Etiology and treatments for gingivitis and gingival overgrowth of the patients with cerebral palsy

脑瘫患者常服用苯妥英等抗惊厥药物。PHT诱导牙龈过度生长，降低骨生长，已被广泛接受。相反，有不良反应，如颅骨增厚的报道。另一方面，甲状旁腺与钙代谢密切相关。本课题旨在通过电镜研究PHT对牙龈和甲状旁腺的作用机制，建立有效的预防和治疗PHT诱导的牙龈过度生长的方法。材料与方法本研究项目由三部分组成。首先，研究人员利用电子显微镜观察脑性瘫痪患者经PHT治疗后切除的牙龈。其次，我们用pht诱导的大鼠进行研究。电镜下观察大鼠的牙龈和甲状旁腺，测定体重、血清磷酸、钙、PHT浓度。最后，我们评估了口腔卫生管理与重症运动和智力障碍患者发热的关系。结果脑瘫患者增生性牙龈胶原纤维增多。电镜观察牙龈成纤维细胞数量增多，面积增大。pht诱导大鼠的平均体重明显低于对照大鼠。pht诱导大鼠血清磷酸盐和钙浓度明显低于对照组。电镜形态学观察发现，pht诱导大鼠牙龈成纤维细胞的高尔基体和粗面内质网（rough -surface endoplasmic network， ER）面积较对照组明显减少。通过对重症脑瘫患者的口腔卫生管理，重症脑瘫患者发热率明显下降。

IntroductionThe patients with cerebral palsy often take anticonvulsants such as phenytoin (PHT). It is widely accepted that PHT induces gingival overgrowth and reduces bone growth. Oppositely an adverse effect such as calvarial thickening is reported. On the other hand, the parathyroid gland is deeply related to calcium metabolism. The purpose of this research project is to clarify the mechanism of PHT for the gingiva and the parathyroid gland by using electron microscope and establish effective prevention and treatment of PHT-induced gingival overgrowth.Materials and MethodsThis research project consisted of three parts. First, the investigators used electron microscope to observe the resected gingiva from the cerebral palsy patients who were given PHT. Secondly, we investigated to use PHT-induced rats. Their gingiva and the parathyroid glands were observed by electron microscope and body weights, serum phosphate, calcium and PHT concentrations were measured. Finally, we evaluated the relationship between oral hygiene management and fever of the patients in the institution for the patients with severe motor and intellectual disabilities.ResultsThe collagen fibers were increased in the hyperplastic gingiva of the cerebral palsy patients. The numbers and areas of the gingival fibroblasts were also increased in the findings of electron microscope.The mean body weight of PHT-induced rats was significantly less than control rats. The serum phosphate and calcium concentrations of PHT-induced rats were significantly lower than controls. In morphological study by electron microscope, the areas of Golgi apparatus and rough-surfaced endoplasmic reticulum (rough ER) in the gingival fibroblasts of PHT-induced rats significantly decreased compared with controls.During oral hygiene management by the dental profession, fever up of the severe cerebral palsy patients got decreased in the institution.