Dental treatment of an adult patient with a history of biliary atresia

Objective: Biliary atresia is a congenital disease treated by liver transplantation. Adults may have oral consequences of the medical therapy. Green teeth are oral manifestations of the induced hyperbilirubinemia. Gingival enlargement is associated with the immunosuppressive drug. This case report describes the successful treatment of an 18-year-old patient displaying severe green teeth and gingival enlargement. Method and Materials: The gingival enlargement was treated by reducing the pathogenic oral microflora through scaling and root planing of the teeth, gingival excision surgeries, and conversion from cyclosporin to tacrolimus. Results: Gingival enlargement and inflammation had completely disappeared after nonsurgical treatment for the maxilla and after surgical treatment for the mandible. The green coloration of the teeth was masked using composite restorations. Conclusion: This case report indicates that a patient's quality of life can be improved by a team approach combining pharmacologic and dental therapies. Keywords: cyclosporin, gingival enlargement, green teeth, hyperbilirubinemia, liver transplantation