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      Assessment of Reliability of Three Indices Measuring Gingival Overgrowth

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          Abstract

          Objectives

          Numerous indices have been used to grade the severity of gingival overgrowth which led to suspicion regarding the results concerning its prevalence and pathogenicity. The aim of this study was to assess the concordance of three different gingival overgrowth indices, which were used widely in previous studies, and check their reliability and reproducibility.

          Material and Methods

          A total of 30 full-mouth plaster casts and 90 intra-oral photographs collected from 30 patients diagnosed with gingival overgrowth were included in our study. Three trained examiners performed measurements twice on plaster casts using gingival hyperplasia index (A index) and hyperplastic index (B index). Intraoral photographs were assessed also twice using (C index).

          Results

          Concordance of intra-examiner and inter-examiner reliability of the recorded measurements was carried out for each index using weighted kappa ( K), with a confidence interval of 95%. The A index revealed intra-examiner total kappa values between 0.724-0.876 for horizontal measurement and 0.512-0.823 for vertical measurement, and inter-examiner total kappa values between 0.255-0.626 horizontally and 0.235-0.279 vertically. The B index presented intra-examiner total kappa values between 0.587-0.868 horizontally and 0.653-0.855 vertically; and inter-examiner total kappa values between 0.393-0.595 and 0.372-0.635 for horizontal and vertical measurements, respectively. The C index achieved the highest intra-examiner concordance with total kappa values between 0.758-0.855 and inter-examiner total kappa values between 0.716-0.804.

          Conclusions

          The C index evaluated through intraoral photographs is considered the most reliable and applicable method to be utilized. The C index is suggested to be used in large scale populations with its definite detailed criteria.

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          Most cited references28

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          Drug-associated gingival enlargement.

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            Designing studies to ensure that estimates of test accuracy are transferable.

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              Drug-induced gingival hyperplasia: a retrospective study using spontaneous reporting system databases

              Background Drug-induced gingival hyperplasia (DIGH) causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patient’s quality of life (QOL). Thus, the aim of this study was to evaluate the incidence of DIGH using spontaneous reporting system (SRS) databases. Methods We analyzed reports of DIGH from SRS databases and calculated the reporting odds ratios (RORs) of suspected drugs (immunosuppressants, calcium channel blockers, and anticonvulsants). The SRS databases used were the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER) database. With the data, we evaluated the time-to-onset profile and the hazard type using the Weibull shape parameter (WSP). Furthermore, we used the association rule mining technique to discover undetected relationships such as possible risk factors. Results The FAERS contained 5,821,716 reports. The RORs (95% confidence interval: CI) for cyclosporine, everolimus, sirolimus, mycophenolate mofetil, amlodipine, nifedipine, carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, and valproic acid, were 39.4 (95% CI: 30.3–51.2), 4.2 (1.7–10.0), 6.6 (2.5–17.7), 13.1 (7.2–23.2), 94.8 (80.0–112.9), 57.9 (35.7–94.0), 15.1 (10.3–22.3), 65.4 (33.8–126.7), 6.5 (3.6–11.8), 19.7 (8.8–44.0), 65.4 (52.4–82.9), 56.5 (21.1–151.7), 2.9 (1.1–7.7), and 17.5 (12.6–24.4), respectively. The JADER database contained 430,587 reports. The median time-to-onset of gingival hyperplasia values for immunosuppressants, calcium channel blockers, and anticonvulsants use were 71, 262, and 37 days, respectively. Furthermore, the 95% CI of the WSP β for anticonvulsants was over and excluded 1, which meant that they were wear-out failure type. Conclusions Our results suggest that DIGH monitoring of patients administered immunosuppressants, calcium channel blockers, or anticonvulsants is important. We demonstrated the potential risk of DIGH following the long-term use of calcium channel blocker over approximately 260 days. Based on the results of the association rule mining approach, patients with intellectual disability who are administered phenytoin should be monitored carefully. We recommend that patients who experience symptoms related to DIGH should be closely monitored.
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                Author and article information

                Journal
                Acta Stomatol Croat
                Acta Stomatol Croat
                ASC
                Acta Stomatologica Croatica
                University of Zagreb School of Dental Medicine, and Croatian Dental Society - Croatian Medical Association
                0001-7019
                1846-0410
                June 2023
                June 2023
                : 57
                : 2
                : 98-112
                Affiliations
                [1 ]deptDepartment of Periodontology, Institute of Health Sciences , Marmara University , Istanbul,
Turkey
                [2 ]deptDepartment of Periodontology, Faculty of Dentistry , Marmara University , Istanbul,
Turkey
                Author notes
                Author for correspondence: Ahmad Safa Alkateb, Marmara University, Institute of Health Sciences, Department of Periodontology, Istanbul, Turkey, GSM: +905465914486, E-mail: safa.alkateb@ 123456outlook.com

                Author’s contribution: Concept and design of the study – A.S.A., H.Ö.Ö., L.K.; Literature review – A.S.A.; Data collection – A.S.A.; Investigation and visualization - A.S.A., H.Ö.Ö., L.K.; Methodology and measuring - A.S.A., H.Ö.Ö., L.K.; Interpretation and sample analysis - A.S.A., H.Ö.Ö., L.K.; Supervision – L.K.; Writing – A.S.A.; Review and editing - H.Ö.Ö., L.K.; Final writing of the version to be published – A.S.A.

                Author information
                https://orcid.org/0000-0002-0716-8637
                https://orcid.org/0000-0002-2156-584X
                https://orcid.org/0000-0002-7599-2409
                Article
                ASC_57(2)_98-112
                10.15644/asc57/2/1
                10323928
                a9f72160-6a14-4e29-b89a-a083f820299d
                University of Zagreb School of Dental Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.

                History
                : 12 December 2022
                : 24 April 2023
                Categories
                Original Scientific Papers

                index,inflammation,gingival overgrowth,photography,mesh terms: gingival overgrowth,reproducibility of results,methods,dental photography

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