• Journal of Periodontal and Implant Science
• /
• v.30 no.2
• /
• pp.359-374
• /
• 2000

Cyclosporine A(CsA) is a widely used immunosuppressant for transplant patients and is also used for the treatment of a wide variety of systemic diseases with immunologic disorders. However, its use is frequently limited because of complications such as nephrotoxicity or gingival hyperplasia. Although several hypotheses have been postulated for CsA-induced gingival hyperplasia, i.e. various cytokine effects of inflammatory cells, existence of plaque or CsA itself, but its pathogenesis is still unclear. For experimental chronic CsA toxicity, salt depletion has been shown to increased susceptibility of rodents to the effects of CsA, and this maneuver facilitates production of arteriolopathy and interstitial fibrosis in kidney that mimic the changes found in human. The purpose of this study was to evaluate pathogenesis of CsA-induced gingival hyperplasia by comparing changes between CsA administration groups of normal standard diet and those of low salt diet group. Specific pathogen-free, 20 to 25 days old(120 to 150 g), male Fisher-344 rats(KIST, Korea), 120 to 150g of body weight, were assigned to four groups of six animals each after one week of adaptation period for powder food. Group 1 received olive oil($300{\mu}l/g\;of\;diet$) with normal standard diet(0.4% of sodium)(NSD). Group 2 received CsA(Cypol-N, Jonggundang, Korea; $300{\mu}g/g\;of\;diet$) with normal standard diet(NSD+CsA). Group 3 received same amount of olive oil with low salt diet(0.05 % of sodium, Teklad Premier, U.S.A.)(LSD). Group 4 received same dose of CsA with low salt diet(LSD+CsA). Rats were pair fed and were sacrificed after six weeks. Renal histologic lesions associated with CsA, consisted of cortical interstitial fibrosis, tubular atrophy and hyalinization of arterioles and the impairment of renal function including increase of serum creatinine and decrease of glomerular filtration rate was more severe in low salt diet group. These were proved as the results of activated of renin-angiotensin system in the kidney by low salt condition. Meanwhile the degree of gingival hyperplasia at incisor and molar tooth was less severe in low salt diet group compared with normal sodium diet group. Hyperplastic gingiva showed mild epithelial hyperplasia and expanded underlyng stroma which consisted of matrix increasement, capillary proliferation and dilatation. While the number and the activation of fibroblasts were increased, inflammatory cells were rare in the stroma. The immunohistochemistry for TGF-${\beta}_1$ in the kidney and gingiva revealed stronger positive in LSD+CsA in kidney but in gingiva of NSD+CsA. These results suggested followings; Gingival hyperplasia can be developed without inflammatory cells infiltration and seemed not induced by CsA by itself. The major role for gingival hyperplasia by CsA would be the secondary effect of TGF-${\beta}$, which maybe upregulated by CsA administration. Low salt diet can attenuate this hyperplasia perhaps by decreasing the activation of $TGF-{\beta}$.

• Journal of Periodontal and Implant Science
• /
• v.24 no.2
• /
• pp.357-375
• /
• 1994

The purpose of this study was to investigate the differences of histochemical characteristics in inflammatory fibrous gingival hyperplasia (FGH), phenytoin-induced gingival hyperplasia(PIGH), idiopathic gingival hyperplasia(IDGH) and control groups (healthy and inflammatory gingiva) by immunohistochemical method with various antibodies and histomorphological analysis. In immunohistochemical finding, antibodies to inflammatory cells (T/B lymphocytes, macrophages, other monocytes), proliferating cell nuclear antigen(PCNA), epidermal growth factor(EGF), factor VIII, and type I collagen were used. 1. The inflammatory infiltrates in FGH were less than those in inflammatory gingiva. The composition of inflammatory cells of PIGH was similar with that of FGH. IDGH showed a similar histologic findings with healthy gingival tissue. 2. In FGH, the number of fibroblasts and newly-formed collagen fibers was increased. No significant increase of fibroblasts and the dense accumulation of thick collagen fibers were seen in PIGH. The increase of fibroblasts and the dense accumulation of thick collagen were seen in IDGH. 3. PCNA-positive cells were localized mainly in the area accumulated with inflammatory cells and blood vessels, significantly increased in all hyperplastic tissue groups, and distributed evenly in IDGH. 4. The distribution of EGF were not observed in healthy gingiva but detected locally in area with confluent blood vessels,without significant difference between the other tissue groups. This results suggest that inflammation plays a significant role in inducing hyperplastic change of gingival tissue. While in DIGH, drug itself as well as inflammation seems to attribute to hyperplastic change.

• The Journal of Advanced Prosthodontics
• /
• v.6 no.6
• /
• pp.555-558
• /
• 2014

Focal epithelial hyperplasia (FEH) is a human papillomavirus (HPV)-induced alteration of the oral mucosa that presents with a clinically distinct appearance. While other HPV-infected lesions such as squamous papilloma, verruca vulgaris, and condyloma acuminatum involve the skin, oral mucosa, and genital mucosa, FEH occurs only in the oral mucosa. The affected oral mucosa exhibits multiple papules and nodules with each papule/nodule being flat-topped or sessile. The affected region resembles the normal color of oral mucosa rather than appearing as a white color since the epithelial surface is not hyperkeratinized. Almost all cases present with multiple sites of occurrence. This rare, benign epithelial proliferation is related to low-risk HPV, especially HPV-13 and -32, and is not transformed into carcinoma. We report a case of FEH that arose on the attached gingiva of an East Asian male adult related to prosthesis without detection of any HPV subtype in HPV DNA chip and sequencing.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.29 no.4
• /
• pp.581-585
• /
• 2002

Focal epithelial hyperplasia(FEH) is Human papilloma virus - induced, localized proliferation of oral squamous epithelium. FEH usually occurs in the childhood, but occasionally affects the young and middle-aged adults. Sites of the greatest involvement include the labial, buccal and lingual mucosa, but lesions of gingiva or tongue have also been reported. This disease is typically characterized by multiple soft, non-tender flattened papules and plaques. Occasional lesions show a slight papillary surface change. Individual lesions are small, discrete and well demarcated. The histopathologic hallmark of FEH is acanthosis of the oral epithelium. Cells demonstrating viral cytopathic changes including koilocytes or mitosoid cells may be present. The 5-year-old female of this case visited Department of Pediatric Dentistry, College of Dentistry, Yonsei University with a chief complaint of exophytic lesions on gingiva. Sessile papillary papules were detected by clinical examination on buccal gingiva at the maxillary left and right second deciduous molars. The patient did not complain of pain by palpation. An excisional biopsy was carried out for a histological examination and acanthosis was observed. The lesions were diagnosed as FEH. FEH would regress spontaneously after several months or years. Conservative excision may be performed for diagnostic or esthetic purpose. The risk of recurrence after this therapy is minimal, and there is no malignant transformation.

• Journal of Yeungnam Medical Science
• /
• v.3 no.1
• /
• pp.383-386
• /
• 1986

Enlargement of the gingiva caused by phenitoin, an anticonvulsant used in the treatment of epilepsy, occurs in some of the patients receiving the drug. Its incidence varies from 3 to 62 percent, with the greater frequencies in younger patients. The hyperplasia is usually generalized throughout the mouth, but is more severe tendency in the maxillary and mandibular anterior regions, 18 year old male patient was admitted to our Department of Dentistry with the complaint of generalized painless gingival swelling. After the consult of the N.M. and laboratory study, the gingivectomy and gingivoplasty was performed. The periodontal pack and tin foil was applied on the attached gingiva to protect a surgical site and bleeding control. We obtained a good result of improved esthetics and function.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.24 no.3
• /
• pp.470-475
• /
• 2010

Calcium-channel blockers such as nifedipine could be associated with gingival overgrowth. The aim of this study was to examine the role of Paeonia lactiflora Pallas(PLP) on nifedipine-induced gingival hyperplasia along with submandibular secretory function in rats. Animals in divided groups received nifedipine (250 mg/kg) alone and in PLP(100, 200 mg/kg) in orally administration for 3 weeks. Pure submandibular saliva was collected intraorally by micropolyethylene cannula and the mandibular gingiva was examined by means of dissecting microscope for signs of redness, tickness, inflammation and exuda. Twenty-one days nifedipine treatment induced gingival hyperplasia accompanied with reduced salivary flow rate and concentrations total protein, epidermal growth factor(EGF) and calcium in comparison with normals. Co-treatment of animals with nifedifine and PLP protected from gingival hyperplasia and retained flow rate, and concentrations of total protein, EGF and calcium in normal levels.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.25 no.3
• /
• pp.499-505
• /
• 1998

Idiopathic gingival hyperplasia is a rare condition of undetermined etiology. The enlargement is usually associated with the emergence of the teeth into the oral cavity and may regress after extraction. The enlarged gingiva may be primarily attributed to hyperplasia of the subepithelial layer that is relatively avascular and consists of densely arranged collagen bundles and numerous fibroblasts. The recommended time for treatment is after completion of eruption of permanent teeth. But the most important thing is the patient's psychological and esthetic needs. Lately, Schluger has proposed modified gingivectomy procedure with horizontal, internal beveled incision for thinning of the flap resulting in less pain and bleeding after treatment, minimal opportunity of infection. The purpose of this report is to document a case of 8-year-old girl who had registered in Dept. of Pediatric Dentistry of Seoul National University dental hospital for treatment of her gingival hyperplasia and delayed tooth eruption

• The Journal of the Korean dental association
• /
• v.52 no.12
• /
• pp.720-725
• /
• 2014

Generalized gingival enlargement, also known as gingival hyperplasia or hypertrophy, is defined as an abnormal diffuse overgrowth of gingival tissues. There are several causes of generalized gingival enlargement and they can be grouped into four categories: hereditary gingival fibromatosis, medication-induced, inflammatory, and systemic or neoplastic causes of gingival enlargement. This paper reviews the clinical features, differential diagnosis and significance of generalized gingival enlargements.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.27 no.4
• /
• pp.346-349
• /
• 2005

Metastatic tumours to oral soft tissue are uncommon and accounts for approximately 1% of malignant oral neoplasms. Because of its rarity and clinical appearance of benign nature, the diagnosis of a metastatic lesion in the oral soft tissue may be challenging, both to clinicians and pathologists. We analyzed the clinical data of 9 patients who had metastatic carcinoma to oral soft tissues. The metastatic site to oral soft tissue was the gingiva in all cases. The most common primary site was lung (6 cases) followed by liver (2 cases) and breast (1 case). The clinical appearance resembled gingiva hyperplasia, pyogenic granuloma or gingival swelling. In one case, the metastatic gingiva lesion was found before detection of primary cancer. The mean survival time after diagnosis of metastatic lesion was 3 months. Although this metastatic lesion is rare, oral and maxillofacial surgeon should recognized that benign inflammatory lesion may be the metastatic malignant lesion or the first sign of undiagnosed underlying malignancy.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.1
• /
• pp.145-149
• /
• 2009

Sturge-Weber Syndrome is a rare congenital disorder and is characterized by port wine nevus following one or more divisions of trigeminal nerve, ocular involvement(eg, glaucoma) and neurologic involvement(eg, epilepsy, mental retardation). Oral menifestations include unilateral blood vessel expansion of the oral mucosa and gingiva, gingival hyperplasia, giant tooth, ipsilateral large tongue, blood vessel anomaly of maxilla or mandible and abnormal eruption sequence. This case report is about 8-year-old Sturge-Weber Syndrome patient presented violet discoloration on upper gingiva and buccal mucosa, gingival hyperplasia and abnormal eruption sequence. In this case, we performed lingual frenectomy and periodic oral hygiene management, and obtained satisfactory result.