tacrolimus and Dental-Plaque

The results from reports analyzing the occurrence of gingival overgrowth (GO) induced by tacrolimus are controversial. In addition, the role of pharmacological and periodontal variables on the development and severity of GO have not been well-established. Therefore, the aim of the present study was to determine the effect of potential risk variables for GO in a Brazilian population comprising renal transplant recipients medicated with tacrolimus in the absence of calcium channel blockers.. Demographic, pharmacological, and periodontal data, recorded from 125 subjects selected to participate in the study, was analyzed with the use of the independent sample t test, the chi-squared statistic, or Mann-Whitney test. The effects of risk variables on GO scores were subsequently examined using multivariate regression analysis and general linear model.. The prevalence of clinically significant GO (> or =30%) in the study population was of 7.25%. These subjects showed greater averages of plaque scores (P=0.0043) as well as papillary bleeding index (P=0.0026) when compared to subjects with GO <30%. Papillary bleeding index, time since transplant and azathioprine dosage were significant in the univariate and multivariate models (adjusted R=43.8%), whereas plaque index was significant only in the univariate model.. This study revealed that, in the absence of calcium channel blockers, gingival inflammation, represented by the papillary bleeding index, was a variable associated with Tcr-induced GO, indicating the importance of periodontal maintenance of subjects under Tcr immunosuppressive regimens.

Topics: Adult; Aged; Azathioprine; Calcium Channel Blockers; Chi-Square Distribution; Dental Plaque; Female; Gingiva; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Prednisolone; Regression Analysis; Retrospective Studies; Tacrolimus; Time Factors

Tacrolimus is a new-generation immunosuppressant as successful as cyclosporin in suppressing organ transplant rejection. Although cyclosporin is known to cause gingival enlargement (GE), tacrolimus has not been associated with this condition. We sought to explore the prevalence of GE among renal transplant recipients (RTRs) in relation to cyclosporin and tacrolimus while controlling for the effect of calcium channel blockers (CCBs) and supragingival plaque.. RTRs were recruited from our institution's Kidney Transplant Unit. Participants completed a standardized questionnaire and received a complete oral examination, including a soft tissue examination and a periodontal examination measuring probing depth, recession, bleeding on probing, plaque index (PI), and GE.. Among 115 RTRs, 39 (34%) presented with GE, with the highest prevalence among those taking cyclosporin and CCBs (76%) and the lowest among tacrolimus users not on a CCB (15%). Tacrolimus was not found to be associated with GE. Cyclosporin was found to be associated with GE in a univariate analysis stratified by the use of CCBs, but multivariate analysis revealed that the only significant risk factors for GE were the use of CCBs and the widespread presence of abundant supragingival plaque (PI > or =2 on >40% of tooth surfaces).. This study confirmed that tacrolimus is not associated with GE. Cyclosporin taken at the currently recommended low dosage and not in combination with a CCB may not be associated with a significant risk for GE in individuals with good oral hygiene. CCBs should be avoided among patients taking cyclosporin and those with poor oral hygiene.

Topics: Adult; Calcium Channel Blockers; Cyclosporine; Dental Plaque; Drug Interactions; Female; Gingival Overgrowth; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Logistic Models; Male; Risk Factors; Statistics, Nonparametric; Surveys and Questionnaires; Tacrolimus

To investigate the prevalence of gingival overgrowth(GO) in a group of renal transplant recipients medicated with cyclosporine A(CsA) in comparison to those medicated with tacrolimus(Tcr).. 107 renal transplant recipients ( 85 CsA and 25 Tcr) were recruited into this study. Demographic, pharmacologic and periodontal data was recorded. The prevalence and severity of GO were compared between the two groups. The data was analyzed by SPSS13.0 software package for independent sample t test, chi(2) test, Mann-Whitney U test and stepwise regression analysis.. The prevalence of GO in the CsA group(49%)was significantly higher than that in the Tcr group(16%)(P<0.05). The CsA group showed a higher mean GO score (30.3+/-15.5) compared with the Tcr group(17.5+/-9.6) (P<0.001).In addition, the patients with GO presented a significantly higher plaque index and papilla bleeding index than those without GO in two groups(P<0.05).. The prevalence of GO is higher in renal transplant recipients taking CsA compared to Tcr. Plaque-induced gingival inflammation has a close relation with the severity of GO.

Topics: Cyclosporine; Dental Plaque; Dental Plaque Index; Gingival Overgrowth; Gingivitis; Humans; Immunosuppressive Agents; Kidney Transplantation; Tacrolimus; Transplant Recipients

Immunosuppressants play an essential role in transplantation therapy. In view of the side effects, e.g. gingival overgrowth, the present in vitro study was performed in order to investigate the effect of selected immunosuppressants on metabolic activities of gingival fibroblasts. Furthermore, the effect on the growth of six oral microorganisms was investigated.. Human gingival fibroblasts were incubated in the presence of azathioprine (Aza), cyclosporin A (CsA), tacrolimus (Tac) or mycophenolatmofetil (Myc). PGE subset 2 release was determined by means of a specific competitive enzyme immunoassay, using monoclonal antibodies specific for PGE subset 2 (clone E2R1). The protein content was measured spectrophotometrically. A redox indicator system was employed to assess the proliferation activity. In an additional trial the growth of six strains of oral bacteria (A. viscosus T14V, S. oralis H1, S. mutans 10449, C. gingivalis DR2001, A. actinomycetemcomitans Y4, and M. micros 33270) in the presence of the immunosuppressants was measured.. In comparison with the controls, the PGE subset 2 release was increased by 39.3% following incubation with Aza, and by 77.0% with CsA. The protein concentrations (1 g immunosuppressant / ml medium) were reduced by 26.0% for Aza and 17.0% for Myc. Furthermore, a drug-dependent inhibition in the cell proliferation rate was noted after an incubation period of 6 hours (Aza 70.7%, CsA 78.2%, Myc 69.8%, Tac 64.0%). The most pronounced growth-inhibiting effects were observed for CsA at values ranging from 21.0% (S. mutans 10449) to 48.6% (A. viscosus T14V) growth inhibition.. The present study with common immunsuppresants demonstrated both a medication- and dose-dependent alteration in the metabolic activity of gingival fibroblasts. Furthermore, growth-inhibitory effects on the selected bacterial strains could be observed.

Topics: Actinomyces viscosus; Aggregatibacter actinomycetemcomitans; Azathioprine; Capnocytophaga; Cell Division; Cells, Cultured; Cyclosporine; Dental Plaque; Dinoprostone; Fibroblasts; Gingiva; Humans; Immunosuppressive Agents; Mycophenolic Acid; Peptostreptococcus; Protein Biosynthesis; Streptococcus mutans; Tacrolimus

To determine the prevalence of dental caries in children undergoing liver transplantation and to compare the plaque, gingivitis, and gingival overgrowth indices and oral mucosal lesions in children before and after liver transplantation.. Patients undergoing liver transplantation at King's College Hospital were examined before transplantation, at 3 and 106 days post-transplantation. Healthy children from the Greenwich Health District, south-east London, were matched to the liver transplant patients by age, gender, socio-economic factors and the presence or absence of active dental caries.. Twenty-seven liver transplant patients (mean age: 7 years and 10 months; SD 3 years and 5 months) and 27 controls (mean age: 8 years and 6 months; SD 3 years and 7 months) were examined. The mean dmft and DMFT scores were 2.3 (SD 4.1) and 0.8 (SD 1.4), respectively, in the liver transplant patients, and 1.2 (SD 2.2) and 0.9 (SD 1.5), respectively, in the controls. There were no significant differences between either the mean plaque or gingivitis indices for the primary and permanent teeth in patients before and after transplantation. There were no significant differences between the liver transplant patients and the controls for either mean plaque or gingivitis indices at each examination time. Gingival overgrowth was present in 41% of liver recipients receiving cyclosporin with or without nifedipine, but not in the majority receiving tacrolimus at the final examination. Oral mucosal lesions were absent in both the patients and controls at each examination time.. The oral health of the children undergoing liver transplantation was inadequate. Funding and implementation of an oral health care programme must become a priority for all children before and after liver transplantation.

Topics: Adolescent; Case-Control Studies; Chi-Square Distribution; Child; Child, Preschool; Cyclosporine; Dental Caries; Dental Plaque; Dental Plaque Index; DMF Index; Female; Follow-Up Studies; Gingival Overgrowth; Gingivitis; Humans; Immunosuppressive Agents; Liver Failure; Liver Transplantation; Male; Nifedipine; Periodontal Index; Prevalence; Reproducibility of Results; Socioeconomic Factors; Statistics as Topic; Statistics, Nonparametric; Tacrolimus; Tooth, Deciduous