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  • 1
    Electronic Resource
    Electronic Resource
    Prevalence of gingival overgrowth in transplant patients immunosuppressed with tacrolimus (2004)
    Oxford, UK : Munksgaard International Publishers
    Journal of clinical periodontology 31 (2004), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aims: The study aims to determine the prevalence and severity of gingival overgrowth in a group of adult organ transplant recipients immunosuppressed with tacrolimus in comparison with ciclosporin, and to examine various risk factors for the development of gingival overgrowth.Methods: Forty patients taking tacrolimus were compared with 197 ciclosporin patients. Demographic, pharmacological and periodontal data were recorded for all patients. Comparison between the groups was made using independent sample t-tests, χ2 statistic or Mann–Whitney test. The effects of risk variables on overgrowth severity were examined using forward and backward stepwise regression analysis.Results: Those taking tacrolimus had a significantly lower mean gingival overgrowth score (14.1%) compared with ciclosporin (22.4%). Fifteen percent of the tacrolimus group had clinically significant gingival overgrowth compared with 30% in the ciclosporin group (p=0.053).Conclusions: The prevalence and severity of gingival overgrowth is less in adult transplant patients taking tacrolimus compared with ciclosporin. Concomitant use of calcium channel blockers and previous medication with ciclosporin are significant risk factors for the presence and severity of gingival overgrowth. Patients who have alteration of their immunosuppressant from ciclosporin to tacrolimus may persist in demonstrating gingival overgrowth attributable to their ongoing therapy with calcium channel blockers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.0303-6979.2004.00459.x
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  • 2
    Electronic Resource
    Electronic Resource
    Risk factors for drug-induced gingival overgrowth (2000)
    Copenhagen : Munksgaard International Publishers
    Journal of clinical periodontology 27 (2000), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background/Aims: Drug-induced gingival overgrowth remains a significant problem for the periodontologist. Many patients medicated with the drugs implicated in this unwanted effect experience significant, recurrent gingival problems that require repeated surgical excisions. In this review, we attempt to identify and quantify the various “risk factors” associated with both the development and expression of the drug-induced gingival changes.Method: The risk factors appraised include age, sex, drug variables, concomitant medication, periodontal variables and genetic factors. Elucidation of such factors may help to identify “at risk patients” and then develop appropriate treatment strategies.Results: Of the factors identified, the only one that can be affected by the periodontologist is the patents' periodontal condition. However, drug variables and concomitant medication do impact upon the expression of gingival overgrowth.Conclusion: The identificatioin of risk factors associated with both the prevalence and severity of drug-induced gingival overgrowth is important for all parties involved with this unwanted effect. Both periodontologist and patient have an important rôle to play in improving oral hygiene and gingival health. Likewise, there is always an opportinity to establish a close liaison between the patient's physician and the periodontologist to try and identify alternative drug regimens that can help reduce the impact of this unwanted effect.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1034/j.1600-051x.2000.027004217.x
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  • 3
    Electronic Resource
    Electronic Resource
    Photographic scoring of gingival overgrowth (2001)
    Copenhagen : Munksgaard International Publishers
    Journal of clinical periodontology 28 (2001), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: A wide range of methods have been employed to determine the severity of gingival overgrowth resulting in uncertainty regarding the prevalence of the side-effect. There is no simple, non-invasive, objective, blind method for assessing gingival overgrowth.Aim: This article aims to describe a method which is suitable for use in large-scale population studies.Materials and Methods: Photographs were taken of the anterior, buccal gingivae and teeth of 925 patients medicated with calcium channel blockers. In addition, each patient was ascribed a clinical gingival overgrowth score. 100 patients had repeat photographs, and a further 10 patients had alginate impressions taken. The models were scored for severity of gingival overgrowth using a described technique. The slides were scored using a modification of this technique.Results: When photographic and study model scores were compared, photographic scores were consistently higher, and as a result, a photographic score of 38.6% was considered to represent a significant overgrowth. There was good agreement between clinically determined scores and photographic scores (κ=0.71).Conclusions: The results indicate that this method is suitable for large-scale population studies where it also has the advantage of providing a continuous scale of gingival changes for subsequent statistical analysis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-051X.2001.280112.x
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  • 4
    Electronic Resource
    Electronic Resource
    Cardiovascular diseases and periodontology (2003)
    Oxford, UK : Munksgaard International Publishers
    Journal of clinical periodontology 30 (2003), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  Cardiovascular diseases represent a widespread heterogeneous group of conditions that have significant morbidity and mortality. The various diseases and their treatments can have an impact upon the periodontium and the delivery of periodontal care.Aim:  In this paper we consider three main topics and explore their relationship to the periodontist and the provision of periodontal treatment.Method:  The areas reviewed include the effect of cardiovascular drugs on the periodontium and management of patients with periodontal diseases; the risk of infective endocarditis arising from periodontal procedures; the inter-relationship between periodontal disease and coronary artery disease.Results and conclusions:  Calcium-channel blockers and β-adrenoceptor blockers cause gingival overgrowth and tooth demineralisation, respectively. Evidence suggests that stopping anticoagulant therapy prior to periodontal procedures is putting patients at a greater risk of thromboembolic disorders compared to the risk of prolonged bleeding. The relationship between dentistry and infective endocarditis remains a controversial issue. It would appear that spontaneous bacteraemia arising from a patient's oral hygiene practices is more likely to be the cause of endocarditis than one-off periodontal procedures. The efficacy of antibiotic prophylaxis is uncertain (and unlikely to be proven), and the risk of death from penicillin appears to be greater than the risk of death arising from infective endocarditis. Finally, the association between periodontal disease and coronary artery disease has been explored and there seem to be many issues with respect to data handling interpretation. Many putative mechanisms have been suggested; however, these only further highlight the need for intervention studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1034/j.1600-051X.2003.00291.x
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  • 5
    Electronic Resource
    Electronic Resource
    Plasma TGF-β1 as a risk factor for gingival overgrowth (2004)
    Oxford, UK : Munksgaard International Publishers
    Journal of clinical periodontology 31 (2004), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background and Aims: Induction of the pro-fibrotic growth factor TGF-β1 has been suggested as a possible mechanism through which immunosuppressant drugs may induce gingival overgrowth. This study aims to investigate plasma levels of TGF-β1 and relate them to the development and severity of gingival overgrowth in immunosuppressed transplant patients.Materials and Methods: One hundred and thirty-two ciclosporin-treated and 13 tacrolimus-treated transplant patients and 24 drug-free control subjects underwent a full periodontal examination including a determination of the presence and severity of gingival overgrowth.Results: Plasma TGF-β1 concentrations were determined by ELISA, and were found to be significantly elevated in samples from the transplant patients (mean=29.1 ng/ml) as compared with controls (mean=6.1 ng/ml, p〈0.0001). There was no significant difference between the levels of plasma TGF-β1 in the ciclosporin- and tacrolimus-treated patient groups.Conclusions: Furthermore, concomitant treatment with calcium channel blockers did not influence the levels of plasma TGF-β1 in the patients group. The relationship between gingival overgrowth, independent periodontal variables and TGF-β1 plasma concentrations was examined using univariate and multivariate regression analyses; low TGF-β1 plasma concentrations were found to be a risk factor for gingival overgrowth in immunosuppressed patients concomitantly receiving a calcium channel blocker.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-051X.2004.00572.x
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  • 6
    Electronic Resource
    Electronic Resource
    Amlodipine-induced gingival overgrowth (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of clinical periodontology 21 (1994), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Amlodipine is a calcium channel blocker used in the management of angina and hypertension. We report 3 cases of gingival overgrowth in adult dentate patients associated with chronic usage of this drug. Gingival changes occurred within 3 months of dosage and appeared to be compounded by the patient's existing periodontal condition. In all 3 patients, there was sequestration of amlodipine in their crevicular fluid. The significance of this finding in relation to the pathogenesis of this unwanted effect remains to be elucidated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-051X.1994.tb00318.x
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  • 7
    Electronic Resource
    Electronic Resource
    Analysis of changes in gingival contour from three-dimensional co-ordinate data in subjects with drug-induced gingival overgrowth (2005)
    Oxford, UK : Munksgaard International Publishers
    Journal of clinical periodontology 32 (2005), S. 0 
    Details
    ISSN: 1600-051X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives: This aim of this study was to develop and assess a technique that could be used to assess accurately the gingival volume changes seen in drug-induced gingival overgrowth by the analysis of data obtained from an entire gingival surface by means of three-dimensional imaging.Material and Methods: Stone dental models of patients before and after gingivectomy procedures were digitized with a laser scanner and then regenerated as computer models constructed from the acquired three-dimensional co-ordinate data. A comparison of superposed “before” and “after” surfaces was undertaken to assess and accurately quantify changes in gingival contour.Results: The mean vertical tissue reduction varied from 1.58 to 2.56 mm in the four study subjects and individual differences are shown. The maximum thickness of removed buccal gingival overgrowth was found to range between 1.20 and 3.40 mm. The volume of tissue removed from each inter-dental papilla ranged from 4.2 to 46.1 mm3 and the mean volume of the papilla removed from each subject±SD values was 24.8±13.1 mm3.Conclusion: This method will measure changes in gingival tissues to within 60 μm in one plane, making it ideal for the assessment of longitudinal changes in gingival contour as seen in the development of gingival overgrowth, its recurrence after surgery or the changes in volume brought about by surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-051X.2005.00769.x
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  • 8
    Electronic Resource
    Electronic Resource
    Adjuvant Composition Determines the Induction of Type II Collagen-Induced Arthritis (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Scandinavian journal of immunology 36 (1992), S. 0 
    Details
    ISSN: 1365-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In this sludy we have investigated the influence of adjuvant composition on the development of collagen-induced arthritis and of anti-collagen type II specific B- and T-cell responses rollowing immunization with type II collagen. DBA/1 mice immunized with bovine collagen type II emulsified in complete Freund's adjuvant (CFA) containing Mycobacterium tuberculosis strain H37Ra developed footpad swelling indicative of arthritis. Animals immunized with collagen type 11 plus CIA containing Mycobacterium butyricum or incomplete Freund's adjuvant showed no significant increase in footpad width. Induction of anti-CII specific T-cell proliferation was also dependent upon immunization with CM plus CFA containing M. tb H37RA. In contrast, ovalbumin-reactive T-cell proliferation was unaffected by the species of mycobacteria, indicating that the difference in adjuvant activity of the mycobacterial species is specific for anti-collagen type II T-cell responses. Antibody response to collagen type II, unlike T-cell responses, was not significantly different using the two adjuvants. This study therefore demonstrates that murine collagen-induced arthritis requires immunization with collagen type II together with complete Freund's adjuvant containing Mycobaterium tuberculosis H37RA. Since only this combination of antigen and adjuvant induces detectable arthritis and T-cell responses against collagen type II, while antibody synthesis does not have such stringent adjuvant requirements, this suggests that the development of the full pattern of the collagen-induced arthritis disease requires synergistic activation of both humoral and cell-mediated responses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-3083.1992.tb02939.x
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  • 9
    Electronic Resource
    Electronic Resource
    Disposition of nifedipine in plasma and gingival crevicular fluid in relation to drug-induced gingival overgrowth (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of periodontal research 28 (1993), S. 0 
    Details
    ISSN: 1600-0765
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The present study investigates the relationship between the pharmacokinetic variables of nifedipine with the incidence and severity of gingival overgrowth in 9 adult male patients medicated with the drug for at least 6 months. Five of the patients had experienced significant gingival changes and were thus designated “responders”. The remaining four patients exhibited no gingival overgrowth, and thus acted as a control. A baseline periodontal examination (plaque scores, bleeding index and gingival overgrowth assessment) was carried out on each patient, and confined to the upper and lower anterior teeth. Serial blood and gingival crevicular fluid samples were collected over an eight-hour investigation period. Samples were analyzed for nifedipine by gas chromatography. No significant difference (p〉0.05) was seen between responders and non-responders with regard to drug therapy, periodontal parameters or plasma pharmacokinetics of nifedipine. Nifedipine was detected in the gingival crevicular fluid of seven subjects (all responders, and two non-responders). The peak concentration of nifedipine in crevicular fluid was 15–90 fold greater than levels observed in plasma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1600-0765.1993.tb01081.x
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  • 10
    Electronic Resource
    Electronic Resource
    Genetic and antigenic variation in the haemagglutinin of recently circulating human influenza A (H3N2) viruses in the United Kingdom (1995)
    Springer
    Archives of virology 140 (1995), S. 1889-1904 
    Details
    ISSN: 1432-8798
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Variation in the haemagglutinin (HA) gene of influenza A (H3N2) viruses isolated in the U. K. and abroad from 1992–1994, was determined by nucleotide sequencing of the HA1 domain of the HA gene. Viruses isolated in the U.K. early in the 1992–93 season were from the A/Beijing/353/89 lineage and were replaced later that season by viruses from the A/Beijing/32/92 lineage. Viruses from the new lineage continued to be isolated during the 1993–94 season, but were heterogeneous. Most of these isolates were more closely related to an A/Beijing/32/92 variant, A Hong Kong/23/92, but could be distinguished into three groups by serology (of which one group was circulating during the previous season) and four groups based on sequence variation in the HA gene. However, phylogenetic analysis of antigenically-distinct isolates showed that the HA gene is evolving along one lineage. Sequence analysis identified mainstream, subgroup and strain specific amino acid substitutions. There was a broad correlation between the observed amino acid changes and the antigenic sites of the HA. The results of this study highlight the value of regular molecular analysis of circulating viruses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01322680
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