Demographic, Pharmacologic, and Periodontal Variables for Gingival Overgrowth in Subjects Medicated With Cyclosporin in the Absence of Calcium Channel Blockers Fernando Oliveira Costa,* Se ´ rgio Diniz Ferreira,* Euge ˆnio Jose ´ Pereira Lages,* Jose ´ Esta ´ quio Costa,* Alcione Maria Soares Dutra Oliveira,* and Luı ´s Ota ´ vio Miranda Cota* Background: The role of cyclosporin in the absence of cal- cium channel blockers and the associated risk variables of devel- opment and severity of gingival overgrowth have not yet been properly established. The present study was conducted to deter- mine the effect of potential risk variables for gingival overgrowth severity in Brazilian renal transplant subjects medicated with cyclosporin in the absence of any calcium channel blockers. Methods: A cross-sectional study was conducted in a public hospital in Belo Horizonte, Brazil. Demographic, pharmacologic, and periodontal data, recorded from 194 subjects taking cyclo- sporin in the absence of calcium channel blockers, were analyzed using independent sample t, x 2 statistic, or Mann-Whitney U tests. The effects of potential risk variables of gingival overgrowth sever- ity were determined using backward stepwise regression analysis. Results: The prevalence of clinically significant gingival over- growth was 34.5% (N = 67). These subjects presented a signifi- cantly higher papillary bleeding index and a higher plaque index compared to those without clinically significant gingival overgrowth. When all demographic, pharmacologic, and peri- odontal data were evaluated in relation to gingival overgrowth severity, time since transplant, papillary bleeding index, serum cyclosporin concentration, and prednisolone and azathioprine dosages were significant in the univariate modeling (P <0.05) and remained significant when evaluated in the multivariate modeling (P <0.0001; adjusted R 2 = 39.4%). Conclusions: In the absence of calcium channel blockers, this study showed that pharmacologic variables, such as cyclosporin serum concentration, prednisolone and azathioprine dosages, and time since transplant, are strongly related to gingival over- growth. In addition, the periodontal variable papillary bleeding index highlighted the primary role of inflammation on the patho- genesis and severity of gingival overgrowth. J Periodontol 2007;78:254-261. KEY WORDS Calcium channel blockers; cyclosporin; gingival overgrowth; risk; transplant recipients. G ingival overgrowth (GO) is com- monly present in transplant recip- ients under immunosuppressant regimens, normally induced by such drugs as diltiazem, 1 nifedipine, 1 verapa- mil, 1 cyclosporin A (CsA), 2 and more recently tacrolimus. 3,4 GO can become a clinically significant problem, leading to functional, esthetic, and phonetic com- plications. The diagnosis, treatment, and factors related to this condition are of special interest for dental professionals, especially for those in the field of peri- odontology. CsA is a powerful immunosuppres- sant, widely used to prevent transplant rejection and to manage various immune disorders. 5 It is the drug of choice in the treatment of these conditions de- spite its various unwanted side effects, such as neurotoxicity, nephrotoxicity, hepatotoxicity, hypertension, hirsutism, cutaneous disorders, and opportunistic infections. 5,6 In these immunosuppres- sive regimens, CsA is used alone or in combination with other drugs, such as azathioprine and prednisolone, 2,4,6,7 to prevent both acute rejection of the organ and chronic deterioration of the graft over longer periods of time. Both of these drugs are also implicated in the reduction * Department of Periodontology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. doi: 10.1902/jop.2007.050445 Volume 78 • Number 2 254