Majola M P, McFadyen M L, Connolly C, Nair Y P, Govender M, Laher M H
Department of Pharmacology, University of Durban Westville, South Africa.
J Clin Periodontol. 2000 Jul;27(7):506-12. doi: 10.1034/j.1600-051x.2000.027007506.x.
To ascertain the prevalence and severity of phenytoin-induced gingival enlargement (PIGE) as well as the relationship between PIGE and risk factors.
An outpatient population of patients on phenytoin treatment and attending the epilepsy clinic at Prince Mshiyeni Memorial Hospital (PMMH) in Durban, South Africa, was requested to participate. A structured questionnaire was used to collect data on patients' demographics, social habits (e.g., drinking and smoking), dental and oral hygiene practices and medication history. Gingival enlargement, dental plaque and gingival bleeding was also measured to assess gingival health. Venous blood was collected for serum folate and phenytoin serum levels measurements. A regression analyses was then undertaken to ascertain the association between PIGE and the risk factors. Factors tested for correlation were serum phenytoin and folate levels, age, bacterial plaque, gingival inflammation, toothbrushing, smoking and alcohol consumption. The association between PIGE and the risk factors was assessed either individually, i.e., as a single entity or in combination--multifactorially.
Of the 134 patients studied, 62% had PIGE scores > or = 1, while 8% had a PIGE score of zero. With the exception of plaque, which showed a moderate association with PIGE (r=0.4), no other factor on its own was statistically significantly related to PIGE. In the multiple linear regression analysis, factors which on their own did not have a strong influence became more important. Bacterial plaque (p=0.0001), younger age (p=0.01) and higher free serum phenytoin levels (p= 0.03), were associated with PIGE. Although known to be associated with periodontal diseases, smoking and alcohol, (p=0.03 and p=0.04 respectively), appeared to give some protection against PIGE.
Risk factors associated with PIGE may have a synergistic effect. Bacterial plaque, however, appears the most important determinant of PIGE severity. This latter finding emphasises the importance of instituting a preventive plaque-control programme, particularly in young patients on phenytoin therapy.
确定苯妥英钠所致牙龈增生（PIGE）的患病率和严重程度以及PIGE与风险因素之间的关系。
邀请在南非德班的姆希耶尼王子纪念医院（PMMH）癫痫门诊接受苯妥英钠治疗的门诊患者参与研究。使用结构化问卷收集患者的人口统计学数据、社会习惯（如饮酒和吸烟）、牙齿和口腔卫生习惯以及用药史。还测量牙龈增生、牙菌斑和牙龈出血情况以评估牙龈健康状况。采集静脉血用于测定血清叶酸和苯妥英钠血清水平。然后进行回归分析以确定PIGE与风险因素之间的关联。检测相关性的因素包括血清苯妥英钠和叶酸水平、年龄、牙菌斑、牙龈炎症、刷牙、吸烟和饮酒。评估PIGE与风险因素之间的关联时，既单独评估，即作为单个因素，也综合评估——多因素评估。
在研究的134例患者中，62%的患者PIGE评分≥1，而8%的患者PIGE评分为零。除牙菌斑与PIGE呈中度关联（r = 0.4）外，其他因素单独来看与PIGE均无统计学显著相关性。在多元线性回归分析中，单独来看影响不显著的因素变得更为重要。牙菌斑（p = 0.0001）、较年轻的年龄（p = 0.01）和较高的血清游离苯妥英钠水平（p = 0.03）与PIGE相关。虽然吸烟和饮酒已知与牙周疾病有关（分别为p = 0.03和p = 0.04），但似乎对PIGE有一定的预防作用。
与PIGE相关的风险因素可能具有协同作用。然而，牙菌斑似乎是PIGE严重程度的最重要决定因素。后一发现强调了开展预防性牙菌斑控制计划的重要性，特别是对于接受苯妥英钠治疗的年轻患者。
