THE PERIODONTAL PROBLEMS AND MANAGEMENT OF THE RENAL-TRANSPLANT PATIENT

This review considers the periodontal problems of renal transplant pat ients with particular reference to their drug therapy and the pretrans plant uremia. If would appear that either disease- or drug-induced imm unosuppression affords the renal transplant patient a degree of ''prot ection'' against periodontal breakdown. However, of more significance to the periodontologist is the problem of drug-induced gingival overgr owth with reference to both cyclosporin and nifedipine. Approximately 30% of dentate renal transplant patients medicated with cyclosporin al one experience significant gingival overgrowth which requires surgical excision. This figure increases to 40% when patients are medicated wi th both drugs. The pathogenesis of this unwanted effect is uncertain a nd the relationship between the expression of gingival overgrowth and various periodontal or pharmacokinetic variables remains a contentious issue. Clinical measures to prevent the occurrence of either cyclospo rin- or nifedipine-induced gingival overgrowth are unsatisfactory.