tacrolimus and Tooth-Discoloration

Systemic complications in patients after renal or liver transplantation may be localized in the oral cavity. Calcium-phosphate disturbances may affect the structure and metabolism of mandible bones, promote calcification of dental pulp, and in children may cause developmental defects of teeth. The aim of this study was to evaluate the incidence of dental and bone abnormalities in children and adolescents after kidney and liver transplantation with respect to the type of the transplanted organ and maintenance immunosuppression.. Overall, 23 kidney and 25 liver recipients (mean age: 13.95±4.2 yrs) were evaluated. Twenty patients received ciclosporin A (CsA) and 28 tacrolimus (TAC). Twenty-one kidney and 14 liver recipients were treated with steroids. Mean time after transplantation was 3.62±2.98 years.. The severity of caries and percentage of odontogenic abnormalities (76.0% vs. 60.86%) was higher in liver transplant recipients. Positive correlations were found between discoloration of the deciduous teeth and liver transplantation, between enamel hypoplasia and kidney transplantation, and between treatment with CsA and its dose and blood concentration (p<0.05). Pulp stones were present in 13.04% of kidney vs. 8.0% in liver recipients, more often in those treated with CsA than with TAC. Jaw bone abnormalities were present in 30.43% kidney recipients vs. 12% liver recipients.. Both kidney and liver recipients present dental and bone abnormalities. The incidence of specific types of oral lesions is different in renal and liver graft recipients; however, it is also correlated with specific immunosuppression.

Topics: Adolescent; Child; Child, Preschool; Cyclosporine; Dental Caries; Dental Enamel Hypoplasia; Dental Pulp Calcification; Glucocorticoids; Graft Rejection; Humans; Immunosuppressive Agents; Incidence; Jaw Diseases; Kidney Transplantation; Liver Transplantation; Postoperative Complications; Retrospective Studies; Tacrolimus; Tooth Discoloration; Tooth Diseases

Immunosuppression by cyclosporin A (CsA) is associated with adverse side-effects, including nephrotoxicity, neurotoxicity and gingival overgrowth. Tacrolimus (TAC/FK506) is a new immunosuppressive agent, recently approved for use in solid-organ transplants. The mode of action of TAC is similar to that of CsA and the toxicity profile of CsA is duplicated by TAC. The effect of TAC on the gingival tissue is not yet conclusive.. Gingival overgrowth was assessed in 30 liver transplant children, 20 boys and 10 girls, aged 2-19 years. Seventeen children (10 boys, seven girls) were on a CsA-based immunosuppressive regimen whereas 13 children (10 boys, three girls) were on TAC for at least 1 year (mean 4.3 +/- 2.7).. In the CsA group, 35% of children exhibited gingival overgrowth characterized by one or more units with increased sulcus probing depth (> or = 4 mm), i.e. pseudopockets. In contrast to the CsA group, none of the children in the TAC group exhibited gingival overgrowth. The occurrence of enamel hypoplasia was observed in 11 children (36%) and enamel opacities were found in 23 children (76%). Six of the 12 children (50%) with hyperbilirubinaemia biliary atresia exhibited a marked greenish discoloration of the teeth. Caries experience (dmft/DMFT) among these children was 2.0 +/- 2.8.. No difference in caries experience or enamel defect was observed between the CsA and TAC group.

Topics: Adolescent; Adult; Biliary Atresia; Child; Child, Preschool; Cyclosporine; Dental Enamel; Dental Enamel Hypoplasia; Dental Plaque Index; DMF Index; Female; Follow-Up Studies; Gingival Overgrowth; Gingivitis; Humans; Hyperbilirubinemia; Immunosuppressive Agents; Liver Transplantation; Male; Mouth Diseases; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Statistics as Topic; Statistics, Nonparametric; Tacrolimus; Tooth Discoloration; Tooth Diseases