Yrd. Doç. Dr. Abubekir ELTAS, Dr. Mustafa Özay USLU, Dr. Özden KAMIŞLI

Epilepsi Tedavisinde Uzun Dönem Fenitoin Kullanımının Alveolar Kemik Kaybı Üzerine Etkisi

Amaç: Epilepsi tedavisinde sıklıkla kullanılan eski nesil antiepileptik ilaçlardan birisi olan fenitoinin diş eti büyümesi ve kemik metabolizmasında değişiklikler gibi bir takım yan etkileri bulunmaktadır. Bu çalışmanın amacı epilepsi hastalarında uzun dönem fenitoin kullanımı ve alveolar kemik kaybı arasındaki ilişkiyi değerlendirmekti. Gereç ve Yöntem: Bu çalışma fenitoin (PHT) kullanan epileptik (n=65) ve PHT kullanmayan epileptik olmayan (kontrol grubu, n=65) toplam 130 birey üzerinde yapıldı. Periodontal değerlendirme için plak indeksi (Pİ), sondlama derinliği (SD), sondlamada kanama (SK) ve klinik ataçman düzeyi (KAD) ölçüldü. Kemik miktarını değerlendirmek için ise panoramik ve periapikal radyografiler kullanıldı. Bulgular: PHT kullanan grup ile kontrol grubu arasında Pİ, SK, SD değerleri benzer bulundu (p>0.05). Ayrıca iki grup arasında ortalama KAD’lerinin, KAD>4 mm bölgelerin yüzdesinin, kemik kaybı yüzdelerinin ve DMFT skorlarının da istatistiksel olarak farklı olmadığı görüldü (p>0.05). Kemik kayıplarının periodontal parametrelerle ilişkili olduğu görülürken (p0.05). Sonuç: Bu çalışmanın bulguları PHT kullanımının alveolar kemik yıkımını artırabileceğini desteklememektedir

Anahtar Kelimeler:

Epilepsi, fenitoin, periodontal hastalık, alveolar kemik kaybı

The Effect On Alveolar Bone Loss Of Long-Term Phenytoin Use İn The Treatment Of Epilepsy

Keywords:

-,

PDF

___

Yeni SN. Epilepsi epidemiyolojisi. Turkiye Klinikleri J Neurol-Special Topics 2008;1(2):9-16.
Engel J. ILAE Commission Report. A proposed diagnostic scheme for people with epileptic seizures and epilepsy: Report of the ILAE Task Force on Classification and Terminology. Epilepsia 2001; 42: 796 -803.
Cornacchio ALP, Burneo JG, Aragon CE. The Effects of Antiepileptic Drugs on Oral Health. J Can Dent Assoc 2011;71: 140.
Asconape JJ. Some common issues in the use of antiepileptic drugs. Semin Neurol 2002; 22(1):27– 39.
Greenwood M, Meechan JG. General medicine and surgery for dental practitioners. Part 4: Neurological disorders. Br Dent J. 2003; 195(1):19-25.
Thomason JM, Seymour RA, Rawlins MD. Incidence and severity of phenytoin-induced gingival overgrowth in epileptic patients in general medical practice. Community Dent. Oral Epidemiol. 1992;20: 288–91.
Turner MD, Glickman RS. Epileps y in the oral and maxillofacial patient: current therap y. J Oral Maxillofac Surg 2005; 63: 996-1005.
Pack AM, Morrell MJ, Randall A, McMahon DJ, Shane E. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy Neurology 2008; 70(18): 1586–1593.
Farhat G,Yamout B,Mikati MA, Demirjian S, Sawaya R, El-Hajj Fuleihan G. Effect of antiepileptic drugs on bone density in ambulatory patients Neurology 2002; 58(9):1348–1353.
Mattson RH, Gidal BE. Fractures, epilepsy, and antiepileptic drugs. Epilepsy Behav. 2004; 5: S36– 40.
Flemmig TF. Periodontitis. Ann Periodontol 1999; 4(1): 32-38.
Greenstein G. Nonsurgical periodontal therapy in 2000: a literature review. J Am Dent Assoc 2000; 131(11): 1580-1592.
Newman MG, Takei H, Caranza F. Carranza’s clinical periodontology. Philedelphia London New York St Louis Sydney Toronto: W.B Saunders Company, 2002: 398-402.
Lamster IB, Lalla E. Periodontal disease and diabetes mellitus: discussion, conclusions, and recommendations. Ann Periodontol 2001; 6(1): 146-149.
Fırat ET, Dağ A. Diabetik hastalarda periodontal tedavi ile HbA1c arasındaki ilişki. Atatürk Üniv. Diş Hek. Fak. Derg. 2009; 19(3):213-218.
Reddy MS. Osteoporosis and periodontitis: discussion, conclusions, and recommendations. Ann Periodontol 2001; 6(1): 214-217.
Amano A, Kishima T, Akiyama S, Nakagawa I, Hamada periodontopathic periodontitis in Down's syndrome. J Periodontol 2001; 72(3): 368-373. I. Relationship of bacteria with early-onset
Lamster IB, Grbic JT, Bucklan RS, Mitchell-Lewis D, Reynolds HS, Zambon JJ. Epidemiology and diagnosis of HIV-associated periodontal diseases. Oral Dis 1997; 3 Suppl 1: 141-148.
Gonzalez YM, De Nardin A, Grossi SG, Machtei EE, Genco RJ, De Nardin E. Serum cotinine levels, smoking, and periodontal attachment loss. J Dent Res 1996; 75(2): 796-802.
Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol 2001; 28(4): 283-295.
Hart TC, Kornman KS. Genetic factors in the pathogenesis of periodontitis. Periodontol 2000 1997; 14: 202-215.
Lang NP, Tonetti MS, Suter J, Sorrell J, Duff GW, Kornman KS. Effect of interleukin-1 gene polymorphisms on gingival inflammation assessed by bleeding on probing in a periodontal maintenance population. J Periodontal Res 2000; 35(2): 102-07.
Genco RJ, Ho AW, Grossi SG, Dunford RG, Tedesco LA. Relationship of stress, distress and inadequate coping behaviors to periodontal disease. J Periodontol 1999; 70(7): 711-23.
Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol 2000; 71(7): 1057-66.
Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Dietary vitamin C and the risk for periodontal disease. J Periodontol 2000; 71(8): 1215-23.
Dahllöf G, Preber H, Eliasson S, Rydén H, Karsten J, Modéer T. Periodontal condition of epileptic adults treated long-term with phenytoin or carbamazepine. Epilepsia. 1993;34(5):960-4.
O’Leary TJ, Drake RB, Naylor JE. The plaque control record. Journal of Periodontology 1972; 43: 38.
Lang NP, Nyman S, Senn C, Joss A. Bleeding on probing as it relates to probing pressure and gingival health. Journal of Clinical Periodontology 1991;18: 257–61.
Miller CS, Damm DD. Incidence of verapamil- induced gingival hyperplasia in a dental population. J Periodontol 1992;63: 453-6.
Miranda J, Brunet L, Roset P, Berrini L, Farre M, Mendieta C. Prevalence and risk of gingival enlargement in patients treated with nifedipine. J Periodontol 2001; 72: 605-11.
Fukuda CT, Carneiro SR, Alves VT, Pustiglioni FE, De Micheli G. Radiographic alveolar bone loss in patients undergoing periodontal maintenance. Bull Tokyo Dent Coll. 2008;49(3):99-106.
Seymour RA, Smith DG, Turnbull DN. The effects of pheny-toin and sodium valproate on the periodontal health of adult epileptic patients. J Clin Periodontol 1985;12(6):413-9.
Majola MP, McFadyen ML, Connolly C, Nair YP, Govender M, Laher MHE: Factors influencing phenytoin-induced gingival enlargement. J Clin Periodontol 2000;27: 506–12.
Ramfjord SP, Ash MM. Periodontology and Periodontics: Modern Theory and Practise. Ishiyaku EuroAmerica, Inc. Publishers, 1989, S:146-7.
Genco RF, Goldman HM, Cohen DW. Contemporary periodontics. The C. V. Mosby Company, 1990, Chp: 21.
Pack AM, Morrell MJ. Epilepsy and bone health in adults. Epilepsy Behav. 2004; 5 Suppl 2: S24-9.
Koide M, Kinugawa S, Ninomiya T, Mizoguchi T, Yamashita T, Maeda K, Yasuda H, Kobayashi Y, Nakamura H, Takahashi N, Udagawa N. Diphenylhydantoin differentiation and function through suppression of NFATc1 signaling. J Bone Miner Res. 2009; 24(8): 1469-80. inhibits osteoclast
Güncü GN, Caglayan F, Dinçel A, Bozkurt A, Saygi S, Karabulut E. Plasma and gingival crevicular fluid phenytoin concentrations as risk factors for gingival overgrowth. J Periodontol. 2006;77(12): 2005-10.
Brunet L, Miranda J, Roset P, Berini L, Farré M, Mendieta C. Prevalence and risk of gingival enlargement anticonvulsant drugs. Eur J Clin Invest. 2001;31(9):781-8. treated with