Medicamentos En Periodoncia

Periodontology 2000, Vol. 40, 2006, 120–129 Printed in the UK. All rights reserved

Copyright Ó Blackwell Munksgaard 2006

PERIODONTOLOGY 2000

Effects of medications on the periodontal tissues in health and disease
R O B I N A. S E Y M O U R
It is now well recognized that the adult population is living longer and retaining their teeth into old age. A major part of this increase in lifeexpectancy is attributed to an expansion in our understanding of disease processes and the subsequent explosion in drug treatments. Some of these drugs will have an impact on the periodontium and its response to bacterial plaque. This paper reviews the various possible interactions between a patient’s medication and their periodontium in both health and disease. The effect of systemic drug therapyon the periodontium can be categorized as follows: • an adverse effect on the periodontal tissues; • affording some degree of protection against periodontal breakdown; • causing an increased risk of periodontal breakdown. gated. Many authors have used hospital-based patients, which is entirely appropriate for cyclosporine. For phenytoin and the calcium channel blockers, again many authors havefrequently examined hospital-based patients. Bearing this in mind, it has nonetheless been estimated that 50% of dentate patients on phenytoin experience gingival changes, whereas the figures for cyclosporine and the calcium channel blockers are 30% and 10%, respectively (1, 2, 15, 63). The above figures do not take into account the severity of gingival changes and that the term Ôclinical significantovergrowthÕ is more appropriate to epidemiologic studies. This term is applied to those patients whose gingival overgrowth requires surgical excision to correct the gingival contour (59).

Adverse effects on systemic medication on the periodontal tissues
Drug-induced gingival overgrowth remains the most widespread unwanted effect of systemic medication on the periodontal tissues. Three drugs aremost frequently implicated; phenytoin, cyclosporine and the calcium channel blockers. Case reports have implicated other drugs (e.g. sodium valproate and erythromycin) but these are rare incidents (60).

Risk factors for drug-induced gingival overgrowth
A variety of risk factors for drug-induced gingival overgrowth have been identified and these have been recently reviewed (59). Essentially,they are age and other demographic variables, drug variables, concomitant medication, periodontal variables, and genetic factors.

Age and demographic variables
Age is now recognized as an important risk factor for both cyclosporine- and phenytoin-induced gingival overgrowth (10, 17, 24, 28, 57). For calcium channel blockers, age is not applicable since the use of these drugs is mainly confined tothe middle-aged and elderly. Children and teenagers are more susceptible to phenytoin and cyclosporine-induced gingival overgrowth. This could suggest that a hormonal

Prevalence of drug-induced gingival overgrowth
The prevalence of drug-induced gingival overgrowth varies significantly and, as with most epidemiological studies, depends upon the population investi-

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Periodontal tissuesin health and disease

component contributes to fibroblast sensitivity to the challenging drugs. Phenytoin has been shown to enhance the ability of gingival fibroblast to metabolize testosterone to the more active 5a dihydrotestosterone (69). Similar results were found for fibroblast, obtained from both cyclosporine- and nifedipine-induced gingival overgrowths (68). Adolescents will have higherlevels of circulating androgens which could stimulate further gingival fibroblast to increase collagen synthesis and ⁄ or decrease collagenase activity. There is also the additional action of increased circulatory sex hormones on the expression of gingival inflammation. Any increase in inflammation will compound the expression of gingival overgrowth.

Gender
A few studies have investigated whether...