{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:12:39Z","timestamp":1789035159812,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":54,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Special Care in Dentistry"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Alpers\u2013Huttenlocher syndrome (AHS) is an ultra\u2010rare, autosomal recessive mitochondrial encephalopathy caused by pathogenic\n                      <jats:italic>POLG<\/jats:italic>\n                      variants, characterized by refractory epilepsy, hepatic dysfunction, and progressive neurodegeneration. Drug\u2010induced gingival overgrowth (DIGO) is a recognized complication of anticonvulsant and immunosuppressive therapy, particularly in medically complex patients. This report describes severe DIGO in a child with genetically confirmed AHS and explores the implications for multidisciplinary dental management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A CARE\u2010compliant case analysis was conducted in a five\u2010year\u2010old girl with AHS, status post living\u2010donor liver transplantation, chronically hospitalized in a long\u2010term intensive care unit. Clinical findings, pharmacologic exposures, multidisciplinary decision\u2010making, and conservative oral management strategies were systematically documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient, ventilator\u2010dependent and gastrostomy\u2010fed, had prolonged exposure to phenytoin, sodium valproate, topiramate, and tacrolimus without prior dental surveillance. Examination revealed severe fibrotic maxillary gingival overgrowth, delayed tooth eruption, and functional compromise. Given her profound systemic fragility, gingivoplasty under general anesthesia was contraindicated. A structured conservative protocol including 0.12% chlorhexidine, mucosal care, and continuous dental follow\u2010up was implemented to reduce inflammatory and infectious burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the necessity of integrating dental care into the multidisciplinary management of rare mitochondrial disorders and represents, to our knowledge, the first reported association between AHS and severe DIGO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scd.70241","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:39:57Z","timestamp":1787582397000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Surgical Intervention Becomes a Risk: Severe Drug\u2010Induced Gingival Overgrowth and Clinical Decision\u2010Making in Alpers\u2013Huttenlocher Syndrome"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8886-7172","authenticated-orcid":false,"given":"Marcus Vin\u00edcius","family":"Bueno","sequence":"first","affiliation":[{"name":"Dentistry Division \u2013 Central Institute \u2013 Hospital Das Cl\u00ednicas, School of Medicine University of S\u00e3o Paulo  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Department of Stomatology, School of Dentistry University of S\u00e3o Paulo  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Department of Dentistry, Children and Adolescents Institute Clinical Hospital of Medical School of the University of S\u00e3o Paulo  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0885-0056","authenticated-orcid":false,"given":"Renata Zoraida Rizental","family":"Delgado","sequence":"additional","affiliation":[{"name":"School of Dentistry State University of Northern Paran\u00e1  Jacarezinho Paran\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9573-2858","authenticated-orcid":false,"given":"Karem","family":"Ortega","sequence":"additional","affiliation":[{"name":"Department of Stomatology, School of Dentistry University of S\u00e3o Paulo  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7787-4062","authenticated-orcid":false,"given":"Juliana Bertoldi","family":"Franco","sequence":"additional","affiliation":[{"name":"Dentistry Division \u2013 Central Institute \u2013 Hospital Das Cl\u00ednicas, School of Medicine University of S\u00e3o Paulo  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Department of Dentistry, Children and Adolescents Institute Clinical Hospital of Medical School of the University of S\u00e3o Paulo  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Department of Dentistry Clinics Hospital of the State University of Campinas (UNICAMP)  Campinas S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S84900"},{"key":"e_1_2_10_3_1","volume-title":"StatPearls","author":"Rose H. 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