Alterações bucais em crianças e adolescentes transplantados renais

Abstract

Tuma MM. Oral Changes in renal transplanted children and adolescents [dissertation]. São Paulo: Faculdade de Odontologia da USP; 2018. Versão Original. Renal transplanted children and adolescents need dental care on a routine basis as there are oral changes related to some underlying diseases as well as to the transplantation itself and immunosuppressive therapy. The objective of the present study is to know and identify the oral health of these patients in order to seek possible relationships with the underlying disease which led to kidney transplantation, transplantation time and adopted immunosuppressive approach. Anamnesis and clinical examination were conducted to evaluate the presence of caries lesions (DMFT/dmf-t indexes), enamel defects (modified DDE index), periodontal condition (modified IPC index) and presence of soft tissue changes. This is an observational, cross-sectional study performed between August 2017 and June 2018 in which renal transplant recipients aged 2-17 years old were followed up at the São Paulo Hospital of Kidney in Brazil. A total of 120 participants were included, with 63 (52.5%) being males with mean age 12.78±3.9 years old. Unknown causes of renal failure involved the majority of the cases, that is, 28 (23.3%), whereas posterior urethral valve (PUV) involved 14 cases (11.7%). Gingival bleeding was observed in 115 (95.8%) participants, dental calculus in 69 (57.5%), caries experience in 51 (42.5%), enamel defects in 49 (40.8%), drug-related gingival hyperplasia (DRGH) in 20 (16.7%), xerostomia in 15 (12.5%) and soft tissue lesions in 5 (4.2%), such as ulcers, geographic tongue and oral wart lesions. The majority of the participants (55%) needed some dental treatment. The use of amlodipine and anticonvulsants has been associated with the presence of DRGH, whereas the immunosuppressant everolimus associated with ulceration (p < 0.05). We have concluded that periodontal disease and caries lesions were the most frequent oral conditions, leading to significant need for dental treatment in the population studied. Most of the oral changes observed were related to the underlying disease (i.e. renal failure), especially enamel defects. Oral opportunistic infections were rarely observed and drug treatment was associated with the presence of ulceration (use of everolimus) and DRGH (use of amlodipine and anticonvulsivants).