Drugs and the periodontium

Abstract

The periodontium and periodontal disease activity can be affected by systemic drug therapy. Many drugs can have an adverse effect on the periodontium, i.e., gingival hyperplasia. Alternatively, some drugs can modify the inflammatory and immunological responses of the periodontal tissues to bacterial plaque. The aim of this review is to evaluate the effects of drug therapy on the periodontium and periodontal disease activity, and where possible, to relate such changes to the pharmacodynamics of the drugs considered. Drugs which have been reported to affect the periodontium can be categorised as follows: anti-epileptics, immunosuppressants, corticosteroids, non-steroidal anti-inflammatory drugs and hormones. Those drugs whose pharmacodynamics are clearly established and which affect the rate of periodontal disease activity, may provide information on the mechanisms of periodontal destruction. Finally, the mechanisms of drug-induced gingival hyperplasia (overgrowth) are discussed in relationship to the drugs' pharmacodynamics and pharmacokinetics.

Drug-induced Gingival Enlargement and Treatment Modalities

“…These enlargements can be edematous or fibrotic depending on the degree of inflammation caused by local factors. 11 Fibrotic enlargements are generally limited; however growth towards coronal can be observed, too. This can effect both the function of mastication and oral care habits which may lead to periodontal disease as well as creating esthetic problems.…”

“…45,46 Lack of good plaque control and the presence of gingivitis, independently from the drugs used, aggravate the drug-induced gingival enlargements. 11,47,48 Most of the evidence about the relationship between bacterial plaque and gingival enlargement was obtained from cross-sectional studies. It is not clear exactly whether plaque is an aggravating factor of gingival enlargement or forms as a result of morphological changes in the gingiva.…”

“…11,12,36,37,38 Similar to phenytoine, gingival enlargement is not observed in every nifedipine using patient, incidence of gingival growth is approximately 20%. 20 Most of the organ transplant patients use nifedipine too together with cyclosporines.…”

Os sanum in corpore sano : (een gezonde mond in een gezond lichaam)

“…De neutrofiele granulocyt (ook vaak PMN genoemd) is met name de cel die de eerste lijn van verdediging vormt bij indringende tandplaquebacteriën. Dit weten we vooral zo zeker, omdat patiënten met een aangeboren functioneel defect in de PMN, zoals bij het Papillon-Lefèvre syndroom (17), maar ook met bepaalde vormen van leukemie of met cyclische neutropenie, al op jeugdige leeftijd een zeer ernstige vorm van parodontitis ontwikkelen, en hierdoor heel dikwijls zowel melktanden als blijvende tanden en kiezen verliezen (18). In ons onderzoek hebben wij aangetoond dat de functie van T-lymfocyten enigszins verstoord wordt door roken.…”

Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft

“…The NSAIDs act by blocking the cyclooxygenase (COX) pathway, producing effects on arachidonic acid metabolism and on the inhibition of the synthesis of certain metabolites, such as prostaglandins (PGs) (14). The SAIDs, also defined as corticosteroids, have a higher activity than NSAIDs due to blockade of the A2 phospholipase enzyme, thereby reducing not only the release of PGs, but also other chemical mediators such as leukotrienes and thromboxanes (15), reducing the accumulation of neutrophils and justifying, at least in part, the power of steroidal anti-inflammatory drugs (16).…”