Gingival hyperplasia treatment using diode laser gingivectomy in a child with cerebral palsy: case report
DOI:
https://doi.org/10.33448/rsd-v10i16.22597Keywords:
Diode laser; Gingival hyperplasia; Gingivectomy.Abstract
Gingival hyperplasia is associated with several factors, such as chronic inflammation due to the large accumulation of biofilm and medications including anticonvulsants. The aim of this study is to report a clinical case of a 4-year-old spastic quadriplegic cerebral palsy patient with gingival hyperplasia in the palatal region of the upper teeth induced by the use of high doses of anticonvulsant medications. The patient attended the Dental Assistance Center for People with Disabilities, with fibrotic gingival hyperplasia in the upper posterior region, covering the dental crowns on the palatal and occlusal surfaces. Oral hygiene instructions were previously carried out using chlorhexidine gluconate solution (0.12%) on the teeth with the aid of a cotton swab, twice a day for seven days, to reduce bacterial plaque levels and control periodontal inflammation. Gingivectomy was performed using a gallium aluminum arsenide diode laser (GaAlAs; 808±10 nm, 2.5 W output power, continuous mode). Following the surgical procedures, photobiomodulation therapy was performed with a low-level aluminum gallium indium phosphide diode laser (InGaAlP; 660±10 nm, 100 mW, 3 J) at three points (anterior, middle and posterior region of surgical wound). The patient returned at 7 and 30 days after surgery presenting accelerated wound healing. It was concluded that the high-level diode laser associated with photobiomodulation therapy were effective for performing a conservative and safe procedure in a patient with severe neurological disorder.
References
Abergel, R. P., Glassberg, E., & Uitto, J. (1988, June). Increased Wound-Healing Rate In Pig Skin Treated By Helium-Neon Laser. In Laser Interaction with Tissue (Vol. 908, pp. 6-11). International Society for Optics and Photonics.
Agarwal, A., & Verma, I. (2012). Cerebral palsy in children: An overview. Journal of clinical orthopaedics and trauma, 3(2), 77-81.
Annegers JF. 2ª edição. Williams e Wilkins; 1997.
Avci, P., Gupta, A., Sadasivam, M., Vecchio, D., Pam, Z., Pam, N., & Hamblin, M. R. (2013, March). Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. In Seminars in cutaneous medicine and surgery (Vol. 32, No. 1, p. 41). NIH Public Access.
Baptista, I. P. (2002). Hereditary gingival fibromatosis: a case report. Journal of clinical periodontology, 29(9), 871-874.
Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., ... & Damiano, D. (2005). Proposed definition and classification of cerebral palsy, April 2005. Developmental medicine and child neurology, 47(8), 571-576.
Bell, K. L., Boyd, R. N., Tweedy, S. M., Weir, K. A., Stevenson, R. D., & Davies, P. S. (2010). A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy. BMC Public Health, 10(1), 1-12.
Bhati, P., Sharma, S., Jain, R., Rath, B., Beri, S., Gupta, V. K., & Aneja, S. (2019). Cerebral palsy in north Indian children: clinico-etiological profile and comorbidities. Journal of pediatric neurosciences, 14(1), 30.
Bilhari, I., & Mester, A. R. (1989). The biostimulative effect of low level laser therapy of long-standing crural ulcers using helium-neon laser plus infrared lasers, and noncoherent light: preliminary report of a randomized double blind comparative study. Lasertherapy, 2, 97-101.
Brooks, J., Day, S., Shavelle, R., & Strauss, D. (2011). Low weight, morbidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics, 128(2), e299-e307.
Brunet, L., Miranda, J., Roset, P., Berini, L., Farre, M., & Mendieta, C. (2001). Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs. European journal of clinical investigation, 31(9), 781-788.
Calis, E. A., Veugelers, R., Sheppard, J. J., Tibboel, D., Evenhuis, H. M., & Penning, C. (2008). Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Developmental Medicine & Child Neurology, 50(8), 625-630.
Campanozzi, A., Capano, G., Miele, E., Romano, A., Scuccimarra, G., Del Giudice, E., ... & Staiano, A. (2007). Impact of malnutrition on gastrointestinal disorders and gross motor abilities in children with cerebral palsy. Brain and Development, 29(1), 25-29.
Cans, C. (2000). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental Medicine & Child Neurology, 42(12), 816-824.
Chung, H., Dai, T., Sharma, S. K., Huang, Y. Y., Carroll, J. D., & Hamblin, M. R. (2012). The nuts and bolts of low-level laser (light) therapy. Annals of biomedical engineering, 40(2), 516-533.
Cláudio, M. M., Rodrigues, J. V. S., Garcia, V. G., & Theodoro, L. H. (2021). Prevalence of Gingival Hyperplasia Induced by Anticonvulsants: A Systematic Review. Brazilian Dental Science, 24(1), 9-p.
Cobb, C. M. (2016). Commentary: is there clinical benefit from using a diode or neodymium: yttrium‐aluminum‐garnet laser in the treatment of periodontitis?. Journal of periodontology, 87(10), 1117-1131.
Colver A, Fairhurst C, Pharoah PO (2014). Cerebral palsy. Lancet, 383(9924):1240-9. doi: 10.1016/S0140-6736(13)61835-8
De Oliveira Guaré, R., Costa, S. C., Baeder, F., De Souza Merli, L. A., & Dos Santos, M. T. B. R. (2010). Drug‐induced gingival enlargement: Biofilm control and surgical therapy with gallium–aluminum–arsenide (GaAlAs) diode laser—A 2‐year follow‐up. Special Care in Dentistry, 30(2), 46-52.
Devi, P. K., Kumar, G. P., Bai, Y. D., & Ammaji, A. D. (2013). Ipsilateral idiopathic gingival enlargement and it's management using conventional gingivectomy and diode laser: A recurrent case after 15 years. Journal of Indian Society of Periodontology, 17(3), 387.
Fernandes, L. A., De Almeida, J. M., Theodoro, L. H., Bosco, A. F., Nagata, M. J. H., Martins, T. M., ... & Garcia, V. G. (2009). Treatment of experimental periodontal disease by photodynamic therapy in immunosuppressed rats. Journal of clinical periodontology, 36(3), 219-228.
Gontiya, G., Bhatnagar, S., Mohandas, U., & Galgali, S. R. (2011). Laser-assisted gingivectomy in pediatric patients: a novel alternative treatment. Journal of Indian Society of Pedodontics and Preventive Dentistry, 29(3), 264.
Goyal, A., Gauba, K., & Singhi, P. (2004). Folic acid and phenytoin induced gingival overgrowth-is there a preventive effect. J Indian Soc Pedo Prev Dent, 22(2), 82-91.
Günhan, Ö., Gardner, D. G., Bostanci, H., & Günhari, M. (1995). Familial gingival fibromatosis with unusual histologic findings. Journal of Periodontology, 66(11), 1008-1011.
Hamblin, M. R. (2017). Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS biophysics, 4(3), 337.
Kanno, C. M., Oliveira, J. A., Garcia, J. F., Castro, A. L., & Crivelini, M. M. (2008). Effects of Cyclosporin, Phenytoin, and Nifedipine on the Synthesis and Degradation of Gingival Collagen in Tufted Capuchin Monkeys (Cebus apella): Histochemical and MMP‐1 and− 2 and Collagen I Gene Expression Analyses. Journal of periodontology, 79(1), 114-122.
Kato, T., Okahashi, N., Kawai, S., Kato, T., Inaba, H., Morisaki, I., & Amano, A. (2005). Impaired degradation of matrix collagen in human gingival fibroblasts by the antiepileptic drug phenytoin. Journal of periodontology, 76(6), 941-950.
Kerac, M., Postels, D. G., Mallewa, M., Jalloh, A. A., Voskuijl, W. P., Groce, N., ... & Molyneux, E. (2014, March). The interaction of malnutrition and neurologic disability in Africa. In Seminars in pediatric neurology (Vol. 21, No. 1, pp. 42-49). WB Saunders.
Kimball, R. F. (1939). A delayed change of phenotype following a change of genotype in Paramecium aurelia. Genetics, 24(1), 49.
Khosraviani, F., Ehsani, S., Fathi, M., & Saberi-Demneh, A. (2019). Therapeutic effect of laser on pediatric oral soft tissue problems: a systematic literature review. Lasers in medical science, 34(9), 1735-1746.
Lafzi, A., Farahani, R. M. Z., & Shoja, M. A. M. (2007). Phenobarbital-induced gingival hyperplasia. Journal of contemporary dental practice, 8(6), 50-56.
Lione, R., Pavoni, C., Noviello, A., Clementini, M., Danesi, C., & Cozza, P. (2020). Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: a randomized controlled trial. European journal of orthodontics, 42(1), 78-85.
Luvizuto, E. R., da Silva, J. B. G., Campos, N., Luvizuto, G. C. R., Poi, W. R., & Panzarini, S. R. (2012). Functional aesthetic treatment of patient with phenytoin-induced gingival overgrowth. Journal of Craniofacial Surgery, 23(3), e174-e176.
Mani, K. S., Rangan, G., Srinivas, H. V., Sridharan, V. S., & Subbakrishna, D. K. (2001). Epilepsy control with phenobarbital or phenytoin in rural south India: the Yelandur study. The Lancet, 357(9265), 1316-1320.
Mavrogiannis, M., Ellis, J. S., Seymour, R. A., & Thomason, J. M. (2006). The efficacy of three different surgical techniques in the management of drug‐induced gingival overgrowth.
Mutch, L., Alberman, E., Hagberg, B., Kodama, K., & Perat, M. V. (1992). Cerebral palsy epidemiology: where are we now and where are we going?. Developmental Medicine & Child Neurology, 34(6), 547-551.
Nakib, N., & Ashrafi, S. S. (2011). Drug-induced gingival overgrowth. Disease-a-month, 57(4), 225-230.
Nazemisalman, B., Vahabi, S., Bandehpour, M., & Aryankia, A. K. (2014). Phenytoin effects on inflammatory mediator's production by gingival fibroblasts: a comparative study in children and adults. Oral health and dental management, 13(3), 847-853.
Ortega-Concepción, D., Cano-Durán, J. A., Peña-Cardelles, J. F., Paredes-Rodríguez, V. M., González-Serrano, J., & López-Quiles, J. (2017). The application of diode laser in the treatment of oral soft tissues lesions. A literature review. Journal of clinical and experimental dentistry, 9(7), e925.
Ozcelik, O., Cenk Haytac, M., Kunin, A., & Seydaoglu, G. (2008). Improved wound healing by low‐level laser irradiation after gingivectomy operations: a controlled clinical pilot study. Journal of clinical periodontology, 35(3), 250-254.
Pakula, A. T., Braun, K. V. N., & Yeargin-Allsopp, M. (2009). Cerebral palsy: classification and epidemiology. Physical Medicine and Rehabilitation Clinics, 20(3), 425-452. doi:10.1016/j.pmr.2009.06.001
Perlik, F., Kolinova, M., Zvarova, J., & Patzelova, V. (1995). Phenytoin as a risk factor in gingival hyperplasia. Therapeutic drug monitoring, 17(5), 445-448.
Priyadharshini, V., Belure, V. V., Triveni, M. G., Kumar, A. T., & Mehta, D. S. (2014). Successful management of phenytoin and phenobarbitone induced gingival enlargement: A multimodal approach. Contemporary clinical dentistry, 5(2), 268.
Quitadamo, P., Thapar, N., Staiano, A., & Borrelli, O. (2016). Gastrointestinal and nutritional problems in neurologically impaired children. European Journal of Paediatric Neurology, 20(6), 810-815.
Rang HP. Rang & Dale farmacologia. 7ª ed. Rio de Janeiro : Elsevier; 2012.
Salo, T., Oikarinen, K. S., & Oikarinen, A. I. (1990). Effect of phenytoin and nifedipine on collagen gene expression in human gingival fibroblasts. Journal of Oral Pathology & Medicine, 19(9), 404-407.
Seki, K., Sato, S., Asano, Y., Akutagawa, H., & Ito, K. (2010). Improved pathologic teeth migration following gingivectomy in a case of idiopathic gingival fibromatosis. Quintessence International, 41(7).
Tan, H., Gürbüz, T., & Dağsuyu, I. M. (2004). Gingival enlargement in children treated with antiepileptics. Journal of child neurology, 19(12), 958-963.
Theodoro LH, Garcia VG. Surgical and non-surgical treatment of periodontal diseases. In: Lasers in Dentistry. Cap 20. p. 153-157. 2015.
To, T. N., Rabie, A. B. M., Wong, R. W., & McGrath, C. P. (2013). The adjunct effectiveness of diode laser gingivectomy in maintaining periodontal health during orthodontic treatment: A randomized controlled clinical trial. The Angle Orthodontist, 83(1), 43-47.
Trackman, P. C., & Kantarci, A. (2015). Molecular and clinical aspects of drug-induced gingival overgrowth. Journal of dental research, 94(4), 540-546.
Tsai, S. R., & Hamblin, M. R. (2017). Biological effects and medical applications of infrared radiation. Journal of Photochemistry and Photobiology B: Biology, 170, 197-207.
Vahabi, S., Moslemi, M., Nazemisalman, B., & Yadegari, Z. (2014). Phenytoin effects on proliferation and induction of IL1β and PGE2 in pediatric and adults’ gingival fibroblasts. Open Journal of Stomatology, 4(09), 452.
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Copyright (c) 2021 Letícia Helena Theodoro; João Victor Soares Rodrigues; Beatriz Alves Furtado; Marina Módolo Cláudio; Liliane Passanezi Almeida Louzada; Valdir Gouveia Garcia
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