Drug-induced gingival overgrowth

Resident’s Name: Joanne Lewis Date: April 23, 2010

Article title: Mechanisms and management of gingival overgrowth in paediatric transplant recipients: a review

Author(s): Chabria D., et al

Journal: International Journal of Paediatric Dentistry

Volume (number): 13

Month, Year: 2003

Major topic: gingival overgrowth, Cyclosporine A

Type of Article: review of literature

Main Purpose: to summarize current knowledge concerning the etiology, pathogenesis, and management of gingival overgrowth.

Key points/Summary: Cyclosporine A (CyA) has been the primary tool to prevent transplant organ rejection in adults and children; one of the side effects of CyA is gingival overgrowth (GO). Studies suggest that children are more susceptible to CyA-induced GO than adults. The pathogenesis of drug-induced GO is unclear; some possible theories include: CyA alters the metabolism of human gingival fibroblasts, increased secretion by gingival fibroblasts, decreased phagocytic activity, a gingival inflammatory response to CyA, or increased gingival levels of plasma-derived growth factors. Factors affecting the severity of GO include: CyA serum concentration and dosage (association still unclear), age (children under the age of 5 at the time of transplantation experience the worst GO, probably due to immature fibroblasts), concomitant medication (nifedipine – administered to offset hypertension), oral hygiene. Management of GO: good oral hygiene, surgical intervention (little evidence for long-term efficacy), and pharmacological approach (improvement in GO has been seen following the administration of azithromycin, metronidazole, and clarithromycin). A new immunosuppressant agent Tacrolimus causes fewer oral side effects than CyA and is becoming more widely used in transplant patients.