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https://doi.org/10.15644/asc52/3/9

Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja

Cíntia Ferreira Gonçalves ; Zavod za dječju stomatologiju Stomatološkog fakulteta Porto Nacional, Porto Nacional, TO, Brazil
Ana Paula Mundim ; Zavod za dječju stomatologiju Stomatološkog fakulteta Porto Nacional, Porto Nacional, TO, Brazil
Rodrigo Fernando Sousa Martins ; Privatna stomatološka ordinacija, Palmas, TO, Brazil
Ricardo Maio Gagliardi ; Zavod za stomatologiju Euroameričkoga sveučilišnog centra, Brasília, DF, Brazil
Paulo Sérgio Silva Santos ; Zavod za stomatologiju Stomatološkog fakulteta Sveučilišta São Paulo, Bauru, SP, Brazil
Orlando Ayrton de Toledo ; Zavod za dječju stomatologiju Stomatološkog fakulteta Sveučilišta Brasília, Brasília, DF, Brazil

Puni tekst: hrvatski, pdf (260 KB) str. 254-258 preuzimanja: 53* citiraj
APA 6th Edition
Gonçalves, C.F., Mundim, A.P., Martins, R.F.S., Gagliardi, R.M., Santos, P.S.S. i de Toledo, O.A. (2018). Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja. Acta stomatologica Croatica, 52 (3), 254-258. https://doi.org/10.15644/asc52/3/9
MLA 8th Edition
Gonçalves, Cíntia Ferreira, et al. "Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja." Acta stomatologica Croatica, vol. 52, br. 3, 2018, str. 254-258. https://doi.org/10.15644/asc52/3/9. Citirano 11.07.2020.
Chicago 17th Edition
Gonçalves, Cíntia Ferreira, Ana Paula Mundim, Rodrigo Fernando Sousa Martins, Ricardo Maio Gagliardi, Paulo Sérgio Silva Santos i Orlando Ayrton de Toledo. "Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja." Acta stomatologica Croatica 52, br. 3 (2018): 254-258. https://doi.org/10.15644/asc52/3/9
Harvard
Gonçalves, C.F., et al. (2018). 'Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja', Acta stomatologica Croatica, 52(3), str. 254-258. https://doi.org/10.15644/asc52/3/9
Vancouver
Gonçalves CF, Mundim AP, Martins RFS, Gagliardi RM, Santos PSS, de Toledo OA. Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja. Acta stomatologica Croatica [Internet]. 2018 [pristupljeno 11.07.2020.];52(3):254-258. https://doi.org/10.15644/asc52/3/9
IEEE
C.F. Gonçalves, A.P. Mundim, R.F.S. Martins, R.M. Gagliardi, P.S.S. Santos i O.A. de Toledo, "Nasljedna gingivna fibromatoza: prikaz slučaja nakon sedmogodišnjeg praćenja", Acta stomatologica Croatica, vol.52, br. 3, str. 254-258, 2018. [Online]. https://doi.org/10.15644/asc52/3/9
Puni tekst: engleski, pdf (260 KB) str. 254-258 preuzimanja: 149* citiraj
APA 6th Edition
Gonçalves, C.F., Mundim, A.P., Martins, R.F.S., Gagliardi, R.M., Santos, P.S.S. i de Toledo, O.A. (2018). Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up. Acta stomatologica Croatica, 52 (3), 254-258. https://doi.org/10.15644/asc52/3/9
MLA 8th Edition
Gonçalves, Cíntia Ferreira, et al. "Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up." Acta stomatologica Croatica, vol. 52, br. 3, 2018, str. 254-258. https://doi.org/10.15644/asc52/3/9. Citirano 11.07.2020.
Chicago 17th Edition
Gonçalves, Cíntia Ferreira, Ana Paula Mundim, Rodrigo Fernando Sousa Martins, Ricardo Maio Gagliardi, Paulo Sérgio Silva Santos i Orlando Ayrton de Toledo. "Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up." Acta stomatologica Croatica 52, br. 3 (2018): 254-258. https://doi.org/10.15644/asc52/3/9
Harvard
Gonçalves, C.F., et al. (2018). 'Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up', Acta stomatologica Croatica, 52(3), str. 254-258. https://doi.org/10.15644/asc52/3/9
Vancouver
Gonçalves CF, Mundim AP, Martins RFS, Gagliardi RM, Santos PSS, de Toledo OA. Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up. Acta stomatologica Croatica [Internet]. 2018 [pristupljeno 11.07.2020.];52(3):254-258. https://doi.org/10.15644/asc52/3/9
IEEE
C.F. Gonçalves, A.P. Mundim, R.F.S. Martins, R.M. Gagliardi, P.S.S. Santos i O.A. de Toledo, "Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up", Acta stomatologica Croatica, vol.52, br. 3, str. 254-258, 2018. [Online]. https://doi.org/10.15644/asc52/3/9

Rad u XML formatu

Sažetak
Uvod: Nasljedna gingivna fibromatoza (NGF) rijetka je bolest koju obilježava povećanje gingive, no boja desni ostaje normalna, a konzistencija je dobra i čvrsta. Taj rast može potaknuti uporaba lijekova
i nakupljanje plaka. Terapija izbora za to kliničko stanje jest kirurško uklanjanje povećanoga gingivnog tkiva ili vađenje svih zuba. Prikaz slučaja: U naš centar upućena je 20-godišnja Brazilka s posebnim potrebama zbog pretjeranog povećanja gingive. Od lijekova je uzimala Carbamazepin i Gardenal. Prema kliničkoj slici i obiteljskoj anamnezi, konačna dijagnoza zbog povećanja gingive bila je NGF. Odlučeno je da je potrebna stomatološka terapija, uključujući osnovno parodontno liječenje, restauracije, pečaćenja i gingivoplastiku s unutarnjim rezovima. Posebno se pazilo na to da se pritom ništa ne promijeni u primjeni antikonvulzivnih lijekova koje je uzimala. Pacijentica je nakon toga praćena sedam godina i hiperplazija gingive nije se ponovno pojavila zahvaljujući stalnom profesionalnom nadzoru i kućnoj kontroli zubnoga plaka.

Ključne riječi
fibromatoza gingive; hiperplazija gingive

Hrčak ID: 205714

URI
https://hrcak.srce.hr/205714

▼ Article Information



Introduction

Hereditary gingival fibromatosis (HGF) is a rare disease in both autosomal dominant and recessive types and has a frequency of 1:175,000 (1). Clinically, it is characterized by benign gingival enlargement with normal color and firm consistency and non-hemorrhagic symptomatic illness (2). Although the gingival enlargement does not directly affect the alveolar bone, the gingival swelling may add to the bacterial plaque accumulation, inducing gingivitis, periodontitis, bone resorption and halitosis (1). Histologically, the connective tissue has increased collagen and few fibroblasts and the epithelial tissue presents hyperplasia areas and prominent buds. Despite these characteristics, the histologic features of HGF are not exactly specific, and the definitive diagnosis should be based on family history and clinical findings (1). Some of the clinical complications of HGF can be excessive gingival growth, which results in pseudo pocketing and periodontal disease due to poor oral hygiene, diastemas, delayed tooth eruption, and facial disfigurement due to lip protrusion. In addition, in the most severe cases, gingival hyperplasia can result in limited tongue movement, speech impediments and difficulty chewing (1-7). There is no consensus among authors about the efficacy of HGF treatment (6) and the recurrence risk is real and needs to be avoided (7). Depending on the severity of the of the growth, treatment involves the excision of the enlarged gingival tissues, using conventional surgery, electrosurgery, an apically positioned flap, or lasers through to the extraction of all teeth and reduction of the alveolar bone to prevent recurrence (1, 2). The success of dental treatment depends on scheduling a return appointment as a preventative for recurring disease (6, 7).

This paper aims to review the diagnosis, treatment, and follow-up of hereditary gingival fibromatosis by the presentation of a case report characterized by the exacerbated gingival enlargement through the use of anticonvulsant medication, associated with the inflammatory factor, i.e., high levels of plaque. In addition, this case report presents the local treatment plaque control as a differential without any interference with systemic medication.

Case report

A bedridden, 20-year-old female patient, who suffered from microcephaly, epilepsy, and mental retardation, was referred to our center in January 2009 with a chief complaint of ‘pain in the jaws’, according to her mother. In the course of taking medical history she reported another case of gum growth in her brother, who had died. The patient was on carbamazepine 200 mg (3 times a day), phenobarbital 100 mg (1 time a day), cyclobenzaprine hydrochloride 5 mg (1 time a day), ranitidine 50 mg (1 time a day), iron (40 drops a day), calcium (10 ml 1 time a day) and minerals (10 ml 1 time day). At that time, she had scored 50 points on the Karnofsky Performance Status Scale (8), ate only a soft diet and weighed 14 kilograms. It is important to note that the patient had grand mal seizures about eight to ten times a day and sometimes there was need for hospitalization due to the severity of her seizures. At the time she went to our service, the seizures were in the initial control phase, since the doctor was adjusting the medication dose. After several alterations of dosage, the seizures stabilized with appropriate and regular use of anticonvulsant medication.

The intraoral examination revealed severe gingival hyperplasia associated with a high plaque index (3.16, according to IHOS index) - gingival calculus, false periodontal pockets, three decayed teeth and four teeth with active white spots (Figures 1, 2 and 3{ label needed for fig[@id='f2'] }{ label needed for fig[@id='f3'] }). Dental treatment was performed under general anesthesia because there were several dental procedures to be carried out and the patient’s general health status was classified as ASA II.

Figure 1 Intraoral view of the maxillary right side, showing HGF before surgical dental treatment under general anesthesia.
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Figure 2 Intraoral view of the maxillary left side, showing HGF before surgical dental treatment under general anesthesia.
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Figure 3 A front view of mandibular incisors before surgical dental treatment under general anesthesia.
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We performed the basic periodontal treatment and composite resin restorations, sealing the active white spots using modified, atraumatic, restorative techniques, and we surgically removed the third molars. Regarding the gum, specifically, after the marking the gingival pockets, we removed the excessive tissue by means of internal bevel gingivectomy on some sections of buccal and palatal-lingual surfaces. The incisions in the internal bezel were designed to preserve a proper amount of gum tissue after surgery as well as to allow the passive replacement of surgical flap, thus achieving healing all at once. We opted for this technique based on the patient’s special care needs and the large amount of tissue to be excised in one session.

The patient is still undergoing follow-up every three months in our center, seven years after the surgical procedures. Currently, her health status is under control, including her oral health, without any signs of gingival hyperplasia, false periodontal pockets, or caries (Figures 4, 5, 6, 7 and 8{ label needed for fig[@id='f5'] }{ label needed for fig[@id='f6'] }{ label needed for fig[@id='f7'] }{ label needed for fig[@id='f8'] }). Informed consent has been obtained from the patient’s mother.

Figure 4 A: Immediately after surgery. B: Fifteen days after surgery.
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Figure 5 One-year follow-up.
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Figure 6 An intraoral view of the maxillary right side seven years after dental treatment under general anesthesia.
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Figure 7 An intraoral view of the maxillary left side seven years after dental treatment under general anesthesia.
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Figure 8 The patient undergoing monitoring without evidence of caries or periodontal disease.
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Discussion

Hereditary gingival fibromatosis is a rare condition of gingival tissues that can be associated with several other clinical manifestations and feature some syndromes (4, 5). This growth is slow and progressive and may be exacerbated by the use of drugs. It can occur in isolation or may be associated with syndromes, such as Zimmermann-Laband, Rutherford, and Ramon syndromes (3, 7). It is important to note that oral health of the patient, including the gums and teeth, was recovered without interfering with her medication, as the doctor took a long time to choose the drug and its dose to control convulsive seizures. For this reason, our team evaluated the three main causes of gingival hyperplasia, which were genetics, the use of anticonvulsant medication and the presence of plaque, i.e., the inflammatory factor. It is noteworthy that in this case, there was no intervention done concerning the genetic and medical factors. On the other hand, the control of the inflammatory factor, through periodic visits to the dentist and the family’s participation at home, has been responsible for the absence of the recurrence of gingival hyperplasia to date. This fact leads us to rule out the hypothesis of medical gingival hyperplasia. In this context, this situation underscores the importance of plaque control to prevent new and recurrent diseases, especially manifestations of rare and severe pathologies, such as HGF, in which the recurrence rate after surgery is relatively high (5). Therefore, despite the fact that HGF is not caused by plaque increase; it can be exacerbated by it (1).

It is worth noting that due to the patient's neurological impairment and disabled protective reflexes, such as coughing, the diet recommended by her medical team had a “doughy consistency”. In addition, her oral health care had been relatively neglected in the context of general health framework that she presented. Such a situation is in accordance with Escribano-Hernández et al (9), who alleged that mentally disabled patients often have their oral health care neglected. They have further stated that the rate of dental caries and periodontal disease is substantially increased in this population because of a pureed, high carbohydrate diet and physiological limitations that prevent adequate teeth cleaning due to impaired muscle function.

Actually, the use of dental general anesthesia has been indicated for handicapped patients that do not have good comprehension as well as children infants and pre-school children who do not have good behavior and patients with excessive fear associated with several dental needs (9, 10). However, it is important to highlight that dental general anesthesia had good results only when associated with a postoperative prevention program (11). We endorse these results and believe that clinical success over seven years of follow-up has been achieved due to the correct diagnosis, precise treatment and family agreement with the professional team’s treatment proposal.

Conclusion

HFG is a rare disease that must be treated very carefully, especially in systemically compromised patients such as mentally disabled patients. This case report has relevance since the correct diagnosis may lead to proper treatment. In this case, it was of fundamental importance not to change the anticonvulsant medication. Associated with this, the differential was exactly the control of inflammatory factors during the postoperative period. Thus, it is extremely important that these patients are regularly seen by the dentist and their plaque index is kept under control because the disease can recur.

Notes

[1] Conflicts of interest The authors deny any conflicts of interest.

References

1 

Kather J, Salgado MA, Salgado UF, Cortelli JR, Pallos D. Clinical and histomorphometric characteristics of three different families with hereditary gingival fibromatosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Mar;105(3):348–52. DOI: http://dx.doi.org/10.1016/j.tripleo.2007.06.006 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/18061489

2 

Tripathi AK, Upadhaya V, Kumar V, Saimbi CS. Hereditary gingival fibromatosis and its management: 2-year follow-up. Contemp Clin Dent. 2014 Oct;5(4):569–71. DOI: http://dx.doi.org/10.4103/0976-237X.142835 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/25395783

3 

Haytac MC, Ozcelik O. The phenotypic overlap of syndromes associated with hereditary gingival fibromatosis: follow-up of a family for five years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Apr;103(4):521–7. DOI: http://dx.doi.org/10.1016/j.tripleo.2006.02.021 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/17395066

4 

Aghili H, Goldani Moghadam M. Hereditary gingival fibromatosis: a review and a report of a rare case. Case Rep Dent. 2013;2013:930972. DOI: http://dx.doi.org/10.1155/2013/930972 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23533834

5 

Chaurasia A. Hereditary gingival fibromatosis. Natl J Maxillofac Surg. 2014 Jan;5(1):42–6. DOI: http://dx.doi.org/10.4103/0975-5950.140171 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/25298717

6 

Majumder P, Nair V, Mukherjee M, Ghosh S, Dey SK. The autosomal recessive inheritance of hereditary gingival fibromatosis. Case Rep Dent. 2013;2013:432864. DOI: http://dx.doi.org/10.1155/2013/432864 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/24416600

7 

Gawron K, Łazarz-Bartyzel K, Potempa J, Chomyszyn-Gajewska M. Gingival fibromatosis: clinical, molecular and therapeutic issues. Orphanet J Rare Dis. 2016 Jan 27;11:9. DOI: http://dx.doi.org/10.1186/s13023-016-0395-1 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/26818898

8 

Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer. 1984 May 1;53(9):2002–7. DOI: http://dx.doi.org/10.1002/1097-0142(19840501)53:9<2002::AID-CNCR2820530933>3.0.CO;2-W PubMed: http://www.ncbi.nlm.nih.gov/pubmed/6704925

9 

Escribano-Hernández A, García-Garraus JM, Hernández-García I. Evaluation of satisfaction among relatives of mentally disabled patients who were users of a dental care protocol under general anaesthesia. Med Oral Patol Oral Cir Bucal. 2012 Jan 1;17(1):e83–8. DOI: http://dx.doi.org/10.4317/medoral.17069 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/21743429

10 

El Batawi HY. Factors affecting clinical outcome following treatment of early childhood caries under general anaesthesia: a two-year follow-up. Eur Arch Paediatr Dent. 2014 Jun;15(3):183–9. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/24030856

11 

Taskinen H, Kankaala T, Rajavaara P, Pesonen P, Laitala ML, Anttonen V. Self-reported causes for referral to dental treatment under general anaesthesia (DGA): a cross-sectional survey. Eur Arch Paediatr Dent. 2014 Apr;15(2):105–12. DOI: http://dx.doi.org/10.1007/s40368-013-0071-2 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23918236


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