IATROGENIC GINGIVAL OVERGROWTH IN CARDIAC TRANSPLANTATION

IT IS WELL ESTABLISHED that both cyclosporin and nifedipine are associ ated with gingival overgrowth. Although both drugs are widely used in the management of organ transplant patients, there is little informati on on the prevalence and severity of this unwanted effect in cardiac t ransplant patients. This study evaluated the gingival health of 94 den tate cardiac transplant patients, all of whom were medicated with cycl osporin as a component of their immunosuppressive therapy. Sixty-three (63) of the patients were also medicated with nifedipine. Significant ly higher gingival overgrowth scores (P < 0.0001) and periodontal prob ing depths (P = 0.001) were observed in patients medicated with the co mbination of cyclosporin and nifedipine than those medicated with cycl osporin alone. Likewise, there was a significantly greater need to car ry out gingival surgery on patients taking the combination (62%), than those medicated with cyclosporin alone (25.8%) (P = 0.001). Patient's age, sex, duration of therapy, gingival bleeding index, and nifedipin e therapy were important determinants for both the expression of gingi val overgrowth and the need for surgery. Significant sequestration of nifedipine in the gingival crevicular fluid (GCF) was observed. The co ncentration of nifedipine in GCF did not relate to either the gingival changes or plasma concentration of the drug. Cardiac transplant patie nts are at risk of developing gingival overgrowth and approximately 50 % require surgical intervention. This risk increases significantly whe n patients are medicated concomitantly with nifedipine.