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The prevalence of gingival overgrowth in rheumatoid arthritis patients treated with cyclosporin McCloy, Deborah F.

Abstract

Cyclosporin has been recognized since the mid 1980's as a potent disease-modifying agent for inflammatory auto-immune diseases that are unresponsive to standard therapeutic regimens. From the organ transplant literature, cyclosporin is known to induce gingival overgrowth in the first ninety days of treatment. In Rheumatoid Arthritis (RA), gingival overgrowth, coupled with the common feature of compromised manual dexterity, may make dental plaque control difficult for immunosupressed patients, resulting in increased susceptibility to oral complications. Determination of oral health status has not been included previously in patient evaluations. The goal of this study was to determine the prevalence of gingival overgrowth, predisposing factors and types of oral complications occurring in this population group. The objectives of the study were to determine the prevalence and severity of gingival overgrowth and to determine at what point in the treatment regime the patients were most at risk. Twenty-eight volunteer R A patients took participated in the study. Twenty-two were placed on a cyclosporin treatment regime while six were used as a control group and placed on Methotrexate. Methotrexate is an immunosupressive medication frequently used in the treatment of advanced RA. It does not induce gingival overgrowth but it does produce a high incidence of oral ulceration. At Day Zero, patients were examined by a calibrated examiner to determine probing depths, periodontal attachment loss, maximum opening and gingival inflammation using standard indices. Plaque scores and the presence and severity of gingival overgrowth were recorded. Patients completed a Quality of Life (QOL) Visual Analogue Scale at Day One. Patients were re-examined every four to six weeks for a minimum of six months. At each appointment they were interviewed about their oral health experiences. Upon leaving the study, participants again completed the QOL visual analogue scale. There was no significant correlation between plaque accumulation and oral complications. Gingival overgrowth was not detected in any of the patients. There was no significant correlation between plaque accumulation and gingival inflammation. Maximum opening scores did not correlate with plaque accumulation scores but did correlate with QOL scores. There was a decrease in gingival inflammation scores through the course of the study.

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