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

前言脑性瘫痪患者常服用苯妥英钠（PHT）等抗惊厥药物。PHT诱导牙龈过度生长并减少骨生长已被广泛接受。据报道，Opalone会产生不良反应，如颅骨增厚。另一方面，甲状旁腺与钙代谢密切相关。本研究项目的目的是通过电子显微镜阐明PHT对牙龈和甲状旁腺的作用机制，并建立有效的预防和治疗PHT引起的牙龈过度生长。首先，研究者用电子显微镜观察了脑瘫患者接受PHT治疗后切除的牙龈。其次，我们研究了使用PHT诱导的大鼠。用电镜观察牙龈和甲状旁腺，并测定体重、血清磷、钙和PHT浓度。最后，我们评估了口腔卫生管理和发热的患者在该机构的严重的运动和智力disability.ResultsThe胶原纤维的脑瘫患者的增生牙龈的关系。电镜下可见牙龈成纤维细胞数量增多，面积增大，平均体重明显低于对照组。血清磷和钙浓度显着低于对照组。电镜形态学观察发现，与对照组相比，PTH诱导的大鼠牙龈成纤维细胞中高尔基体和粗面内质网（rough-surfaced endoplasmic reticulum，rough-ER）面积明显减少。

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.