Assessment of Gingival Status and Gingival Overgrowth among Immunosuppressed Patients in Universiti Sains Malaysia Hospital

Authors

Wan Majdiah Wan Mohamad, School of Dental Sciences, USM Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia 2School of MedicalFollow
Syamimi Izzati Mat Zaid, School of Dental Sciences, USM Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
Haslina Taib, School of Dental Sciences, USM Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

Abstract

Drug-induced gingival overgrowth (DIGO) is defined as an abnormal growth of the gingiva due to adverse effect of some drugs such as immunosuppressant, calcium channel blocker, and anticonvulsant. Immunosuppressive drugs play an important role in controlling organ transplant rejection and were widely used to treat different diseases. Objective: Immunosuppressive drugs are used for prevention of transplant rejection and management of autoimmune disease. Drug-induced gingival overgrowth (GO) is abnormal growth of gingiva due to adverse effect of these drugs. This study aimed to assess the gingival status, the prevalence of gingival overgrowth and its associated factors among immunosuppressed patients. Methods: A total of 33 patients had participated in this cross-sectional study. Patients’ data such as age, race, gender, type of medication, and dosage were retrieved from patients’ medical record. Clinical oral examination was performed to assess the periodontal parameters: oral hygiene index, bleeding index and clinical gingival overgrowth index. Data were analysed using SPSS version 24.0. Results: The prevalence of gingival overgrowth among immunosuppressed patients is 57.6% at 95% confidence interval (40%,75%). Clinical index of gingival overgrowth shows 45.5% in grade 1 and 15.2% in grade 2. Oral hygiene status is significantly associated with gingival overgrowth based on plaque score (p= 0.01) and bleeding index score (p=0.05). Conclusion: The presence of gingival overgrowth among immunosuppressed patients is quite evidenced which could be contributed by poor oral hygiene.

References

1. Tungare S, Paranjpe AG. Drug Induced Gingival Overgrowth [Updated 2019 Dec 20]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih. gov/books/NBK538518/

2. Malek R, El Houari B, Kissa J. Periodontal management of cyclosporin A-induced gingival overgrowth: A nonsurgical approach. Hindawi, Case Report in Dentistry. 2019; Article ID 8609547:1-8.

3. Amit B, Verma Shalu B. Gingival enlargement induced by anticonvulsants, calcium channel blockers and immunosuppressants: A review. Int Res J Pharm. 2012;3(7):116-9.

4. Kant V, Kumar VP, Kumar P. Immunosuppressive drug therapy: An overview. J Immunol Immunopathol. 2009;11(2):21-32.

5. Sukhpreet, Tiwari P. Therapeutic drug monitoring of immunosuppressants: An overview. Indian J Pharmacol. 2007;39(2):66-70.

6. Silness J , Loe H . P eriodontal Disease in Pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-35.

7. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229-35.

8. Inglés E, Rossmann JA, Caffesse RG. New clinical index for drug-induced gingival overgrowth. Quintessence Int. 1999;30(7):467-73.

9. Cota LOM, Franco GCN, Aquino DR, Cortelli JR. Gingival overgrowth in subjects under immunosuppressive regimens based on cyclosporine, tacrolimus, or sirolimus. J Clin Periodontol. 2010;37(10):894-902.

10. Gopal S, Joseph R, Santhosh VC, Kumar VVH, Joseph S, Shete AR. Prevalence of gingival overgrowth induced by antihypertensive drugs: A hospital-based study. J Indian Soc Periodontol. 2015;19(3):308-11.

11. Rapone B, Ferrara E, Santacroce C, Cesarano F, Arazzi M, Di Liberato L et al. Periodontal microbiological status influences the occurrence of cyclosporine-A and tacrolimus-induced gingival overgrowth. Antibiotics (Basel). 2019;8(3):124.

12. Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol. 2014;35(3):347-69.

13. Moroni L, Bianchi I, Lleo A. Geoepidemiology, gender and autoimmune disease. Autoimmunity Rev. 2012;11(6-7):A386-92.

14. Reali L, Zuliani E, Gabutti L, Schonholzer C, Marones C. Poor oral hygiene enhances gingival overgrowth caused by calcineurin inhibitors. J Clin Pharm Ther. 2009;34:255-60.

15. Banthia R, Gupta S, Banthia P, Singh P, Raje S, Kaur N. Is periodontal health a predictor of druginduced gingival overgrowth? A cross-sectional study. DRJ. 2014;11(5):579-584.

16. Chang Y, Woo HG, Park J, Lee JS, Song T-J. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study. Eur J Prev Cardiol. 2020;27(17):1835- 1845.

17. Bekit A, Bagis N, Arpak N. Evaluation of effects of different immunosuppressant agents on gingival overgrowth. Int J Exp Dent Sci. 2015;4(1):17-22.

18. Samudrala P, Chava VK, Chandana TS, Suresh R. Drug-induced gingival overgrowth: A critical insight into case reports from over two decades. J Indian Soc Periodontol. 2016;20(5):496-502.

19. Costa LC, Costa FO, Cortelli SC, Cortelli JR, Cota LO. Gingival overgrowth in renal transplant subjects: A 44-Month follow-up study. Transplantation. 2013;96(10):890-6.

Recommended Citation

Wan Mohamad, W., Mat Zaid, S., & Taib, H. Assessment of Gingival Status and Gingival Overgrowth among Immunosuppressed Patients in Universiti Sains Malaysia Hospital. J Dent Indones. 2021;28(1): 27-32