Oral health in liver transplant children administered cyclosporin A or tacrolimus.
BACKGROUND
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
No difference in caries experience or enamel defect was observed between the CsA and TAC group.
Wondimu
B
B
Department of Paediatric Dentistry, School of Dentistry, Karolinska Institutet, Huddinge, Sweden. biniyamwondimu@ofa.ki.se
Németh
A
A
Modéer
T
T
D000293:Adolescent; D000328:Adult; D001656:Biliary Atresia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects*; D004245:DMF Index; D003743:Dental Enamel / Q000002:abnormalities / Q000187:drug effects; D003744:Dental Enamel Hypoplasia / Q000139:chemically induced; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D019214:Gingival Overgrowth / Q000139:chemically induced; D005891:Gingivitis / Q000139:chemically induced; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D009059:Mouth Diseases / Q000139:chemically induced*; D017622:Periodontal Attachment Loss / Q000139:chemically induced; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000139:chemically induced; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D016559:Tacrolimus / Q000009:adverse effects*; D014075:Tooth Discoloration / Q000209:etiology; D014076:Tooth Diseases / Q000139:chemically induced*
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus