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Saudi Journal of Kidney Diseases and Transplantation
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Year : 1996  |  Volume : 7  |  Issue : 4  |  Page : 391-393
Relationship of Cyclosporine and Gingival Overgrowth


Royal Medical Services, Jordan-Irbid, Kufur Kefia

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   Abstract 

Cyclosporine is used as an immunosuppressive agent in organ transplantation. It has several side effects including gingival overgrowth. We evaluated 30 renal transplant patients on cyclosporine for the degrees of the gingival overgrowth. All the patients were males with mean age of 37.5 years. Eighteen patients (60%) had moderate to severe degrees of gingival overgrowth. No correlation was found with the trough levels of cyclosporine in blood. We conclude that gingival overgrowth is associated with cyclosporine immunosuppressive therapy but may not be dose related. The effect of other factors such as dental plaque and oral hygiene should be further studied.

Keywords: Gingival overgrowth, Transplantation, Cyclosporine.

How to cite this article:
Omari MA, Al-Akash NA, Maani MM. Relationship of Cyclosporine and Gingival Overgrowth. Saudi J Kidney Dis Transpl 1996;7:391-3

How to cite this URL:
Omari MA, Al-Akash NA, Maani MM. Relationship of Cyclosporine and Gingival Overgrowth. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Jan 21];7:391-3. Available from: http://www.sjkdt.org/text.asp?1996/7/4/391/39410

   Introduction Top


Despite the overall improvement of graft survival with the advent of cyclosporine as an immunosuppressive agent in renal trans plantation, many adverse effects are associated with this drug. These include nephrotoxicity, hypertension, hepatotoxicity, increased risk of lymphoma and gingival overgrowth [1] . The latter complication has especially been reported in the dental literature [2],[3],[4] . The gingival overgrowth may be due to increased cell proliferation, increased degeneration, or a combination thereof synthesis activity of fibroblasts, decreased Several factors that can influence drug induced gingival overgrowth have been investigated, particularly oral hygiene. More over, calcium channel antagonists, especially nifedipine, which is used frequently in the control of post-­transplant hypertension, has also been implicated as a contributing factor for the development of gingival overgrowth [5] . The aim of this study is to investigate the prevalence and severity of gingival overgrowth in patients treated by cyclosporine.


   Materials and Methods Top


Thirty renal transplant patients who approved to participate in this study were examined and followed-up in the dental clinic at King Hussein Medical Center, Amman, Jordan. None of the patients examined was taking anti convulsant therapy, calcium channel antagonists or any other medication known to produce gingival overgrowth. All the patients were males aged between 20 and 55 years (mean 37-5 years). After transplantation, the duration of the follow-up was between four months and four years. The patients were treated with cyclosporine, prednisolone and azathioprine, or cyclosporine and prednisolone. Gingival overgrowth was assessed by the Index developed by King et al [6] , [Table - 1]. Each patient underwent a routine periodontal assessment and scores were recorded for levels of dental plaque, which represented the level of oral hygiene according to a plaque index. Periodontal probing was measured to the nearest millimeter using a standardized periodontal probe.


   Result Top


The patients in this study had varying degrees of gingival overgrowth. Two patients had Class O gingival overgrowth, ten patients Class I, twelve patients Class II and six patients Class III. The patients received dental treatment including scaling, polishing and root planning. Six of these needed gingivectomy. The mean serum trough level of cyclosporine (measured by radioimmu-noassay) was within the therapeutic range in all patients and there was no significant correlation between drug level and the severity of gingival overgrowth [Figure - 1].


   Discussion Top


The association between cyclosporine therapy and gingival overgrowth was first noticed in the early 1980's when the drug was undergoing initial evaluation in organ transplantation [7] . The gingival tissue affected by cyclosporine often shows marked inflamma­tory changes, bleeds readily on probing, and is generally more hyperemic than the gingival tissue affected by other drugs such as phenytoin. This type of gingival overgrowth commences as a papillary enlargement and is restricted to the width of the attached gingiva, but can extend coronally [8] . Cyclosporine induced gingival overgrowth varies from 8% to 70% as reported in the literature [1] . In our study, severe gingival enlargement was shown in 20% of the patients, while mild to moderate degrees were in the rest of them. This may be due to individual variations in cyclosporine metabolism or variations of response of the gingival fibroblasts to cyclosporine. All the patients in our study were males, however, there was no significant difference of gingival overgrowth according to sex in previous studies [5] . Clinical studies suggest that the incidence and severity of gingival overgrowth in cyclosporine treated patients is dependent upon the interaction of several factors. These include the presence of dental plaque, the level of gingival inflammation, the age of the patient and the dosage and duration of cyclosporine therapy [9] . In our study we did not find any direct correlation between the trough serum levels of cyclosporine and the severity of gingival overgrowth. Nefidepine was described as an independent risk factor for the development of the gingival overgrowth [5] . However, the number of patients treated by nefidepine in our study was too small to draw definite conclusions about its effect on gingival overgrowth, so the patients treated by this drug were excluded from the study. A relationship between dental plaque and gingival overgrowth was reported elsewhere [10] . Our study supports the association between treatment with cyclosporine and the development of gingival overgrowth. Further investigations are required for better understanding of the relationships of dental plaque and oral hygiene with the cyclosporine related gingival overgrowth.

 
   References Top

1.Shaw LM. Advances in cyclosporine pharmacology, measurement, and therapeutic monitoring. Clin Chem 1989;35:1299-308.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Rateitschak-pluss EM, Hefti A, Lortscher R, Thiel G. Initial observation that cyclosporine-A induces gingival enlargement in man. J Clin Periodontal 1983;10:237-46.  Back to cited text no. 2    
3.Wysocki GP, Gretzinger, Laupacis A, Ulan RA, Stiller CR. Fibrous hyperplasia of the gingiva: aside effect of cyclosporine-A therapy. Oral Surg Oral Med Oral Pathol 1983;55:274-8.  Back to cited text no. 3    
4.Tyldesley WR, Rotter B. Gingival hyperplasia induced by cyclosporine-A. Br Dent J 1984;157:305-9.  Back to cited text no. 4    
5.Pernu HE, Pernu LM, Knuuttila ML, Huttunen KR. Gingival overgrowth among renal transplant recipients and uraemic patients. Nephrol Dial Transplant 1993;8:1254-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.King GN, Fullinfaw R, Higgins TJ, Walker RG, Francis DM, Wiesenfeld D. Gingival hyperplasiain renal allograft recipients receiving cyclosporine-A and calcium antagonists. J Clin Periodontol1993;20:286-93.  Back to cited text no. 6  [PUBMED]  
7.Calne RY, Rolles K, White DJ, et al. Cyclosporine A in clinical organ grafting. Transplant Proc1981;13:349-58.  Back to cited text no. 7  [PUBMED]  
8.Seymour RA, Jacobs DJ. Cyclosporine and the gingival tissues. J Clin Periodontol 1992;19:1-11.  Back to cited text no. 8  [PUBMED]  
9.Friskopp J, Klintmalm G. Gingival enlargement. A comparison between cyclosporine and azathioprine treated renal allograft recipients. Swed Dent J1986;10:85-92.  Back to cited text no. 9    
10.Pan WL, Chan CP, Huang CC, Lai MK. Cyclosporine-induced gingival overgrowth. Transplant Proc 1992;24:1393-4.  Back to cited text no. 10  [PUBMED]  

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Correspondence Address:
Mohammed A Omari
Royal Medical Services, Jordan-Irbid, Kufur Kefia

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PMID: 18417769

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