Reduction of Severe Gingival Overgrowth in a Kidney Transplant Patient by Replacing Cyclosporin A With Tacrolimus

Abstract

Side effects of certain drugs such as cyclosporin A (CsA) and phenytoin may induce gingival overgrowth which in some instances become unacceptable to the patient because esthetic, functional, and other effects. Use of these drugs is related to important medical situations, such as organ transplantation and control and withdrawal of the drugs is contraindicated. Tacrolimus is an immunosuppressant used to prevent graft rejection in organ transplant patients and has been shown to cause fewer oral side effects than CsA. This report deals with a case of probable synergism between the use of CsA and phenytoin which caused an intense gingival overgrowth in a kidney transplant patient. A treatment protocol including very thorough oral hygiene, scaling and root planing, clorhexidine digluconate rinses (0.12%), and substituting CsA with tacrolimus is described. Response to treatment after 6 months of tacrolimus use was excellent with almost complete reversion of the gingival enlargement. One-year follow-up demonstrated a stable gingival situation. The successful substitution of CsA with tacrolimus provides great expectations for the management of CsA-related gingival enlargement.

Agrandamiento gingival inducido por medicamentos. Reporte de un caso clínico / Drug-Induced Gingival Overgrowth. A Clinical Case Report

“…Los resultados de los estudios que evalúan el desarrollo de agrandamiento gingival inducido por Tcr son controversiales (21) Greenberg y James reportan que Tcr no se asocia con el desarrollo de agrandamiento gingival (20,22). Otros autores han sugerido que el agrandamiento observado en sujetos que toman Tcr es menor que en aquellos que toman CsA y tiende a ser menos severo (23,24).…”

“…Hernández y colaboradores en sus estudios de caso, han reportado disminución del agrandamiento gingival al hacer conversión de CsA por Tcr (24,25). Esto no ocurrió en esta paciente quien luego de algún tiempo de usar Tcr volvió a desarrollar agrandamiento gingival.…”

“…Actualmente no existe un consenso sobre la necesidad de realizar profilaxis antibiótica antes y durante el tratamiento periodontal en pacientes receptores de trasplante (24). La Asociación Americana del Corazón restringe el uso de profilaxis antibiótica a pacientes receptores de trasplante cardiaco que desarrollen valvulopatía cardiaca (37).…”

İlaca Bağli Di̇şeti̇ Büyümesi̇ İki̇ Vaka Sunumu

“…Fakat kalp transplantasyonu olan hastalarda durumu stabilse ve CsA'nın yan etkileri kontrol altına alınabiliyorsa, ilaç değiştirilmesine gerek olmayabilir. 19,21 Büyümeler genellikle ön bölge labialde görüldü-ğünden, cerrahi tedavi fonksiyondan ziyade estetik problemlerden dolayı uygulanır. Genellikle cerrahi olarak gingivektomi ve gingivoplasti uygulanır.…”

Drug-induced Gingival Enlargement and Treatment Modalities

“…Recently, some studies, that show regression in gingival growth when cyclosporine A is replaced with tacrolimus, are published. 49 Step 2: The physician should emphasize the importance of plaque control. In drug-induced gingival enlargement cases, pseudo pocket can be formed and this situation, that facilitates the accumulation of plaque, raises the probability of occurrence of periodontitis.…”