Conversion from Cyclosporin A to Tacrolimus as a Non‐Surgical Alternative to Reduce Gingival Enlargement: A Preliminary Case Series

Hernández, Gonzalo; Arriba, Lorenzo de; Frías, María Cruz; Macorra, José C. de la; Vicente, Juan Carlos de; Jiménez, Carlos María Gómez-Centurión; Andrés, Amado; Moreno, Enrique

doi:10.1902/jop.2003.74.12.1816

Cited by 32 publications

(26 citation statements)

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“…Reported cases of gingival enlargements were induced by different drugs; CCBs (50/119 – of which amlodipine-25;[8910111213141516171819202122232425262728] nifedipine-13;[26293031323334353637383940] verapamil-4;[41] felodipine-2;[4243] nisoldipine-1;[44] manidipine-1;[45] and unspecified CCBs-4[46]); phenytoin (11/119);[4748495051525354555657] cyclosporine (31/119);[3546585960616263646566676869707172737475] phenobarbital (4/119);[767778] sodium valproate (3/119 - including one report of congenital drug-induced gingival hyperplasia);[798081] d-penicillamine (2/119);[82] combination oral contraceptive pill-lynestrenol and ethinyl estradiol (1/119);[83] vigabatrin (1/119). [84] Cases of gingival enlargement after combination drug therapy have also been reported; a combination of cyclosporine and CCBs (11/119);[354685...…”

Section: Resultsmentioning

confidence: 99%

“…[35606164656667686970727475] It has also been used for treating aplastic anemia,[586073] psoriasis,[62] and Behcet disease. [71] Cyclosporine is known to alter the metabolism of gingival fibroblasts and also upregulates specific growth factors such as platelet-derived growth factor B, thereby causing adverse gingival changes such as overgrowth.…”

Section: Discussionmentioning

confidence: 99%

“…Kennedy and Linden in 2000[72] and Hernández et al . in 2003[66] reported rapid reduction in gingival overgrowth after cyclosporine withdrawal and its conversion to tacrolimus in organ transplant patients. Similarly, Gonçalves et al .…”

Section: Discussionmentioning

confidence: 99%

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Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Samudrala

Chava

Chandana

et al. 2016

J Indian Soc Periodontol

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Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Samudrala

Chava

Chandana

et al. 2016

J Indian Soc Periodontol

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“…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.…”

Section: Discussionunclassified

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

2018

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RESUMENAntecedentes: el agrandamiento gingival inducido por medicamentos es una condición clínica frecuente en pacientes que ingieren anticonvulsivantes, inmunosupresores y bloqueadores de los canales de calcio. La prevalencia de agrandamiento gingival inducido por medicamentos es de 3 -20 % en comparación con otras condiciones gingivales inflamatorias. Todos estos medicamentos producen lesiones clínicas y características histológicas indistinguibles unas de otras, que llegan a comprometer la función y la estética de los pacientes afectados. Propósito: Describir el manejo terapéutico integral y el seguimiento a 12 meses de una paciente con agrandamiento gingival inducido por tacrolimus y amlodipino. Descripción del caso: Paciente de 22 años con discapacidad mental limítrofe, receptora de trasplante renal fue remitida al servicio de Odontología del Hospital 2 Infantil Universitario de San José (Bogotá, Colombia) por presentar agrandamiento gingival. El examen clínico mostró un índice de placa de O'Leary del 84,3 %, inflamación generalizada y bolsas gingivales de 4 a 6 mm. El protocolo de tratamiento periodontal fue revisado por el equipo de trasplante renal e incluyó: trabajo con la familia para red de apoyo, diseño de un programa personalizado de higiene oral, gingivectomía y mantenimientos periodontales periódicos. Esta estrategia terapéutica permitió reducir el índice de placa y lograr un resultado clínico favorable. Conclusión: La condición sistémica y psicológica de la paciente determinó desarrollar un plan de tratamiento ajustado a sus necesidades. Pacientes susceptibles deben ser instruidos sobre la importancia de tener unas prácticas adecuadas de higiene oral y ameritan ser incluidos en un programa de mantenimiento periodontal. PALABRAS CLAVEAgrandamiento gingival; amlodipino/efectos adversos; reporte de caso; tacrolimus/uso terapéutico; trasplante renal/complicaciones ÁREAS TEMÁTICAS diagnóstico clínico; farmacología; medicina oral; periodoncia ABSTRACT Background: drug-influenced gingival enlargement, is a frequent clinical condition in patients who ingest anticonvulsant, immunosuppressant and calcium channel blockers. The prevalence of gingival overgrowth due to prescribed medications ranges from 3% to 20% in comparison to other gingival inflammatory conditions. These drugs produce clinical lesions and histological characteristics that are indistinguishable from one another, which compromise the function and aesthetics of the affected patients. Purpose: To describe the total therapeutic management and the clinical follow up at 12-months from a patient with gingival enlargement induced by tacrolimus and amlodipine. Case description: A 22-year-old patient with borderline mental disability who received a kidney transplant was referred to San Jose Hospital -Medical Dental Unit (Bogotá, Colombia) presenting gingival enlargement. The clinical examination revealed an O'Leary plaque index of 84.3%, generalized inflammation, and gingival pockets of 4 to 6 mm. The periodontal treatment protocol was reviewed by t...

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“…Drug induced GE prevalence varies among studies. General prevalence rates of CsA- associated GE vary from 8% to 81% (14). …”

Section: Discussionmentioning

confidence: 99%

The Impact of Amlodipine on Gingival Enlargement After Kidney Transplantation

Rahimi

Einollahi

et al. 2012

Nephro Urol Mon

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Background: Although cyclosporine (CsA) and calcium channel blockers (CCBs) parallel to each other may provoke gingival enlargement (GE), there are few considerations about combined effects of CsA and CCBs on gingival tissues.Objectives: This study aimed to determine prevalence of GE among renal transplant recipients and to compare its occurrence in patients who received only CsA and those who were on CsA and amlodipine.Patients and Methods: We conducted a prospective randomized case-control trial including 213 renal transplant recipients between February 2010 and August 2010. They were randomly divided into two groups including control group (on continuous treatment with CsA alone; n = 112) and trial group (treated with combined CsA and amlodipine; n = 101). Buccal, lingual, and inter-proximal membranes at last 12 anterior teeth were assessed for GE and packet depth (PD) using Gingival Index of McGaw and others, and Packet Index of Turesky–Gilmore–Glickman, respectively.Results: Marked GE was observed in 26 patients (25.7%) in trial group and only in 4 individuals (3.6%) in control group (P = 0.000). In logistic regression analysis, obese (OR = 3, P = 0.04), older (OR = 2.8, P = 0.03), and female (OR = 1.3, P = 0.03) recipients as well as who received high dose amlodipine (OR = 4.4, P = 0.000) were at risk for marked GE.Conclusions: There is a strong correlation between GE, in particular marked GE, and combination therapy with CsA and amlodipine in transplant patients compared to those treated by CsA alone. We suggest CsA dose reduction may restrain this adverse effect.

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Conversion from Cyclosporin A to Tacrolimus as a Non‐Surgical Alternative to Reduce Gingival Enlargement: A Preliminary Case Series

Cited by 32 publications

References 32 publications

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades

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

The Impact of Amlodipine on Gingival Enlargement After Kidney Transplantation

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