Dentists have become increasingly aware of the effects that systemic medications can have on the oral cavity. Cyclosporin has long been known to be associated with gingival enlargement, and the degree of enlargement appears to be associated with both the daily dose and length of time the drug is taken. This was first observed in patients with renal transplants and these patients remain the group most commonly affected by cyclosporin-induced gingival hyperplasia.1 However, cyclosporin and other immunomodulatory drugs are commonly used for patients with severe psoriasis. Cyclosporin-induced gingival enlargement resolves following cessation of the drug and, in some patients, it will also resolve following a reduction in drug dosage.2

A recent study has shown that isotretinoin (a retinoid used for severe acne) has significant oral adverse effects with a decrease in salivary flow and a concomitant increase in the number of decayed, missing or filled teeth.3 It is possible that acitretin (a retinoid used for severe psoriasis) could have a similar effect. Acitretin is known to cause dry mouth and gingivitis. Patients taking methotrexate also have a decrease in salivary function, although this has not been studied in patients with severe psoriasis. People taking medication for severe psoriasis require very high levels of oral hygiene and regular professional cleaning to prevent or minimise deterioration of their periodontal structures. It would be advisable for these measures to start at the same time they begin their treatment for psoriasis.


Michael McCullough

Chair, Therapeutics Committee, Australian Dental Association