Fay Ann Adams, Satheesh Keerthana, Gapski Ricardo
Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, 650 East 25th Street, Kansas City, MO 64108, USA.
J Periodontol. 2005 Jul;76(7):1217. doi: 10.1902/jop.2005.76.7.1217.
The potential of calcium channel blockers (CCBs) to induce gingival enlargement (GE) as well as the influence of diabetes mellitus on periodontal tissues has been well documented. This case report documents a conservative clinical approach to the management of felodipine-influenced gingival enlargement and displays a clinical and histologic case of felodipine-influenced GE in an undiagnosed type 2 diabetic patient.
At the initial examination, a medical consultation was requested and two incisional biopsies were taken for pathological evaluation. The patient was diagnosed with uncontrolled type 2 diabetes. Felodipine was withdrawn and the diabetes was controlled before dental treatment was initiated. The patient then underwent selective extractions and full-mouth scaling and root planing as well as oral hygiene instructions. No surgical therapy was indicated.
The histological results demonstrated the presence of elongated rete pegs; fibrous hyperplasia; a low-grade chronic inflammatory infiltrate, predominantly consisting of lymphocytes; and collagen bundle groups randomly distributed. These features were similar to those present in other drug-influenced GE. Clinical results have demonstrated almost complete resolution of GE after the withdrawal of felodipine and the control of diabetes. Further improvements were seen after scaling and root planing and oral hygiene instructions. No recurrences were noted 12 months after initial therapy.
This report demonstrated that the control of systemic factors seemed to have the most influence on success for this particular case. Since the control of diabetes was managed at the same time as the felodipine withdrawal, it remains difficult to speculate how these two factors impacted both the severity of the GE and the therapeutic results. More importantly, the conservative treatment rendered demonstrated the stability of periodontal status during maintenance phase and the avoidance of surgical interventions.
钙通道阻滞剂（CCB）诱发牙龈增生（GE）的可能性以及糖尿病对牙周组织的影响已有充分记录。本病例报告记录了一种治疗非洛地平所致牙龈增生的保守临床方法，并展示了一例未确诊的2型糖尿病患者受非洛地平影响的GE的临床和组织学病例。
在初次检查时，请求进行医学咨询并取了两块切口活检组织进行病理评估。该患者被诊断为2型糖尿病控制不佳。停用非洛地平并在开始牙科治疗前控制糖尿病。然后患者接受了选择性拔牙、全口洁治和根面平整以及口腔卫生指导。未进行手术治疗。
组织学结果显示存在延长的 rete 嵴；纤维增生；低度慢性炎症浸润，主要由淋巴细胞组成；以及随机分布的胶原束群。这些特征与其他药物所致GE中的特征相似。临床结果表明，停用非洛地平并控制糖尿病后，GE几乎完全消退。洁治和根面平整以及口腔卫生指导后有进一步改善。初始治疗12个月后未观察到复发。
本报告表明，对于该特定病例，全身因素的控制似乎对治疗成功影响最大。由于在停用非洛地平的同时控制了糖尿病，因此难以推测这两个因素如何影响GE的严重程度和治疗效果。更重要的是，所采用的保守治疗显示了维持期牙周状况的稳定性并避免了手术干预。
