Some of the drugs commonly prescribed to transplant patients have a side effect which induces gum overgrowth (gingival hypertrophy/hyperplasia). The principal drugs involved include the immunosuppressant cyclosporin A (Neoral) and the anti-blood pressure medicine nifedipine. The mechanism which causes the overgrowth is not understood but causes the gums to increase in bulk and in severe cases cover the tooth surfaces. This may interfere with eating and speaking and therefore can also be uncomfortable and unsightly. The effect of gum overgrowth may be made worse by plaque building on the teeth causing gum inflammation (gingivitis).
It is a widespread problem associated with these medicines after transplant. Children and young adults seem to suffer from the problem more than older adults. The condition normally occurs within 3-6 months of commencing the drugs, but may occur at any time It would be preferable to find an alternative medicine to these drugs, however this is not a realistic option when the protective effects of cyclosporin (Neoral) are considered against this unwanted side effect.
As the medications can not be altered easily, it is important to make sure that your teeth and gums are kept in the best possible condition to avoid the problems caused by plaque and poor oral hygiene. This should start before transplant surgery in order to reduce the likelihood of gum overgrowth by keeping plaque at bay.
Teeth and gums should be kept scrupulously clean to control plaque. You should have regular check ups with your dentist before and after your transplant. Your dentist will be able to advise you further on how to look after your teeth and gums. If gum overgrowth does occur, it may be recommended that you are seen more frequently than previously by your dentist and hygienist.
The severity of gum overgrowth is very variable. At its most severe the excess tissue may need to be surgically removed. Unfortunately, as the drugs causing the problem are still being taken, recurrence will occur. However, if scrupulous oral hygiene is maintained, it may not be as severe as before. Recurrence normally occurs within 2-5 years. Less severe overgrowth may simply require regular dental hygiene treatment, often 2-3 monthly. Meticulous tooth brushing and flossing at home is essential to control the problem.
Because untreated gum overgrowth makes tooth cleaning more difficult there may be an increase risk of dental problems such as tooth decay and gum disease. The build up of plaque on teeth can also lead to bad breath (halitosis) and bad taste.