title: Sonic tooth brushing reduces gingival overgrowth in renal transplant recipients.
abstract: Cyclosporine (CSA) is a commonly used immunosuppressive medication in pediatric transplantation. Drug-induced gingival overgrowth (DIGO) is a frequent side effect associated with CSA use and can impair the patient's ability to achieve good oral hygiene. This study tested the hypothesis that sonic tooth brushing and oral hygiene instruction can reduce the occurrence or severity of DIGO in CSA-treated pediatric renal transplant recipients. Twenty-three pediatric renal transplant patients with DIGO were randomly allocated to treatment or control groups. The treatment group received oral hygiene instruction and use of a sonic toothbrush, while the control group continued their usual home care with manual brushes. Dental impressions and photographs of all subjects were taken at baseline and every 3 months for a year. The casts and photographs were evaluated by a dental panel to compare the DIGO levels from baseline until the end of the study. After 12 months the control group had significantly more severe DIGO than did the sonic tooth brushing and oral hygiene instruction group (OR=4.5, 95%CI=1.2-16.0, P=0.03). Of the risk factors considered, only male gender was significantly associated with worse outcome (OR=6.1, 95%CI=2.3-16.1, P=0.03). The use of a powered toothbrush, together with oral hygiene instruction, may be an important component of health maintenance for pediatric transplant patients on CSA.
authors.affiliation: Pediatric Nephrology, Children's Hospital and Regional Medical Center, Seattle, WA, USA.
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Smith
authors.forename: Craig S
authors.initials: CS
authors.lastname: Wong
authors.forename: Eva B
authors.initials: EB
authors.lastname: Salamonik
authors.forename: Beth M
authors.initials: BM
authors.lastname: Hacker
authors.forename: Ruth A
authors.initials: RA
authors.lastname: McDonald
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Mancl
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Williams
authors.forename: Alfaiyaz
authors.initials: A
authors.lastname: Ibrahim
authors.forename: Frank A
authors.initials: FA
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects*; D003742:Dental Devices, Home Care; D005260:Female; D019214:Gingival Overgrowth / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009910:Oral Hygiene; D013010:Sonication; D014099:Toothbrushing / Q000592:standards*
chemical_list: D016572:Cyclosporine