Reduction of Cyclosporine‐Induced Gingival Overgrowth Following a Change to Tacrolimus. A Case History Involving a Liver Transplant Patient

Abstract

During immunosuppression with cyclosporine, gingival overgrowth, a minor secondary effect, may appear in the first weeks of treatment. In certain cases it may affect the function and/or esthetic appearance in a manner intolerable to the patient. A new immunnosuppressive molecule, tacrolimus, presently used as a treatment of second choice to control acute corticoresistant rejection, may bring oral comfort to these patients, since it reduces gingival overgrowth to negligible levels.

Periodontal Changes in Liver Cirrhosis and Post‐Transplantation Patients. I: Clinical Findings

“…Furthermore, when CsA-treated patients within the PT group were compared to the tacrolimus-treated subjects, they manifested statistically higher GO, which is in agreement with Bader et al 14 and James et al 15 This suggests that the overgrowth is attributable primarily to the CsA itself. CsA-induced gingival overgrowth is a well-doc-1238 Table 3.…”

“…[13][14][15][16] Nevertheless, there are very few, if any, clinical trials comparing CsA and tacrolimus. The purpose of the present study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy on the periodontium.…”

Tacrolimus is not associated with gingival overgrowth in renal transplant patients

“…However, the finding that tacrolimus has no adverse effects on the gingival tissues confirms that this drug has potential as a suitable alternative immunosuppressant in patients susceptible to cyclosporin A induced gingival overgrowth. A number of case reports have shown that conversion from cyclosporin A to tacrolimus can alleviate mild to moderate cyclosporin A associated gingival overgrowth (Bader et al 1998, Busque et al 1998) although severe gingival enlargement does not appear to completely regress even after twelve months (James et al 2000a, b). In addition, some of the converted patients were found to have developed other problems, such as alopecia, an effect which could be considered at least as disturbing as gingival overgrowth, if not more so.…”

Gingival Overgrowth Among Patients Medicated With Cyclosporin A and Tacrolimus Undergoing Renal Transplantation: A Prospective Study

“…Using the index scores adapted from Seymour et al, 21 individuals who presented a value ≥30% were classified as having clinically significant GO (i.e., patients with GO in which surgical intervention might be needed to correct it) 7,16,22 …”

“…GO is characterized by an increase in gingival volume that is usually located in the gingival papillae without extending beyond the mucogingival junction 2,7,8 . Sometimes, this alteration may extend to the dental crown and interfere in the occlusion, mastication, and phonetics of individuals 5,9 …”