Oral Surgery


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		*Oral Surgery Question 1: Is my jawbone growing!?*

	I recently went to an oral surgeon to find out why my jaw appears to be growing on one side even though I'm 26 years old. He told me it was in fact premature growth of my jaw on the right side. I have nearly one inch more of bone in the right side than the left. Could you tell me what this condition is called and maybe what possibly causes it, if known? I thought he said condylar hypersomethingorother! :) Thanks.




	I think you're close with that name! It sounds like the condition you are referring to is "condylar hyperplasia." This term is somewhat misleading because the condition itself is a state where bone has grown more than usual, whereas the word "hyperplasia" actually refers to an increase in the number of individual cells. The actual condition is, in fact, manifest due to an increased amount of extracellular mineralized bone matrix. In most instances, the cause of this "extra growth" is not known and the condition is thus called "idiopathic condylar hyperplasia." The term "condylar" refers to the mandibular condyle - there is a condyle on each end of the lower jaw which forms part of the TMJ (temporomandibular joint). When extra growth takes place on both sides of the jaw, it may result in a Class III occlusion, or the prognathic "bulldog" look. When this extra growth only occurs on one side, the lower jaw deviates to the other side of the face, the teeth don't meet properly, and the resultant condition, as you have mentioned, is termed "condylar hyperplasia." I hope this helps Ted Fields, DDS Oral Surgery



			*Oral Surgery Question 2: BP meds causing gum swelling?*

			Since a surgery on my gums to accommodate crowns on my teeth, I have been experiencing swelling (fluffiness) of the gums. Could a combination of medications I've been taking for hypertension have anything to do with the swellings? Has anything been recorded to this effect?

		Gingival enlargement (swelling of the gums) can occur as a side effect of taking certain medications. Several clinical reports have been published in the dental literature over the years. The mechanism whereby drugs induce gingival overgrowth are not clear. Researchers have suggested the mechanism could involve growth factors. Often implicated is platelet derived growth factor (PDGF) originating from macrophages. Research data indicates that phenytoin has the capability of stimulating bone cell proliferation and bone remodeling. Just what effect this would have, it any, on gingival enlargement is unknown. Earlier work suggested gingival overgrowth might be related to the influence of calcium in the tissues. Among the drugs which definitely have been associated with gingival enlargement is phenytoin (Dilantin). This drug is use primarily in the treatment of tonic-clonic seizure disorders. The incidence of gingival overgrowth is reported to in the range of 3% to 62%. A carefully directed dental hygiene home care plan is clearly helpful in reducing the severity of the gingival overgrowth. However, excessive enlargement may require treatment by surgical removal of the enlarged gingival tissues. Gingival enlargement is also associated with the use of cyclosporine (Sandimmune). This drug acts to suppress the immune response associated with organ transplant procedures. Indeed, the majority of patients who have had transplant surgery will be taking this drug. The effect of cyclosporine on PDGF has been the focus of a number of research efforts. The other major drug group implicated as a cause of gingival enlargement are the calcium channel antagonists. These drugs are used in the treatment of hypertension and angina pectoris. Ten different calcium channel antagonists are now availabe for use by physicians. Gingival overgrowth if more frequently associated with the use of nifedipine (Adalat, Procardia). Whether it occurs more often with this particular drug or not is not certain as this is the most widely prescribed of this drug class. Gingival overgrowth has also been associated with other calcium channel antagonists including verapamil, diltiazem and others. In fact, some have suggested that all member drugs of this class have the potential to cause gingival enlargement. It is estimated that gingival enlargement may occur in 5% of the patients taking calcium channel antagonists. However, it appears that one drug in this class, isradipine (DynaCirc), has the least likelihood of producing this side effect. In a letter from the manufacturer of isradipine, they reported that less than 5 probable cases have been alleged. Regular visits to the dentist and dental hygienist for examination and oral hygiene therapy will reduce the severity of gingival enlargement. Patients may not be able to stop the use of the medications causing the enlargement as loss of disease control may occur. However, there are other drugs which can be used to treat hypertension and angina. In this case, the dentist may be able to work with the patient's physician to encourage selection of an alternative drug from another class. [Top] Tommy W. Gage, BS, DDS, PhD Prof, Vice Chairman Oral Surgery/Pharmocology

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