Hernández G, Arriba L, Lucas M, de Andrés A
Department of Oral Medicine and Bucofacial Surgery, School of Dentistry, Complutense University, Madrid, Spain.
J Periodontol. 2000 Oct;71(10):1630-6. doi: 10.1902/jop.2000.71.10.1630.
Side effects of certain drugs such as cyclosporin A (CsA) and phenytoin may induce gingival overgrowth which in some instances become unacceptable to the patient because esthetic, functional, and other effects. Use of these drugs is related to important medical situations, such as organ transplantation and control and withdrawal of the drugs is contraindicated. Tacrolimus is an immunosuppressant used to prevent graft rejection in organ transplant patients and has been shown to cause fewer oral side effects than CsA. This report deals with a case of probable synergism between the use of CsA and phenytoin which caused an intense gingival overgrowth in a kidney transplant patient. A treatment protocol including very thorough oral hygiene, scaling and root planing, clorhexidine digluconate rinses (0.12%), and substituting CsA with tacrolimus is described. Response to treatment after 6 months of tacrolimus use was excellent with almost complete reversion of the gingival enlargement. One-year follow-up demonstrated a stable gingival situation. The successful substitution of CsA with tacrolimus provides great expectations for the management of CsA-related gingival enlargement.
某些药物如环孢素A（CsA）和苯妥英钠的副作用可能会导致牙龈增生，在某些情况下，由于美观、功能和其他影响，患者可能无法接受。这些药物的使用与重要的医疗情况相关，如器官移植，且禁忌停用这些药物。他克莫司是一种免疫抑制剂，用于预防器官移植患者的移植物排斥反应，已证明其引起的口腔副作用比CsA少。本报告涉及一例CsA和苯妥英钠联合使用可能产生协同作用的病例，该病例导致一名肾移植患者出现严重的牙龈增生。文中描述了一种治疗方案，包括非常彻底的口腔卫生、龈下刮治和根面平整、洗必泰葡萄糖酸盐冲洗（0.12%），以及用他克莫司替代CsA。使用他克莫司6个月后的治疗效果极佳，牙龈增生几乎完全消退。一年的随访显示牙龈情况稳定。用他克莫司成功替代CsA为治疗与CsA相关的牙龈增生带来了很大的期望。
