Authored by Mehdi Honarparvar*
Abstract
Patients receiving chemotherapy experience a variety of side effects in the oral cavity. Fortunately, most of them are short-term. One long-term side effect which has been reported due to chemotherapy is oral hyperpigmentation. This is challenging to diagnose due to a variety of conditions having similar clinical appearance. It can easily be misdiagnosed as racial pigmentation which is far more common. In this case report we will describe a 58-year-old African American female experiencing localized gum bleeding during brushing. She mentioned during the appointment that she also would like to get the hyperpigmentation on the dorsal surface of her tongue evaluated. The diagnosis of drug-induced pigmentary changes is based on correlating the onset of clinical appearance of pigmentation with initiation of chemotherapeutic drug use. The mechanism of chemotherapy-related oral hyperpigmentation remains unknown. However, lesion size measurements and photographs can be documented and tracked over time to rule out the possibility of melanoma. Patients should be made aware that oral hyperpigmentation due to chemotherapy is a benign condition.
Keywords: Hyperpigmentation; Chemotherapy; Oral; Tongue; Cyclophosphamide
Abstract
The study aimed to evaluate the wound healing activity of topical phenytoin on gingival wound healing. In particular, 24 rabbits with the same gender, race and diet were kept in the same environment and were divided into two groups: Twelve (12) for the experimental group and another (12) for the control group. Each rabbit was prepared for surgery. The study focused on the clinical analysis in terms of color, size and gross appearance of the sound. Likewise, it also focused on the histopathological appearance of the wound for 1, 2 and 4 weeks with regard to polymorphonuclear cells, fibroblast and epithelialization.
Findings related that in terms of color, no significant differences were observed during the 1st, 2nd, and 4th week on both control and experimental group A because the pink color was consistently present. Significant improvement in size from the 1st to 4th week of the control and experimental group occurred because significant decrease in size from the 2nd to the 4th week. Meanwhile there was a significant difference in the gross appearance from the 2st to 4th week of the control group because the edema became normal on the 2ndand 4th weeks. It was therefore concluded that the experimental group is effective in 1st week decreasing the size, normalizing the gross appearance, decreasing of polyphon clear cells and increasing epithelialization. On the other hand, it cannot lessen the fibroblast. Finally effect of experimental is almost similar with control after 4th week.
Introduction
Proper wound healing processes are important in the prevention of complications (i.e. post-operative infection) which may lead to the formation of scar tissue that compromises esthetics. This would indicate that the acceleration of wound healing might be an important target in medicine. In dentistry, gingival wound healing comprises a series of sequential responses that allow the closure of breaches in the masticatory mucosa. This process is of critical importance to prevent the invasion of microbes or other agents into tissues, avoiding the establishment of a chronic infection. Wound healing may also play an important role during cell and tissue reaction to long-term injury [1]. Wound healing is very important and should always address the needs of the patient, promote normal healing and prevent complications. Dressings applied to acute wounds may require review by the patient themselves so clear instructions are necessary on what to do, when to do it and what should be raised as a concern. Surgical wounds are usually left covered for up to a week after surgery. In the case of graft donor sites, the dressing is left for up to 2 weeks [2].
Phenytoin is an example of agent that has been widely studied for its supposed benefits albeit controversial effects in wound healing. Oral phenytoin is used widely for the treatment of convulsive disorders, particularly as an effective anticonvulsant against tonic-clinic and partial seizures. A common side effect with phenytoin treatment of is the development of fibrous overgrowth of gingival tissues. This apparent stimulatory effect of phenytoin on connective tissue suggests the possibility for its use in wound healing, promoting numerous investigations on its contribution to wound healing processes [3].
Method of Research
This study utilized the experimental method of research. This methodology relied on random assignment and laboratory controls to ensure the most valid, reliable results. Although the researcher recognized that correlation does not mean causation, experimental designs produce the strongest, most valid results.
Procedures of data gathering
The test animals in the study were composed of 24 rabbits divided equally into two groups (experimental and control). For the experimental group, 6 rabbits underwent horizontal incision on the upper maxillary anterior labial part while 6 rabbits underwent horizontal incision on the lower mandibular anterior labial part. General anesthesia was then administered in 10 to 15 minutes to the rabbits. After this, sterile water was utilized in cleaning the affected area and then 1% phenytoin was applied. The same protocol was applied for the control group except for the topical PHT application. For the first, second and fourth weeks, 24 test animals respectively were sent to the laboratory. Likewise, per any week 4 rabbits from the experimental as well as 4 other rabbits from the control group were introduced. They were all observed from first to four weeks in the laboratory for histological and clinical analysis.
Phenytoin preparation
Preparation of phenytoin mucoadhesive paste 1% Phenytoin mucoadhesive paste 1% was prepared. As part of the preparation of this, 1 mg of phenytoin capsule was mixed with 100 mg of mucoadhesive paste compositions (including polyethylene LD, liquid paraffin, gelatin powder, lemon pectin powder, sodium carboxy methylcellulose powder, equal from each one). The resulting paste was deposited into 100mg tubes [4].
Results
(Figure 1) demonstrates the comparison of clinical analysis of color between control and experimental groups on the 1st, 2nd, and 4th weeks’ observation. No significant differences were observed with p-value above 0.05 (p=1.00) at all observations.
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