The Study Of Relationship Between Putative Periodontopathogenic Bacteria And Cyclosporine-induced Gingival Overgrowth

[Objective]The aim of our study was to analyzed the effect of putative periodontopathogenic bacteria on the development of cyclosporine(CsA) -induced gingival overgrowth(GO).Then,we evaluated the effect of non-surgical periodontal therapy on the clinical and microbiological parameters of CsA-induced GO in renal transplanted patients.Furthermore, the prevalence of GO in a group of renal transplant recipients treated with CsA in comparison to those treated with tacrolimus(Tcr) was also investigated.[Methods]PartⅠInvestigation of the prevalence of drug-induced gingival overgrowth in renal transplant recipients administered cyclosporine A or tacrolimus:113 renal transplant recipients(87 CsA and 26 Tcr) were recruited for the study.Demographic,pharmacologic and periodontal data were recorded.The prevalence and severity of GO were compared between two groups.The data was analyzed by SPSS13.0 software. Independent sample t test,χ~2 test,Mann-Whitney U test and stepwise regression analysis were used for the statistical analysis.PartⅡRelationship of putative periodontopathogenic bacteria and cyclosporine-induced gingival overgrowth:74 patients undergoing CsA treatment were divided into two groups according to GO scores:with gingival overgrowth(GO+) and without gingival overgrowth(GO-).Demographic, pharmacologic and periodontal data were analyzed.The real-time PCR method was used to detect and quantify five putative periodontopathogenic bacteria, including Porphyromonas gingivalis(Pg),Ac tinobacillus actinomycetemcomitans (Aa),Prevotella intermedia(Pi),Treponema denticola(Yd) and Tannerella forsythia(Tf) in subgingival samples.Moreover,the relationship between the bacterial amount and the severity of GO was analyzed.PartⅢThe effect of periodontal therapy on the clinical and microbiological parameters of cyclosporine A-induced gingival overgrowth in renal transplanted patients:Thirty-four renal transplanted patients with CsA-induced GO were divided into therapy group and control group.At baseline,therapy group received scaling and root planning(SRP) while control group received oral instructions only. Plaque index(PLI),papilla bleeding index(PBI),probing depth(PD) and GO scores were measured at baseline and after 1,3,and 6 months.Subgingival samples were also taken at these same four appointments to determine the prevalence and levels of Porphyromonas gingivalis(Pg),Actinobacillus actinomycetemcomitans(Aa),Prevotella intermedia(Pi),Treponema denticola(Td) and Tannerella forsythia(Tf) using a real-time polymerase chain reaction-based method.Difference in clinical parameters and levels of bacterial species were analyzed between two groups using the Wilcoxon signed ranks test,χ~2 test,or one-way analysis of variance.[Results]PartⅠ:The prevalence of GO in the CsA group(49%)was significantly higher than that in the Tcr group(15%)(P＜0.05).The CsA group showed a higher mean GO score(30.4±15.7) compared with the Tcr group(17.5±9.4)(P＜0.001).In addition,the patients with GO presented a significuntly higher plaque index and papilla bleeding index than those without GO in two groups(P＜0.05).PartⅡ:GO+group presented a significantly higher plaque index,papilla bleeding index and probing depth than GO- group(P＜0.01).The occurrences of Pg,Td,and Tf in the GO+ group(88%,85%and 85%) were significantly increased compared with those in the GO- group(68%60%and 60%)(P＜0.05),respectively.The prevalence of Pg,Td,and Tf(Red complex) in the GO+ group(71%)was markedly higher than that in the GO-group (35%)(P＜0.01).The bacterial amount of Pg,Td,Tf and Pi were enhanced along with the severity of GO.However,the bacterial amount of Aa had no difference between two groups.PartⅢ:The patients in therapy group showed a significant improvement in all clinical parameters at 1,3,and 6 months compared to baseline(P＜0.05),which was particularly evident at 3 months in GO scores that was reduced from 44.4±8.6(baseline) to 26.8±10.5.Six months after therapy,PLI,PD,and GO scores increased significantly compared to 3 months(p＜0.05).In control group,only PLI at 1,3,and 6 months decreased significantly while GO scores,PBI and PD had no significant difference compared with baseline.At 1 and 3 months,the prevalence and levels of Pg,Td and Tf in therapy group were also markedly reduced in comparison to baselihe (p＜0.05).Six months after therapy,the prevalence and levels of Pg increased significant]y(p＜0.05).In control group,we did not find any significant changes in the prevalence and levels of five periodontopathogenic bacteria except for the levels of Td(6 months) and Tf(1 month).[Conclusions]1.The prevalence of GO is higher in renal transplant recipients taking CsA compared to Tcr.Plaque-induced gingival inflammation has a close relation with the severity of GO.2.Pg,Td,and TT(Red complex)may have a significant relationship with the development of GO.3.Non-surgical periodontal therapy decreased the severity of CsA-induced GO effectively,and maintenance therapy may be essential in consolidating clinical and microbiological improvements.