Are Inflammatory Cytokines Potential Mediators of Phenytoin-induced Gingival Overgrowth?

Authors: NURCAN BUDUNELİ, GÜL ATİLLA, NECİL KÜTÜKÇÜLER

Abstract: The levels of interleukin-1beta, tumour necrosis factor-alpha, and interleukin 6 in gingival crevicular fluid of phenytoin-treated patients (from sites exhibiting overgrowth and sites not exhibiting overgrowth) and control subjects were investigated. Six epileptic patients exhibiting severe phenytoin-induced gingival overgrowth, 12 patients with chronic gingivitis and 11 subjects with clinically healthy periodontium were included in the study. The cytokine levels were analysed by enzyme-linked immunosorbent assay and expressed as ng/2 sites. Wilcoxon signed-rank test, Kruskall-Wallis, Mann-Whitney U test and Spearman rank correlation were used for statistical analysis of the data. Overgrown sites showed significantly higher levels of interleukin-1beta compared to the healthy and gingivitis sites (p=0.0009, p=0.049 respectively). However, the difference was not statistically significant between overgrown and non-overgrown sites in epileptic patients (p=0.1159). Tumour necrosis factor-alpha values did not reveal any significant difference among the study groups. For interleukin 6, the highest value was found in the gingivitis sites, followed by overgrown, non-overgrown, and healthy sites, in descending order. No correlation was found between gingival crevicular fluid cytokine levels and papilla bleeding index values in phenytoin-treated patients. The results suggest that these cytokines play an indirect role in the complex mechanism of phenytoin-induced gingival overgrowth.

Keywords: phenytoin, interleukin-1beta, tumour necrosis factor-alpha, interleukin-6, gingival crevicular fluid

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