Factors related to the incidence and severity of cyclosporin-induced gingival overgrowth in transplant patients: A longitudinal study
The purpose of this longitudinal study was to assess the incidence, severity, and evolution of cyclospor-ininduced gingival enlargement in heart, liver, and kidney transplants and to investigate the most significant factor contributing to gingival overgrowth. Researchers sampled 100 patients undergoing heart, kidney, or liver transplantation (39 heart, 29 liver, and 32 kidney). Of these, 81% were between 10 and 50 years old. All patients had at least one tooth in each group (incisors, canines, premolars, and molars).All patients were studied during the third and fourth week following transplant surgery and then monthly until the sixth month. All patients were trained in oral hygiene during the first visit, but no professional cleaning was rendered (hospital protocol). Each month a complete oral exam was conducted evaluating PI, GI, overgrowth, and cyclosporin blood levels.
A statistical analysis was applied to evaluate the relationship between overgrowth and study variables and to test the influence of sex, time, age, and type of transplant. Sex did not seem to be a factor influencing gingival overgrowth (42% males and 46% females).A total of 43% of the patients developed gingival overgrowth. Regarding age, the highest incidence occurred in the second and third decades. Kidney transplant patients showed the lowest scores throughout the study. Gingival overgrowth increased steadily until the fifth month, then stabilized. Plaque indices in all patients were higher than GI. Plaque indices went down steadily until they reached the sixth month. GI, even though lower than PI, showed a pattern that was nearly parallel to PI. Heart and liver transplant patients showed higher cyclosporin blood concentrations than kidney patients. There was a highly significant correlation between gingival overgrowth and cyclosporin blood concentrations, followed by PI and GI (regression analysis PIN 0.01). There was a significant negative correlation between age and gingival overgrowth indicating that younger patients had significantly higher gingival overgrowth than older patients. The basic factor influencing gingival overgrowth is cyclosporin blood concentration, followed by plaque and gingival levels. Differences between age and type of transplant maybe attributed to differences in cyclosporin concentrations. No significant differences were found between sex groups. [c.c.]
Somacarrera, M.L., G. Hernandez, J. Acero, and B.S. Moskow, J Periodont, 65:671,1994