The Journal of Korea Assosiation for Disability and Oral Health (대한장애인치과학회지)

Korean Association for Disability and Oral Health (대한장애인치과학회)
권호 표지
DOI QR코드

DOI QR Code

VALPROATE-INDUCED GINGIVAL OVERGROWTH : A CASE REPORT

Valproate 연관 치은 증식 : 증례 보고

  • Song, Jihyeo (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Lee, Koeun (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Shin, Minkyung (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Oh (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Choi, Byungjai (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Choi, Hyung-Jun (Department of Pediatric Dentistry, College of Dentistry, Yonsei University)
  • 송지혜 (연세대학교 치과대학 소아치과학교실) ;
  • 이고은 (연세대학교 치과대학 소아치과학교실) ;
  • 신민경 (연세대학교 치과대학 소아치과학교실) ;
  • 김성오 (연세대학교 치과대학 소아치과학교실) ;
  • 최병재 (연세대학교 치과대학 소아치과학교실) ;
  • 최형준 (연세대학교 치과대학 소아치과학교실)
  • Received : 2018.07.12
  • Accepted : 2018.08.06
  • Published : 2018.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Drug-induced gingival overgrowth is an abnormal increase of gingival tissues caused as a side effect of systemic medication. This report presents a severe case of valproate-induced gingival overgrowth combined with ulcerative and hemorrhagic lesions in a patient with Lennox-Gastaut syndrome. Considering the patient's limited cooperative ability, gingivectomy and excisional biopsy under general anesthesia were performed. The lesions were successfully treated without recurrence. When gingival enlargement does not subside with nonsurgical treatments, surgical procedure and excisional biopsy are to be performed. Postoperative management of oral hygiene is critical to prevent recurrence.

Keywords

KDOHJY_2018_v14n2_92_f0001.png 이미지

Fig. 1. (A) Intraoral photograph and (B) Periapical radiograph taken on the patient’s first visit to the clinic. Gingival overgrowth is observed on mandibular left molar area.

KDOHJY_2018_v14n2_92_f0002.png 이미지

Fig. 2. (A-C) Preoperative intraoral photographs and (D-F) Postoperative intraoral photographs taken in operating room. (A) and (D) show the maxillary right quadrant. (B) and (E) show the mandibular left quadrant. (C) and (F) show the mandibular right quadrant.

KDOHJY_2018_v14n2_92_f0003.png 이미지

Fig. 3. (A-C) Histopathological examination of gingival overgrowth. (A) Low-power view showing excess fibrous connective tissue and hemorrhage (H-E, X40). (B) Excessive fibrous connective tissue (HE, X100). (C) Extensive hemorrhage (HE, X100). (D) Mature cancellous bone with fibrous stroma (H-E, X100).

References

  1. Newman M, Takei H, Klokkevold P, Carranza F : Carranza's clinical periodontology, 11th ed., Elsevier/Saunders, 2012.
  2. Brunet L, Miranda J, Farre M, et al. : Gingival enlargement induced by drugs. Drug Saf, 15:219-231, 1996. https://doi.org/10.2165/00002018-199615030-00007
  3. Rees TD, Levine RA : Systematic drugs as a risk factor for periodontal disease initiation and progression. Compendium, 16:20, 22, 26 passim; quiz 42, 1995.
  4. Dongari A, McDonnell HT, Langlais RP : Drug-induced gingival overgrowth. Oral Surg Oral Med Oral Pathol, 76:543-548, 1993. https://doi.org/10.1016/0030-4220(93)90027-2
  5. Dahllof G, Preber H, Eliasson S, et al. : Periodontal condition of epileptic adults treated long-term with phenytoin or carbamazepine. Epilepsia, 34:960-964, 1993. https://doi.org/10.1111/j.1528-1157.1993.tb02118.x
  6. Markand ON : Lennox-Gastaut syndrome (childhood epileptic encephalopathy). J Clin Neurophysiol, 20:426-441, 2003. https://doi.org/10.1097/00004691-200311000-00005
  7. St Louis EK : Minimizing AED adverse effects: improving quality of life in the interictal state in epilepsy care. Curr Neuropharmacol, 7:106-114, 2009. https://doi.org/10.2174/157015909788848857
  8. Suneja B, Chopra S, Thomas AM, Pandian J : A clinical evaluation of gingival overgrowth in children on antiepileptic drug therapy. J Clin Diagn Res, 10:Zc32-36, 2016. https://doi.org/10.1111/crj.12178
  9. Kato T, Okahashi N, Ohno T, et al. : Effect of phenytoin on collagen accumulation by human gingival fibroblasts exposed to TNF-alpha in vitro. Oral Dis, 12:156-162, 2006. https://doi.org/10.1111/j.1601-0825.2005.01175.x
  10. Behari M : Gingival hyperplasia due to sodium valproate. J Neurol Neurosurg Psychiatry, 54:279-280, 1991.
  11. Joshipura V : Sodium valproate induced gingival enlargement with pre-existing chronic periodontitis. J Indian Soc Periodontol, 16:278-281, 2012. https://doi.org/10.4103/0972-124X.99277
  12. Rodriguez-Vazquez M, Carrascosa-Romero MC, Pardal-Fernandez JM, Iniesta I : Congenital gingival hyperplasia in a neonate with foetal valproate syndrome. Neuropediatrics, 38:251-252, 2007. https://doi.org/10.1055/s-2007-985901
  13. Kataoka M, Shimizu Y, Kunikiyo K, et al. : Cyclosporin A decreases the degradation of type I collagen in rat gingival overgrowth. J Cell Physiol, 182:351-358, 2000. https://doi.org/10.1002/(SICI)1097-4652(200003)182:3<351::AID-JCP5>3.0.CO;2-U
  14. Kataoka M, Shimizu Y, Kunikiyo K, et al. : Nifedipine induces gingival overgrowth in rats through a reduction in collagen phagocytosis by gingival fibroblasts. J Periodontol, 72:1078-1083, 2001. https://doi.org/10.1902/jop.2001.72.8.1078
  15. Dongari-Bagtzoglou A : Drug-associated gingival enlargement. J Periodontol, 75:1424-1431, 2004. https://doi.org/10.1902/jop.2004.75.10.1424
  16. Fitchie JG, Comer RW, Hanes PJ, Reeves GW : The reduction of phenytoin-induced gingival overgrowth in a severely disabled patient: a case report. Compendium, 10:314, 317-320, 1989.