Severity Of Gingival Overgrowth Research Articles

Tacrolimus-Induced Gingival Hyperplasia.

A 66-year-old man with a history of an orthotopic heart transplant and rheumatoid arthritis presented to the clinic for a routine follow-up appointment. The patient reported swelling in his gums that started after his heart transplant surgery. He underwent gingival laser excision twice in the past, but the swelling recurred. Since his heart transplant surgery, he has taken daily tacrolimus, mycophenolic acid, and prednisone. Gingival hyperplasia (Figure, A) affecting the alignment of the teeth was notable on physical examination. His laboratory workup, including complete blood cell count, was within normal limits. The patient has had no cardiac complications since his surgery and chose to continue taking tacrolimus despite its adverse effect.FIGURE: A and B, Gingival hyperplasia affecting the alignment of the teeth.Tacrolimus is an immunosuppressant used in organ transplants. It has been replacing cyclosporine as it showed it is associated with a lower prevalence and severity of gingival overgrowth. Differential diagnosis: Vitamin C deficiency (scurvy) Gingival plaques Acute myeloid leukemia Peripheral giant cell granuloma Sarcoidosis

Local and Systemic Effects of Cyclosporine A on the Severity of Gingival Overgrowth in Post-Transplant Renal Patients.

Background:Cyclosporine A (CsA) is a potent immunosuppressant widely used to prevent renal post transplantation rejection. Gingival overgrowth (GO) is among various side effects of the long-term administration of CsA. Up to 90% of the patients under CsA therapy has been reported to develop CsA-induced GO.Objectives:The aim of the present prospective pilot study is to determine the local and systemic effects of Cyclosporine A (CsA) on the severity of gingival overgrowth and its relationship with periodontal parameters in post-transplant renal patientsMethods:Twenty post-transplant renal patients, 12 females and 8 males, presenting gingival overgrowth were selected from Rizk Hospital’s clinic in Beirut. Patient’s CsA plaque levels were evaluated when CsA is administered by syrup and capsules mode. Periodontal parameters including gingival overgrowth, papillary bleeding, plaque and gingival indices were assessed for all patients.Results:Plaque concentration CsA levels, when administered in syrup mode, affected significantly the severity of gingival overgrowth as opposed to the administration by capsule mode. Significant correlations between severity of gingival overgrowth on one hand and plaque index, gingival index, and papillary bleeding index on the other hand were only observed in the Capsule group but not in the syrup group. A significant relationship was established between the severity of gingival overgrowth and all periodontal parameters (gingival, papillary and plaque).Conclusion:The present study underlines CsA dental plaque local effect, as a co-factor, in the development of gingival overgrowth. Cyclosporine plaque accumulation acts as a reservoir in the gingival inflammation and the periodontal indices seem to be the most accurate parameters associated with gingival overgrowth severity. Plaque CsA concentrations could be considered as a risk factor for inflammation and gingival overgrowth depending on CsA delivery mode in renal transplant patients.

A novel gingival overgrowth mouse model induced by the combination of CsA and ligature-induced inflammation

Drug-induced gingival overgrowth (DIGO) is a side effect of the enlargement of gingival tissue by phenytoin, nifedipine, and cyclosporine A (CsA). Gingival inflammation has been identified as a key factor that initiates DIGO. However, a sufficient animal model for clarifying the role of inflammation in DIGO has not yet been generated. We herein describe a novel CsA-induced gingival overgrowth mouse model to evaluate the role of inflammation. A ligature was placed around the second molar in maxillae for 7days to induce gingival inflammation, and CsA (50mg/kg/day) was administered to mice during each experimental period. The severity of gingival overgrowth and mRNA expression of inflammatory cytokines in gingiva were assessed by the gingival overgrowth degree, histological analyses, and RT-PCR. The administration of CsA for 28days in combination with ligation significantly increased the gingival overgrowth degree and expanded the connective tissue area. Increases in the gingival overgrowth degree continued in a time-dependent manner until 21days. Furthermore, the cessation of CsA reduced gingival overgrowth. Thin ligatures (7–0 size) induced weaker tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 mRNA expression and less gingival overgrowth than thick ligatures (5–0 ligature). Moreover, the administration of an antibiotic cocktail, which suppressed the expression of these inflammatory cytokines in gingiva, attenuated gingival overgrowth induced by ligatures and CsA. These results suggest that inflammation in gingival tissue plays a role in initiating CsA-induced gingival overgrowth. This gingival overgrowth mouse model has potential for elucidating the etiology of DIGO from the view point of gingival inflammation.

Using Salivary Nitrite and Nitrate Levels as a Biomarker for Drug-Induced Gingival Overgrowth.

Aim: Drug-induced gingival overgrowth has a multifactorial nature and the pathogenesis is still uncertain. It has been suggested that Nitric Oxide (NO) might play a role in the pathogenesis of drug-induced gingival overgrowth due to the contribution of NO to immune response and matrix degradation. NO levels in biological fluids have been used as a diagnostic biomarker in many diseases. The aim of this study is to determine whether NO levels in plasma, saliva, and gingival crevicular fluid (GCF) can serve as a potential biomarker for the evaluation of drug-induced gingival overgrowth risk.Materials and Methods: A total of 104 patients, receiving cyclosporine A (n = 35), phenytoin (n = 25), nifedipine (n = 26), or diltiazem (n = 18) participated in the study. The amount of gingival overgrowth was evaluated with two indices and was given as percentage. Periodontal clinical parameters including plaque index (PI), gingival index (GI), gingival bleeding time index (GBTI), and probing depth (PD) were also assessed. Saliva, GCF, and plasma samples were obtained from each participants. Nitrite and nitrate levels in saliva, GCF, and plasma were analyzed by Griess reagent.Results: Salivary nitrite and nitrate levels in responders were significantly higher than those in non-responders in only phenytoin group (p < 0.05). Nitrite and nitrate levels of gingival crevicular fluid and plasma did not significantly differ between responders and non-responders in all study groups (p > 0.05). Salivary nitrite levels exhibited a significant correlation with PD, GBTI, severity of gingival overgrowth (%GO), and GCF volume (p < 0.05). Additionally, a strong positive correlation was detected between saliva and plasma nitrate levels (p < 0.005). However, both nitrite and nitrate levels in GCF and plasma demonstrated no significant correlation with clinical parameters, GO severity, and GCF volume (p > 0.05).Conclusion: Salivary nitrite and nitrate levels could be used as periodontal disease biomarkers in phenytoin induced gingival overgrowth, and that saliva seems to have a better diagnostic potential than GCF and plasma for the evaluation of drug-induced gingival overgrowth risk. However, when all drug groups were considered, saliva nitrite and nitrate levels could not be used as a biomarker for drug-induced gingival overgrowth.

Pattern of Gingival Overgrowth among Patients on Antihypertensive Pharmacotherapy at a Nairobi Hospital in Kenya

The objective of the study was to describe the prevalence and severity of gingival overgrowth (GO) among patients on anti-hypertensive pharmacotherapy at a Nairobi hospital in Kenya and to evaluate the relationship between GO and associated risk factors among these patients. The study design was a cross-sectional survey using a consecutive convenient sampling method. All the patients were examined for gingival enlargement by the method described by Seymour, et al. and modified by the authors to allow for measurement in millimetres. Gingival inflammatory status and plaque scores were also evaluated. The results showed that of the 164 hypertensive patients recruited, 20.7% had gingival overgrowth. Slightly over half (56.1%) of these patients were on calcium channel blockers (CCB). Patients on CCB had a higher prevalence (31.5%) of GO compared to those on non-CCB (7%). This difference was statistically significant (Yates χ2 = 13.39: 1 df: P = 0.000) with an odds ratio of 6.17 (95% CI 0.21 - 19.45). There was no statistically significant association between gender, drug dosage, plaque levels and gingivitis with GO. In conclusion, usage of CCB pharmacotherapy showed a significant association with GO.

Phenytoin- and amlodipine-induced gingival overgrowth

Drug-induced gingival overgrowth is an adverse event associated with three types of drugs, i.e., anticonvulsants, immunosuppressants, and calcium-channel blockers. It was shown that the combined use of an immunosuppressant (cyclosporine) and a calcium-channel blocker increases the prevalence and severity of gingival overgrowth. However, few reports discussed the effects of the combination of an anticonvulsant (phenytoin) and a calcium-channel blocker (amlodipine). In this case report, we present an epilepsy patient who was using both phenytoin and amlodipine, which caused extensive gingival overgrowth. After periodontal treatment and a gingivectomy, the gingival overgrowth was significantly reduced. A postoperative drug-substitution regimen and intensive professional care ensured a stable result 1 year after surgery.

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

The aim of this study is to make a longitudinal evaluation of the incidence and severity of gingival overgrowth (GO) induced by immunosuppressive agents, such as tacrolimus (Tcr) and cyclosporin A (CsA), in the absence of calcium channel blockers in patients undergoing renal transplantation (RT). This longitudinal study is conducted in 49 patients with RT who were divided into a CsA group (n = 25) and Tcr group (n = 24). The individuals were assessed at four time intervals: before transplant and 30, 90, and 180 days after RTs. Demographic data and periodontal clinical parameters (plaque index, cemento-enamel junction to the gingival margin, probing depth, clinical attachment level, bleeding on probing [BOP], and GO) were collected at all time intervals. The mean GO index was significantly lower in the Tcr group compared to the CsA group after 30 (P = 0.03), 90 (P = 0.004), and 180 (P = 0.01) days of immunosuppressive therapy. One hundred eighty days after RTs, a clinically significant GO was observed in 20.0% of individuals in the CsA group and 8.3% of individuals in the Tcr group. However, this difference was not statistically significant (P = 0.41). There was a reduction in periodontal clinical parameters regarding the time of immunosuppressive therapy for PI and BOP (P <0.001) in both groups. Although there was no statistical difference in the incidences of clinically significant GO after 180 days of immunosuppressive therapy, it was observed that GO occurred later in the Tcr group, and the severity of GO in this group was lower than in patients who used CsA.

Gingival Enlargement in Children Administered Cyclosporine After Liver Transplantation

Cyclosporine, a potent immunosuppressant agent, has significantly reduced the morbidity and mortality rates associated with solid-organ transplantations. The major side effect of this drug in the oral cavity is gingival enlargement. Cyclosporine-induced gingival enlargement was reported by different transplant centers as varying from 7% to 80%. Many factors related to cyclosporine-induced gingival overgrowth have been investigated. However, controversies still exist. This study investigates the effects of cyclosporine on the gingival tissues of liver-transplant pediatric patients, determines the prevalence and severity of gingival overgrowth, and analyzes the relationship between gingival enlargement and possible risk factors. Twenty-five children aged <4 years old (15 males and 10 females) with end-stage liver disease, and awaiting liver transplantation were selected for this study. During the pretransplant period, baseline data were collected including serum level of cyclosporine and gingival enlargement, plaque, and gingival bleeding indices. After liver transplantation, all subjects received <5 mg/kg cyclosporine as an immunosuppressant agent. The children had the same data collected immediately and 3, 6, and 12 months after liver transplantation. The results show that the cyclosporine-induced gingival enlargement of these children is not statistically associated with their age, gender, gingival inflammation, or serum level of cyclosporine (P >0.05). The gingival enlargement was found to be significantly related to the plaque index at each time period until 12 months after liver transplantation (P <0.05). An increased tendency of gingival enlargement was found in the immediate post-transplant examination and at 3 months after liver transplantation. Children administered cyclosporine after liver transplantation show that gingival enlargement is statistically more related to the plaque index than other factors such as age, gender, gingival inflammation, or the serum level of cyclosporine, which suggests that plaque control plays an important role in eliminating gingival enlargement in children who have undergone liver transplantation.

Prevalence of Gingival Overgrowth in Renal Transplant Recipients on Sirolimus Immunosuppressive Therapy is not Clearly Established

The authors attempted to study the gingival status of renal transplant patients receiving sirolimus immunosuppressive therapy by measuring the presence and severity of gingival overgrowth (GO) and by investigating the association between GO and sociodemographic, medical, and pharmacologic variables. Grants from the Coordination of Improvement of Upper Level Personnel (CAPES), Brasilia, DF, Brazil, and the Foundation for Support of Research in Minas Gerais (FAPEMIG/#13016). Cross-sectional Level 3: Other evidence. Not applicable.

Epidemiological analysis of nifedipine and phenytoin-induced gingival overgrowth in users of the Primary Health Care System

PURPOSES: The aim of this study was to evaluate the prevalence of drug-induced gingival overgrowth (DIGO) in Brazilian users of nifedipine and/or phenytoin and to determine the presence of predisposing/modifying factors. METHODS: Demographic, pharmacological, and periodontal data were obtained from 100 users of the Brazilian Primary Health Care System in Diamantina, Jequitinhonha Valley, Minas Gerais state, Brazil, who were taking nifedipine and/or phenytoin. Clinical evaluations including gingival overgrowth analysis were carried out by a single calibrated examiner. Bivariate analysis (Chi-square test or Student's t-test) were used to identify demographic, periodontal and drug-related significant factors associated with gingival overgrowth severity. Multivariate analysis (Poisson regression) was used to assess confounding factors. RESULTS: The prevalence of DIGO was high (86%), but its severity was predominately mild. The prevalence of DIGO was significantly higher in phenytoin users than in nifedipine users (p=0.01). There was no association between DIGO and demographic, pharmacological or periodontal variables. CONCLUSION: The high occurrence of DIGO among users of nifedipine and phenytoin emphasizes the importance of the dentist as part of the public health team to provide the prevention, early diagnostic, and control of this alteration.

Poor oral hygiene enhances gingival overgrowth caused by calcineurin inhibitors

To estimate the prevalence of gingival overgrowth in kidney allograft recipients in southern Switzerland and to determine the factors associated with it. We hypothesized that poor oral hygiene was a risk factor. We assessed the level of oral hygiene among renal transplant patients and determined whether a good level of information and regular dental checkups in addition to good oral hygiene could prevent gingival hyperplasia. Seventy-six adults who had undergone kidney transplantation were examined. The level of oral hygiene, gender, age, time elapsed from transplantation, medication and dose were recorded. In general the level of oral hygiene was average. We found a significant association between the severity of gingival overgrowth and the level of oral hygiene. No statistical relationship between gingival hyperplasia and the other recorded variables was detected. Patients on tacrolimus had a tendency to have less gingival hyperplasia. Patient education, along with regular dental checkups and a good level of oral hygiene, should prevent gingival hyperplasia or maintain it at an acceptable level. Intensive motivation of patients to maintain good oral hygiene is necessary to reduce the incidence of gingival hyperplasia.

Incidence of tacrolimus‐induced gingival overgrowth in the absence of calcium channel blockers: a short‐term study

The aim of this study was to determine the incidence and severity of gingival overgrowth (GO) induced by tacrolimus (Tcr) compared with ciclosporin A (CiA) in the absence of calcium channel blockers (CCB) in renal transplant recipients. Forty patients (20 Tcr and 20 CiA) were evaluated before and 30 and 90 days after kidney transplantation. Demographic (age, gender) and periodontal parameters were recorded for all patients. Patients taking CCB at any time during the study were excluded from the investigation. The mean GO score was significantly lower (p=0.014) in the Tcr group (6.4%) compared with the CiA group (17.9%) after 90 days of immunosuppressive therapy. At 90 days post-transplant, clinically significant GO was observed in four patients of the CiA group and in two of the Tcr group. This difference was not statistically significant (0.66). No significant difference in the incidence of clinically significant GO was observed between the CiA and Tcr groups up to 90 days of immunosuppressive therapy.

Demographic, Pharmacologic, and Periodontal Variables for Gingival Overgrowth in Subjects Medicated With Cyclosporin in the Absence of Calcium Channel Blockers

The role of cyclosporin in the absence of calcium channel blockers and the associated risk variables of development and severity of gingival overgrowth have not yet been properly established. The present study was conducted to determine the effect of potential risk variables for gingival overgrowth severity in Brazilian renal transplant subjects medicated with cyclosporin in the absence of any calcium channel blockers. A cross-sectional study was conducted in a public hospital in Belo Horizonte, Brazil. Demographic, pharmacologic, and periodontal data, recorded from 194 subjects taking cyclosporin in the absence of calcium channel blockers, were analyzed using independent sample t, chi2 statistic, or Mann-Whitney U tests. The effects of potential risk variables of gingival overgrowth severity were determined using backward stepwise regression analysis. The prevalence of clinically significant gingival overgrowth was 34.5% (N = 67). These subjects presented a significantly higher papillary bleeding index and a higher plaque index compared to those without clinically significant gingival overgrowth. When all demographic, pharmacologic, and periodontal data were evaluated in relation to gingival overgrowth severity, time since transplant, papillary bleeding index, serum cyclosporin concentration, and prednisolone and azathioprine dosages were significant in the univariate modeling (P <0.05) and remained significant when evaluated in the multivariate modeling (P <0.0001; adjusted R2 = 39.4%). In the absence of calcium channel blockers, this study showed that pharmacologic variables, such as cyclosporin serum concentration, prednisolone and azathioprine dosages, and time since transplant, are strongly related to gingival overgrowth. In addition, the periodontal variable papillary bleeding index highlighted the primary role of inflammation on the pathogenesis and severity of gingival overgrowth.

Prevalence, Severity, and Risk Variables Associated With Gingival Overgrowth in Renal Transplant Subjects Treated Under Tacrolimus or Cyclosporin Regimens

Some reports suggest that the prevalence and severity of gingival overgrowth (GO) is lower in patients taking tacrolimus (Tcr) than in those taking cyclosporin A (CsA). The present study was conducted to determine the prevalence and severity of GO in a group of renal transplant recipients treated with Tcr in comparison to those treated with CsA and to evaluate the risk variables associated with the development of GO in these two drug regimens. A cross-sectional study was conducted in a public hospital in Belo Horizonte City, Brazil. Demographic, pharmacological, and periodontal data were recorded for each subject. Variables from 134 subjects taking Tcr were compared to 451 subjects taking CsA using independent sample t, chi(2) statistic, or Mann-Whitney tests. The effects of potential risk factors on GO severity were determined using forward and backward stepwise regression analysis. Subjects taking CsA showed a higher mean GO score (29.03% +/- 22.9%) compared to subjects taking Tcr (16.9% +/- 3.4%) (P = 0.0038). In the Tcr group, 17.9% of the subjects had clinically significant GO compared to 38.1% in the CsA group (P = 0.045). In the multivariate final model, papillary bleeding index, azathioprine dosage, and concomitant use of calcium channel blockers (CCB) were significant variables associated with severity of GO in Tcr and CsA groups. In addition, previous CsA use also remained significant for GO in subjects under a Tcr regimen. The prevalence and severity of GO is lower in transplant subjects taking Tcr compared to CsA. GO severity in both groups was strongly associated with the papillary bleeding index, highlighting the role of inflammation in this condition. Concomitant CCB use, azathioprine dosage, and previous CsA use in the Tcr group reinforces the possible synergistic effects of these pharmacological variables on GO severity.

Cyclosporin But Not Tacrolimus Significantly Increases Salivary Cytokine Contents in Rats

Cyclosporin (CsA) and tacrolimus (FK-506) are immunosuppressive drugs that specifically inhibit T-cell activation via calcineurin inhibition. Gingival overgrowth is a common side effect following the administration of CsA. The severity of gingival overgrowth seen in patients taking FK-506 is less than that observed with CsA. Little is known about the involvement of saliva in drug-induced gingival overgrowth. The purpose of this study was to investigate the salivary contents of tumor growth factor beta1 (TGF-beta1), epidermal growth factor (EGF), and interleukin-6 (IL-6) as well as the hystometry of gingival tissue obtained from rats treated with either FK-506 or CsA. For 30 or 60 days rats received daily subcutaneous injection doses of either CsA or FK-506 (10 mg/kg). The concentrations of TGF-beta1, EGF, and IL-6 in saliva were determined by enzyme-linked immunosorbent assay, and after histological processing, the oral epithelium and connective tissue were assessed at the region of the lower first molars. The levels of TGF-beta1, EGF, and IL-6 in saliva were not significantly altered by any of the treatments after 30 days. After 60 days of treatment with CsA, gingival overgrowth and significant increase in salivary TGF-beta1, EGF, and IL-6 concentrations were observed; no statistically significant changes were induced by FK-506. Within the limits of this experimental study, it can be concluded that CsA, but not FK-506, induced gingival overgrowth associated with an increase of the salivary levels of the cytokines TGF-beta1, EGF, and IL-6.

Risk factors for gingival overgrowth in patients medicated with ciclosporin in the absence of calcium channel blockers

This study investigates the effect of a range of potential risk factors on the severity of gingival overgrowth in transplant patients medicated with ciclosporin in the absence of any calcium channel blockers. One hundred dentate solid organ transplants medicated with ciclosporin (but not calcium channel blockers or phenytoin) were recruited for the study. Demographic, pharmacological and periodontal data were recorded and gingival overgrowth assessed from stone models. Univariate analysis identified the duration of transplant, papilla bleeding index, creatinine serum concentration, azathioprine and prednisolone dosage as risk factors for overgrowth severity. Multivariate modelling, excluding the periodontal parameters, gave a predictive model that included dosages of ciclosporin, azathioprine, prednisolone and weight (p<0.0001, adjusted-R2=19%). Adding the periodontal variables strengthened the model (p<0.0001, adjusted-R2=34.5%). The explanatory models in this study contain a number of variables that moderate inflammation (azathioprine and prednisolone) or are markers of it (papilla bleeding index). Dosage of each of the three immunosuppressants was identified as a risk factor for the severity of gingival change. This observation appears to have been masked by the effects of the calcium channel blockers in earlier studies.

Plasma TGF-beta1 as a risk factor for gingival overgrowth.

Induction of the pro-fibrotic growth factor TGF-beta1 has been suggested as a possible mechanism through which immunosuppressant drugs may induce gingival overgrowth. This study aims to investigate plasma levels of TGF-beta1 and relate them to the development and severity of gingival overgrowth in immunosuppressed transplant patients. One hundred and thirty-two ciclosporin-treated and 13 tacrolimus-treated transplant patients and 24 drug-free control subjects underwent a full periodontal examination including a determination of the presence and severity of gingival overgrowth. Plasma TGF-beta1 concentrations were determined by ELISA, and were found to be significantly elevated in samples from the transplant patients (mean=29.1 ng/ml) as compared with controls (mean=6.1 ng/ml, p<0.0001). There was no significant difference between the levels of plasma TGF-beta1 in the ciclosporin- and tacrolimus-treated patient groups. Furthermore, concomitant treatment with calcium channel blockers did not influence the levels of plasma TGF-beta1 in the patients group. The relationship between gingival overgrowth, independent periodontal variables and TGF-beta1 plasma concentrations was examined using univariate and multivariate regression analyses; low TGF-beta1 plasma concentrations were found to be a risk factor for gingival overgrowth in immunosuppressed patients concomitantly receiving a calcium channel blocker.

Cytomegalovirus and cyclosporin-induced gingival overgrowth in children with liver grafts.

To determine whether cytomegalovirus (CMV) is associated with gingival overgrowth in paediatric liver graft recipients treated with cyclosporin. Thirty-four children, 25 of whom were under 5 years of age, who had undergone liver transplantation, were examined. An Index of Severity of Gingival Overgrowth was used to measure the prevalence and severity of the gingival overgrowth. The trough cyclosporin level was recorded and the CMV status of the patient matched to the dental findings. The association between the severity of gingival overgrowth and CMV infection was examined using the contingency coefficient. An anova was used to assess the association between the circulating trough cyclosporin concentration and the severity of gingival overgrowth. Pearson's Product Moment Correlation Coefficient was used to examine the association between the duration of exposure to cyclosporin and the severity of gingival overgrowth. There was a significant inverse association between the duration of exposure to cyclosporin and the severity of gingival overgrowth. There was no relationship between the trough cyclosporin concentration and the severity of gingival overgrowth. There was no association between CMV and gingival overgrowth. Gingival overgrowth was related to the duration of cyclosporin therapy but was neither more prevalent nor more severe in subjects who were CMV seropositive.

Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs.

Predictors of gingival enlargement in patients treated with anti-epileptics have not been previously assessed. This study was conducted to determine, with the aid of two indices that score vertical and horizontal overgrowth, the prevalence and risk factors for gingival enlargement in patients treated with phenytoin and other anticonvulsant drugs. A cross-sectional study was conducted and data from 59 patients taking antiepileptics were compared with 98 controls. Gingival enlargement was evaluated with two indices to score vertical overgrowth [Gingival overgrowth index (GO] and horizontal overgrowth [Miranda-Brunet index (MB)]. Gingival index, plaque index, and probing depth were also evaluated. The prevalence of gingival enlargement was significantly higher (P < 0.0001) for both indices in the anticonvulsants treated groups than in the control group. Gingival overgrowth was significantly higher for both indices in the phenytoin group than in the non phenytoin group. Among the possible risk factors, only the gingival index showed a significant association with gingival enlargement. For the MB index the risk of gingival enlargement (odds ratio) associated to phenytoin therapy and other anticonvulsants therapy were 52.6 (13.5-205) and 6.6 (1.5-28.2). Gingival index-adjusted odds ratios for the same drugs were 5.7 (1.3-24.7) and 18.1 (2-158), respectively. The concordance between GO and MB indices in the control group and in the phenytoin-group and non phenytoin-group showed a Kappa value of 0.773 and 0.697, respectively. This study reports significant differences in the prevalence and severity of gingival overgrowth in two groups of patients, one treated with phenytoin, and another treated with other anticonvulsants. Gingival inflammation is a significant risk factor for gingival enlargement in these patients.

Cyclosporin associated gingival overgrowth in renal transplant recipients.

To investigate the prevalence and severity of gingival overgrowth in a group of renal transplant recipients treated in one centre in Northern Ireland. A consecutive group of patients who had had a renal transplant for at least 6 months and were attending the Renal Unit in Belfast City Hospital took part in the study. These were divided into a group of 84 subjects treated with cyclosporin since their transplant who were compared with a control group of 36 transplant recipients who had never received cyclosporin. Each subject had a periodontal examination and completed a questionnaire. The severity of gingival overgrowth was scored from plaster models. Clinically significant gingival overgrowth was equated with a score of > or = 30 using the index developed by Seymour et al (1985). 41 (49%) of the cyclosporin group had clinically significant gingival overgrowth compared with none of the controls. A significantly higher proportion of males had overgrowth than females. There were significant correlations between age at transplant, plaque, bleeding, pocketing and the severity of gingival overgrowth. Many patients with clinically significant gingival overgrowth were apparently unconcerned about this condition. It is concluded that gingival overgrowth is a significant problem for renal transplant patients treated with cyclosporin, particularly if they are also treated with a calcium channel blocker. None of the factors measured, in isolation, explained the variable expression of gingival overgrowth in those at risk.