Dental Procedures

The importance of daily oral hygiene, and regular dental prophylaxis cannot be over emphasized. Patients must maintain good daily oral hygiene, and they should have regular interval cleaning and examinations. Importantly, when problems are identified they must be promptly addressed. It is mandatory to use antibiotic prophylaxis for cleaning, as well as more invasive dental procedures. Specific recommendations should follow established guidelines for antibiotic prophylaxis in cardiac disease.

An important side effect of cyclosporine is development of gingival hyperplasia.2 This problem is well controlled with careful dosing, avoidance of medications that exacerbate gingival hyperplasia, and regular dental prophylaxis. However, this problem can become sufficiently severe to warrant extensive gingival resection. Cyclosporine dose reduction and when possible reduction or elimination of calcium channel blocking agents has been helpful. It has rarely been necessary to discontinue cyclosporine, usually with conversion to tacrolimus based immuno-suppression for specific management of gingival hyperplasia.

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