Gingival

Salts of acetarsone are used in the treatment of intestinal amoebiasis, vaginal trichomoniasis, and necrotizing ulcerative gingivitis (Vincent s angina). The diethylamine salt (acetylarsan [534-33-8]) has antisyphilitic properties. Because of toxicity problems, safer dmgs have been developed. Oral LD q in rabbits is 150 mg /kg. 

The usual symptoms in human thaHotoxicosis resulting from acute, subacute, or chronic intoxication are generaHy the same. Common symptoms include nausea, vomiting, abdominal coHc, pain in legs, nervousness and irtitabHity, chest pain, gingivitis or stomatitis, and anorexia. Alopecia (hair loss) does not always occur, especiaHy in cases of mass intake of thallium and low resistance where the patient may die before the occurrence of hair loss. 

Phenytoin s absorption is slow and variable yet almost complete absorption eventually occurs after po dosing. More than 90% of the dmg is bound to plasma protein. Peak plasma concentrations are achieved in 1.5—3 h. Therapeutic plasma concentrations are 10—20 lg/mL but using fixed po doses, steady-state levels are achieved in 7—10 days. Phenytoin is metabolized in the fiver to inactive metabolites. The plasma half-life is approximately 22 h. Phenytoin is excreted primarily in the urine as inactive metabolites and <5% as unchanged dmg. It is also eliminated in the feces and in breast milk (1,2). Prolonged po use of phenytoin may result in hirsutism, gingival hyperplasia, and hypersensitivity reactions evidenced by skin rashes, blood dyscrasias, etc... 

Impressions of inlay and crown preparations, and all gingival areas, are best obtained by filling the preparation or gingival area with impression material injected from a hypodermic syringe. This eliminates trapping air in the corners and recesses and gives a more faithful reproduction without nodules or other imperfections. 

Ghlorhexidine Gluconate. Chlorhexidine gluconate [18472-51 -0] (l,l -hexamethylene bis[5-(p-chlorophenyl) biguanide] di-D-gluconate) is used as an antimicrobial against both aerobic and anaerobic bacteria ia the oral cavity. It is used as a therapeutic supplement ia the treatment of gingivitis, periodontal disease, and dental caries. A mouth riase form is available as a 0.12 wt% aqueous solution (288). 

An antimicrobial agent that reduces dental plaque and can be deUvered effectively from toothpaste is a combination of Triclosan [3380-34-5] (0.2% in the toothpaste) and zinc citrate (0.5%) (7). This agent influenced plaque accumulation and reduced the incidence of gingival bleeding in clinical tests. Additional dentifrices for improved gingival health are in the offing. 

Active agents vary according to use. For controlling bad breath, 2iac salts, sodium lauryl sulfate, and flavors are used. To destroy oral microorganisms, chlorhexidine, cetylpyridinium chloride [123-03-5] and ben2alkonium chloride [68391-01-5] are valuable. Essential oils, such as thymol [89-83-8] eucalyptol [470-82-6] menthol, and methyl salicylate [119-36-8] reduce plaque-related gingivitis (see Oils, essential). Sodium fluoride aids ia caries coatrol. 

Bacterial catabolism of oral food residue is probably responsible for a higher [NHj] in the oral cavity than in the rest of the respiratory tract.Ammonia, the by-product of oral bacterial protein catabolism and subsequent ureolysis, desorbs from the fluid lining the oral cavity to the airstream.. Saliva, gingival crevicular fluids, and dental plaque supply urea to oral bacteria and may themselves be sites of bacterial NH3 production, based on the presence of urease in each of these materials.Consequently, oral cavity fNTi3)4 is controlled by factors that influence bacterial protein catabolism and ureolysis. Such factors may include the pH of the surface lining fluid, bacterial nutrient sources (food residue on teeth or on buccal surfaces), saliva production, saliva pH, and the effects of oral surface temperature on bacterial metabolism and wall blood flow. The role of teeth, as structures that facilitate bacterial colonization and food entrapment, in augmenting [NH3J4 is unknown. 

Gingival crevicular fluid Liquid found in gingival crevices located around... 

The antiepileptic drug phenytoin, an orally available class DB antiarrhythmic, is mainly effective in digitalis-induced arrhythmias. This diug exhibits nonlinear pharmacokinetics and a number of side effects including neuropathy, gingival hypetplasia, hepatitis, immunological disorders and suppression of white blood cells. 

Associations can be of physical nature too. Chitosan blends with hydrophilic polymers including polyvinylalcohol, polyethyleneoxide and poly-vinylpyrrohdone, were investigated as candidates for oral gingival delivery systems. Chitosan blends were superior to chitosan alone in terms of comfort, ease of processing, film quality, and flexibihty [325]. 

Nifluril (UPSA) Nifluril gel gingival (UPSA)-comb. 

Table I lists the concentrations of nitrosodimethylamine (NDMA) and nitrosodiethylamine (NDEA) in some of the tobacco products which had greater than 0.5% nitrate content. Tobacco with less than 0.5% nitrate content, such as Bright tobaccos, yielded NDMA, NDEA and nitrosopyrrolidine (NPYR) generally below 5 ppb. The relatively high concentrations of NDMA in fine cut tobaccos and in snuff are possibly of significance in the increased risk for oral cancer among snuff dippers who use these tobacco types repeatedly each day by placing a pinch of the product directly into the gingival buccal fold (6,7).

Kasten, F. H., Pineda, L. F., Schneider, P. E., Rawls, H. R. Foster, T. A. (1989). Biocompatibility testing of an experimental fluoride releasing resin using human gingival epithelial cells in vitro. In Vitro Cellular Development Biology, 25, 57-62. 

Welsh, E. L. Hembree, J. H. (1985). Microleakage of the gingival wall with four class V anterior restorative materials. Journal of Prosthetic Dentistry, 54, 370-2. 

Amlodipine Hypotension, dependent peripheral edema, gingival hyperplasia BP every shift during oral administration during hospitalization, then every 6 months following hospital discharge dental exam and teeth cleaning every 6 months... 

Cyclosporine (Sandimmune , 4-5 mg/kg by mouth twice Neurotoxicity, gingival hyperplasia, Sandimmune ... 

Gingival hyperplasia + + Patient education appropriate dental... 

Hypertension Calcium channel blockers ACE inhibitors ARBs Diltiazem, verapamil inhibit CSA/TAC metabolism Dihydropyridines may potentiate CSA-gingival hyperplasia May exacerbate hyperkalemia monitor K+, SCr to assess for renal allograft vascular disease may be useful in posttranplant erythrocytosis (hematocrit greater than 55%)... 

Half-life 10-20 mcg/mL Ataxia, diplopia, Anemia, gingival... 

Coil JM, Tonzetich J. 1992. Characterization of volatile sulphur compounds production at individual gingival crevicular sites in humans. J Clin Dent 3 97-103. 

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