College for a six-month duration. The diagnosis of epulis was made on the basis of clinical and histological examination. The research data was recorded on pre-designed proforma, and data were analyzed using SPSS version 22.0 (IBM, Corporation). RESULTS: Out of 150 study subjects, 90 (60%) patients were female, while 60 (40%) were male. Majority of the cases in our study were found with a maxillary site (n=93, 62.0%). Most had a size of 2cm-3cm (n=132, 76%). Coral Pink color was the most common in (n=90, 60%) patients, followed by red color (n=45, 30%) and pale color was found in (n=15,10%) of the cases. The histological findings proved pyogenic granuloma was most common in (n=75, 50%) of the cases followed by fibrous epulis (n=63, 42%), peripheral giant cell granuloma (n=6, 4%) and Peripheral ossifying fibroma (n=6, 4%). CONCLUSION: Pyogenic granulomas are the most prevalent reactive lesion. The lesions were more common in females in maxilla portion, and they were mostly found in the second to third decade of life.

Hyaline fibromatosis syndrome: a case presenting with gingival enlargement as the only clinical manifestation and a report of two new mutations in the ANTXR2 gene

Background Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder caused by mutations in the gene for anthrax toxin receptor-2 (ANTXR2). The clinical features of HFS include skin thickening with nodules, papules and plaques, gingival enlargement, joint stiffness and contractures, and systemic manifestations. Notably, in all patients with HFS reported in the literature, gingival enlargement has never occurred alone. Case presentation A case of a child with gingival enlargement as the only clinical manifestation, who was later diagnosed with HFS, is described. In this case, the absence of skin and joint lesions and other characteristic clinical presentations gave rise to a diagnostic problem. This uncommon condition was clinically indistinguishable from other diseases or conditions that presented with diffuse gingival enlargement. A definitive diagnosis of HFS was reached through genetic analysis. Trio whole exome sequencing revealed compound heterozygous mutations of ANTXR2 in this patient and two new mutations were reported. Conclusions The findings of this case serve as an important reminder to clinicians. When dental practitioners encounter gingival manifestations of HFS without accompanied skin or joint involvement, there is a need to pay attention to the differential diagnosis and increase awareness of HFS.

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.

Oral findings in patients with chronic kidney disease: A cross-sectional descriptive study in Cuenca, Ecuador

Objective: To determine the different oral findings in patients with renal insufficiency, chronic. Methods: A descriptive cross-sectional study was carried out that included 123 individuals who were diagnosed with renal insufficiency, chronic and underwent dialysis treatment at the Renal Services Unit of the Austro of the city of Cuenca-Ecuador. Once the study was approved by the Research Directorate of the Faculty of Dentistry (DIFO) of the University of Cuenca (code UC-DIFO-PROY-17-010), the oral cavity of the patients was examined to detect gingival enlargement non-inflammatory, hemorrhagic lesions (purpura and ecchymosis), uremic stomatitis and oral candidiasis. Data analysis was performed using the IBM-SPSS Statistics 20.0 program for Windows software (IBM Corporation, Armonk, NY, USA); the results were presented in simple distribution tables by calculating their percentage frequency. Results: Of the 123 subjects who participated in this study, 52% (n=64) were women, while 48% (n=59) were men. The mean age of the study population was 60.2 (SD: 14.6) years. Oral findings were described in 74% (n= 91) of patient’s with renal insufficiency, chronic. Among them were: non-inflammatory gingival enlargement (64.7%) (n=57), hemorrhagic lesions such as purpura and ecchymosis (57.7%) (n=71), uremic stomatitis (10.6%) (n=13) and oral candidiasis (8.1%) (n=10). Conclusion: Patients with renal insufficiency, chronic present important oral findings that should be identified and treated during dental practice.

Calcium-Channel-Blocker-Influenced Gingival Enlargement: A Conundrum Demystified

The aim of the article is to discuss the development of calcium channel blocker (CCB) influenced gingival enlargement. Data and Sources: MEDLINE/PubMed, Scopus, ScienceDirect, and Google Search databases. The article reviews contemporary and classic literature with a focus on pathophysiology, clinical presentation, and risk factors associated with this condition. The application of various treatment options is also discussed. Study selection: Clinical studies, systematic reviews, in vitro studies, and case reports. Conclusion: Dental plaque, genetic predisposition, and type of drug used are critical in the development of drug-influenced gingival enlargement (DIGE). The surgical technique employed to treat the pathosis plays an important role in long term success of therapy. There has been an upward trend in occurrence of CCB-influenced gingival enlargement due to the unbridled use of CCBs. Due to the cosmetic and functional ramifications; the review underscores the importance of clinical research on prevention, treatment, and causes of recurrence of CCB-influenced gingival enlargement.

The “Epulis” Dilemma. Considerations from Provisional to Final Diagnosis. A Systematic Review

“Epulis” is a widely used term to describe a localized gingival enlargement. However, a wide range of neoformations might present as localized, slow-growing, asymptomatic gingival masses. A systematic review was conducted to outline the pathological entities that were provisionally dignosed as “epulis” and whose final diagnosis was made after microscopic examination. An electronic search of PubMed, Google Scholar and Scopus databases from January 2000 to February 2021 was performed. An initial search of the databases identified a total of 864 documents, and after a careful process of screening and selection, 14 studies were included in this systematic review and processed for data extraction. The results show that histological examination, sometimes combined with immunohistochemistry, might reveal a wide spectrum of lesions, including hamartomatous lesions, non-neoplastic lesions, benign and malign neoplasms and metastases from distant cancers.