A systematic review evaluating manual and powered toothbrushes with respect to oral
health has made some important conclusions. Compared to manual toothbrushes,
rotating/oscillating designs of powered toothbrushes reduced plaque and gingivitis by
7-17% although the clinical significance of this could not be determined. Powered
brushes, therefore, are at least as effective and equally as safe as their manual
counterparts with no evidence of increased incidence of soft tissue abrasions or
trauma. No clinical trials have looked at the durability, reliability, and relative cost of
powered and manual brushes so it is not possible to make any recommendation
regarding overall toothbrush superiority.
613H
Fig. 11.4 Chronic marginal gingivitis in a
10-year-old girl.11.5 DRUG-INDUCED GINGIVAL ENLARGEMENT
11.5.0 Introduction
Enlargement of the gingiva is a well-recognized unwanted effect of a number of
drugs. The most frequently implicated are phenytoin, cyclosporin, and nifedipine (614HFig.
11.5).
615H
Fig. 11.5 Drug (phenytoin)-induced
gingival enlargement in a 12-year-old
boy.11.5.1 Phenytoin
Phenytoin is an anticonvulsant used in the management of epilepsy. Gingival
enlargement occurs in about 50% of dentate subjects who are taking the drug, and is
most severe in teenagers and those who are cared for in institutions. The exact
mechanism by which phenytoin induces enlargement is unclear. The gingival
enlargement reflects an overproduction of collagen (rather than a decrease in
degradation), and this may be brought about by the action of the drug on
phenotypically distinct groups of fibroblasts that have the potential to synthesize large