Surgical Treatment of Cyclosporine A‐ and Nifedipine‐Induced Gingival Enlargement: Gingivectomy Versus Periodontal Flap

Pilloni, Andrea; Camargo, Paulo M.; Carere, Mauro; Carranza, Fermín A.

doi:10.1902/jop.1998.69.7.791

Cited by 35 publications

(19 citation statements)

References 10 publications

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“…19 Group II showed acanthotic epithelium with hyperorthokeratosis and elongated rete processes within the underlying collagenous and vascular connective tissue. This is in agreement with Rahman et al, 20 Gonçalves et al, 21 Seibel et al, 22 and Pilloni et al 23 They indicated that thickening of the epithelium and elongated rete processes appeared to be a characteristic feature of CsAinduced GO. Spolidorio et al 24 and Nurmenniemi 25 attributed increased epithelial thickness in CsA-induced GO to the influence of connective tissue on epithelial architecture causing an increase in the mitotic activity in the oral epithelium.…”

Section: Discussionsupporting

confidence: 90%

In vivo association of immunophenotyped macrophages expressing CD163 with PDGF-B in gingival overgrowth-induced by three different categories of medications

Almahrog

Radwan

El-Zehery

et al. 2016

Journal of Oral Biology and Craniofacial Research

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Section: Discussionsupporting

confidence: 90%

In vivo association of immunophenotyped macrophages expressing CD163 with PDGF-B in gingival overgrowth-induced by three different categories of medications

Almahrog

Radwan

El-Zehery

et al. 2016

Journal of Oral Biology and Craniofacial Research

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“…[41] described a case of cyclosporin‐induced gingival overgrowth treated initially with oral hygiene instruction, scaling and root planning under local anaesthesia, which brought about a significant reduction in gingival enlargement, and subsequently, cessation of drug therapy combined with continued periodontal treatment to further improve the oral condition. However, surgical intervention is also common, and it has recently been suggested that a periodontal flap may give a more sustained reduction than gingivectomy [42]. Nevertheless, the impact of repeated surgery on the child has not been fully explored.…”

Section: Management Of Cyclosporin‐induced Gingival Overgrowthmentioning

confidence: 99%

Cyclosporin‐induced gingival overgrowth in children

Wright¹,

Welbury²,

Hosey³

2005

Int J Paed Dentistry

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Cyclosporin is a potent immunosuppressant drug commonly used to prevent organ transplant rejection. In recent years, there has been a widening of its therapeutic use and an increase in the number of patients undergoing transplantation. Gingival overgrowth is one of several oral side-effects of cyclosporin, with a quoted prevalence of between 8% and 100%. There is continued debate over the factors which modify the degree of overgrowth, including individual sensitivity, age, dose of drug, duration of drug therapy and the presence of dental plaque. The exact mechanism of gingival overgrowth is still being debated, but appears to be caused by a combination of the proliferation of fibroblasts within the gingival tissue, an increase in the deposition of collagen and extracellular matrix, and a decrease in phagocytosis with a net gain in gingival tissue mass. A number of treatment options are utilized in the treatment of gingival overgrowth, including CO2 laser surgery, improved oral hygiene, the use of antibiotics such as metronidazole and azithromycin, and surgical intervention. In the clinical application of cyclosporin, there is little correlation between cyclosporin dose, serum trough levels and total exposure to the drug, making it difficult to achieve the desired therapeutic response. These problems were previously further complicated by the variability of absorption of the drug via the gastrointestinal tract. The original cyclosporin formulation, Sandimmune, was replaced by a new formulation, Neoral, which has a more reliable absorption, and gives a closer correlation between trough concentration levels and individual bioavailability. There is a conflict of opinion over whether or not the side-effect profile of Neoral varies from its precursor Sandimmune. It has yet to be seen whether the increased bioavailability of Neoral will result in an increased severity and prevalence of gingival overgrowth. An alternative immunosuppressant drug, tacrolimus, which is a macrolide antibiotic with a different side-effect profile, has emerged as a substitute for cyclosporin in organ transplantation. However, there have been conflicting reports of its side-effects and its capacity to cause gingival overgrowth.

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“…7,75 It has been shown that nifedipine-induced gingival enlargement may be reduced or prevented by good plaque control, aimed at reducing gingival inflammation, and that in the most severe cases, resective periodontal surgery is used to eliminate excess tissue. [76][77][78][79][80] Also, wherever possible, reducing the drug dose or replacing it with another agent should be considered. 25,81 In our case, alternatives to nifedipine include the other dihydropyridines or non-dihydropyridine calcium antagonists, although verapamil 24,25 and diltiazem 29,30 also have been related to gingival enlargement.…”

Section: Periodontal Evaluation Of Control and Nifedipine-treated Patmentioning

confidence: 99%

Prevalence and Risk of Gingival Enlargement in Patients Treated With Nifedipine

Miranda

Brunet

Roset

et al. 2001

Journal of Periodontology

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Background: Gingival enlargement is a known side effect of nifedipine use. This study was conducted to determine the prevalence and risk factors for gingival enlargement in nifedipinetreated patients.Methods: A cross-sectional study was conducted in a primary care center. Data from 65 patients taking nifedipine were compared with 147 controls who had never received the drug. All patients were examined for the presence of gingival enlargement using 2 different indices: vertical gingival overgrowth index (GO) in 6 points around each tooth, and horizontal MB index in the interdental area. Gingival index, plaque index, and probing depth were also evaluated.Results: The prevalence of gingival enlargement was significantly higher in nifedipine-treated cases than in controls (GO index, 33.8% versus 4.1%; MB index, 50.8% versus 7.5%, respectively). Higher gingival and plaque indices were observed in patients taking nifedipine. Among the possible risk factors, only the gingival index showed a significant association with gingival enlargement. The risk (odds ratio [OR]) of gingival enlargement associated with nifedipine therapy was 10.6 (3.8-29.1) for the GO index and 14.4 (6-34.6) for the MB index. Gingival index-adjusted ORs were 9.6 (3.3-28.1) and 9.7 (3.9-23.3), respectively. In the subset of high nifedipine exposure patients, the odds ratio for gingival enlargement increased to 17.4 (5.3-56.3) for the 3) for the MB index. The concordance between GO and MB indices showed a kappa value of 0.689 in controls and 0.642 in patients treated with nifedipine.Conclusions: Patients taking nifedipine are at high risk for gingival enlargement, and gingivitis acts as a predisposing factor. J Periodontol 2001;72:605-611.

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Surgical Treatment of Cyclosporine A‐ and Nifedipine‐Induced Gingival Enlargement: Gingivectomy Versus Periodontal Flap

Cited by 35 publications

References 10 publications

In vivo association of immunophenotyped macrophages expressing CD163 with PDGF-B in gingival overgrowth-induced by three different categories of medications

In vivo association of immunophenotyped macrophages expressing CD163 with PDGF-B in gingival overgrowth-induced by three different categories of medications

Cyclosporin‐induced gingival overgrowth in children

Prevalence and Risk of Gingival Enlargement in Patients Treated With Nifedipine

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