Oral soft and hard tissue abnormalities in pediatric renal transplant recipients

Abstract

An increasing number of dental patients are living with the end-stage renal diseases (ESR) or are the recipient of renal transplant. Soft and hard oral tissues may be affected by both renal diseases and also by the therapeutic immunosuppressive medications. Cyclosporin is associated with gingival overgrowth as a result of an interaction between the drug and its metabolites with susceptible gingival fibroblasts. The combined cyclosporine and an antihypertensive nifedipine regime enhances the degree of gingival overgrowth in renal graft recipients compared with cyclosporin alone. Cyclosporine-induced gingival overgrowth may stabilize 6 or 12 months after transplantation depending on the plaque level. Immunosuppression may inhibit periodontal tissue reaction to plaque stimulation and can mask the early signs of oral infection. Fever as the only sign of odontogenic infection has been reported in renal transplant recipients. A case of bilateral mandibular cysts has been reported in an 8-year-old boy treated with cyclosporin A (CsA). CsA might contribute to the cyst genesis by (1) interference with control mechanisms that regulate the reabsorption of gingival stromal tissue, allowing progressive dental eruption, and (2) an increase in the gingival connective tissue components.1 Viral infections, candidacies, large and slow-healing ulcers, lymphoma, Kaposi's sarcoma, carcinoma arising in cyclosporin-induced gingival hyperplasia, hairy leukoplakia, and dental pulp narrowing have been reported. There is an increase in the prevalence of enamel hypoplasia in children with chronic kidney diseases. The severity and extent of this depends on the degree of renal failure and its time of onset. Developmental enamel defects may occur through the period of enamel formation and may include hypoplasia, demarcated and diffuse opacities, and a combination of these defects. Altered vitamin D, calcium, and phosphate metabolism contribute to enamel opacities, loss of lamina dura, teeth mobility, bony fractures, and tumors from secondary hyperthyroidism. The incidence of caries experienced is generally low in these children, and radiographic assessments have shown only a slight delay in dental eruption. More aggressive periodontal treatments, such as periodontal surgery or orthodontics, should be undertaken only after the first year following transplantation. Prophylactic antibiotics are recommended for aggressive dental treatments.