Gingival overgrowth is a well-documented unwanted effect, associated with phenytoin, cyclosporin, and the calcium channel blockers. The pathogenesis of drug-induced gingival overgrowth is uncertain, and there appears to be no unifying hypothesis that links together the 3 commonly implicated drugs. In this review, we consider a multifactorial model which expands on the interaction between drug and/or metabolite, with the gingival fibroblasts. Factors which impact upon this model include age, genetic predisposition, pharmacokinetic variables, plaque-induced inflammatory and immunological changes and activation of growth factors. Of these, genetic factors which give rise to fibroblast heterogeneity, gingival inflammation, and pharmacokinetic variables appear to be significant in the expression of gingival overgrowth. A more thorough understanding of the pathogenesis of this unwanted effect will hopefully elucidate appropriate mechanisms for its control.

The pathogenesis of drug-induced gingival overgrowth.

Pooled estimate of world leukoplakia prevalence: a systematic review

The aim of this paper is to review our understanding of the mechanisms and clinical significance of adhesion of C. albicans to denture-base materials in relation to denture plaque and denture-related stomatitis. Earlier reports in the literature of a 65% prevalence level of denture-related stomatitis seem to be exaggerated. More recent studies indicate that denture-related stomatitis is considerably less common, particularly in normal healthy subjects. The etiology of the condition is discussed in this review, and although much of the literature supports the view that the condition is strongly associated with C. albicans, this is not always so. In some subjects, the cause appears to be related to a non-specific plaque. This review also considers the role of denture plaque in the pathogenesis of denture-related stomatitis, the sequential development of denture plaque, and its colonization by Candida organisms. Designing controlled in vivo studies is difficult, and as a consequence, many investigators have had to resort to in vitro studies. The majority of these studies have attempted to investigate the hydrophobicity of C. albicans, relating the surface free-energy of denture-base materials, particularly acrylic resin, to that of the organism. Surprisingly little work has been directed at surface roughness and how it affects retention of organisms. Further, no attention has been paid to the properties and character of the surface, other than average surface roughness, as it affects adhesion. A comparison of results from in vitro studies on the effect on adhesion of pre-coating the surfaces of denture-base materials with saliva has produced equivocal conclusions. This is largely due to little standardization of experimental protocols between studies, particularly in the collection and handling of the saliva used. In conclusion, the review strongly supports the suggestion that adherence of C. albicans to denture-base materials in vitro is related to the hydrophobicity of the organism. The clinical significance of the observation and the mechanisms for the development and maturation of denture plaque are yet to be understood. There is a clear need for further investigation of other factors that may moderate the adhesion of organisms and subsequent colonization of denture-base materials.

Denture plaque and adherence of Candida albicans to denture-base materials in vivo and in vitro.

This review has provided an overview of variants of oral mucosal candidiasis and current therapeutic techniques followed by an outline of the rare oral mycoses and their management. The advent of the HIV infection and the increasing prevalence of compromised individuals in the community as a consequence of surgical and medical advances have resulted in a resurgence of opportunistic infections, including oral candidiasis and other rare mycoses that were once considered exotic. It is now recognized that oral candidiasis may present in many clinical guises, including the classic white lesion of thrush as well in as nondescript, red mucosal lesions that may confound the unwary clinician. Other mycotic diseases, such as aspergillosis, cryptococcosis, histoplasmosis and mucormycosis, may manifest intra-orally, both as primary lesions and as secondary manifestations of systemic disease. Periodontal manifestations of mycotic diseases are rare. If at all, such lesions may present as erythematous areas as in linear gingival erythema and rarely as ulcerations in exotic mycoses. Most of the oral mycoses respond well to either topical or systemic therapy with the polyenes or azoles. In general, the management of oral fungal infections has been revolutionized by the triazole group of drugs, fluconazole and itraconazole, although recent reports indicate an alarming increase of resistant organisms, in particular to fluconazole.

Oral mucosal fungal infections

OBJECTIVES: The goals of this study were as follows: to obtain baseline information on the incidence of oral mucosal conditions in a population of elderly Thai patients and to investigate differences in the presentation of these findings in relation to age, sex and the wearing of dentures



SUBJECTS AND METHODS: The incidence of oral mucosal conditions was determined by the clinical examination of a sample of 500 Thai patients aged 60 years and older



RESULTS: The overall incidence of oral mucosal conditions was 836% with no significant difference between men (814%) and women (85%) The incidence of oral mucosal conditions indicated a significant increase with advancing age Varices (596%), fissured tongue (28%) and traumatic ulcer (156%) were the three most common conditions; and the incidence increased with age Leukoplakia and smoker's melanosis were more common in men whereas lichen planus was seen more frequently in women Three cases of oral cancer were detected, representing an incidence of 06% Denture wearers (627%) exhibited a significantly higher prevalence of oral mucosal conditions than subjects who had no dentures (285%) and subjects with crowns and/or bridges (88%) The three most common denture-related problems were traumatic ulcer (226%), denture stomatitis (143%) and angular cheilitis (48%) In addition, the incidence of denture-related conditions among complete denture wearers (463%) was higher than in those wearing partial dentures (408%)



CONCLUSION: The current results regarding an elderly Thai population support the studies of other populations whereby the incidence of oral mucosal conditions in the elderly is related to age, sex and the wearing of dentures

Oral mucosal conditions in elderly dental patients

Hereditary Gingival Fibromatosis (HGF) is the most common genetic form of gingival fibromatosis. The condition is most frequently reported to be transmitted as an autosomal-dominant trait, but autosomal-recessive inheritance has also been reported. The clinical presentation of HGF is variable, both in the distribution (number of teeth involved) and in the degree (severity) of expression. It is unknown if the variable clinical expression of HGF in different families is due to variable expression of a common gene mutation, allelic mutations, or non-allelic mutations. The apparently different modes of Mendelian inheritance of HGF suggest genetic heterogeneity. A gene locus for HGF has been localized to a 37-cM genetic interval on chromosome 2p21-p22 (D2S1352, Zmax = 5.10, theta = 0.00) flanked by D2S1788 and D2S441. To evaluate the generality of this linkage, we tested linkage with 9 markers from this candidate region in another large family, segregating for an autosomal-dominant form of generalized HGF, and found no support for linkage with any of these markers. Furthermore, statistical tests of this apparent heterogeneity were highly significant. Analysis of these data provides direct evidence that at least two genetically distinct loci are responsible for autosomal-dominant hereditary gingival fibromatosis.

Evidence of Genetic Heterogeneity for Hereditary Gingival Fibromatosis

Hereditary gingival fibromatosis. Report of an extensive four-generation pedigree

During the last decade, many studies in Europe and North America have evaluated oral conditions and dental needs in the elderly. Similar information does not exist in Brazil. The aim of this study was to determine the prevalence of oral health and disease in elderly persons living in an institution in the city of Piracicaba, State of Sao Paulo, Brazil. Of 350 elderly persons, 134 males and 136 females were interviewed and clinically examined. Less than one half had healthy mouths. 58.9% of the examined individuals showed one or more lesions in the oral mucosa, the most frequent being denture-induced stomatitis (20.0%). Fibrous hyperplasias (11.8%) and angular cheilitis (9.3%) were fairly common. Gender, use and degree of hygiene of the denture were factors statistically significantly contributing to prevalence of denture stomatitis. Precancerous lesions such as leukoplakia (3.0%), actinic cheilitis (2.6%) were uncommon but three cases of squamous carcinoma (1.1%) were revealed. This study emphasizes the need for regular oral examinations of the elderly by personnel trained in oral diagnosis.

Oral mucosal health and disease in institutionalized elderly in Brazil

Three cases of generalized and severe HGF in young patients of the same family without other features are reported. The purpose of this article is to present documented cases and discuss the identification, treatment, and control of the disease. The histopathological characteristics of HGF are emphasized.

Hereditary gingival fibromatosis: report of three cases.

Oral paracoccidioidomycosis: A study of 36 South American patients

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