Dental management in transplant patients

Abstract

Introduction: Transplant is the replacement with therapeutic purposes, of organs, tissues or cellular material for others, from a donor who is usually a human, alive or dead. In recent years, transplant organs have been developed by the advances that have occurred with immunosuppressive drugs and medical-surgical technology. Due to the frequency of transplants that are performed today, it is common to find these patients in dental clinics. Objectives: To review the literature on oral manifestations in transplant patients and general dental management and according to transplant organs (heart, lung, liver, kidney, pancreas and bone marrow). Material and Methods: For the literature review, we carried out a search in Pubmed / Medline database using limits and keywords according to the controlled vocabulary "Medical Subject Headings" (MeSH). We obtained a total of 30 articles (eight literature reviews, three randomized clinical trials, one cohort study, three case-control studies, eight clinical case series and seven cross-sectional studies). Results and discussion: We describe the most common oral manifestations in transplant patients (viral, bacterial and fungal infections, gingival enlargement secondary to drug therapy and higher risk in the development of oral malignancy) and the special dental management that should be carried out on these patients, generally and specifically according to the type of transplant.

Pre-Cardiac Dental Treatment Does Not Increase the Risk of Adverse Events

“…A comprehensive dental examination is commonly part of CVS workup; however, there is limited data regarding the benefits of performing dental treatment prior to CVS. 6,[8][9][10][11][12][13] This study sought to determine if dental treatment completed on patients prior to CVS is associated with an increased risk of dental complications, medical adverse events, and death. The results of this study suggest that medical adverse events and deaths are comparable between groups and as a result dental treatment prior to CVS should not put the patient at increased risk of morbidity or mortality.…”

“…7 A comprehensive dental exam and treatment is a common part of presurgical protocols at many hospitals and facilities. [8][9][10][11][12] Not only does pre-cardiac dental clearance reduce the risk of postoperative infection seeding from the oral cavity, but it also reduces the need for dental treatment in the postoperative period. 7 The majority of patients who present for CVS at the University of California Los Angeles (UCLA) Ronald Reagan Medical Center are required to undergo multiple areas of evaluation and clearance prior to their surgical procedure.…”

Complications and treatment errors in periodontal therapy in medically compromised patients

“…Invasive periodontal therapy may require further preoperative investigations and close liaison with the patient's physician. To minimize the risk of infection when patients are immunosuppressed, a pretransplant dental assessment should be undertaken 124,125 . Periodontal health should be stabilized, and the source of infection eliminated 124…”

“…To minimize the risk of infection when patients are immunosuppressed, a pretransplant dental assessment should be undertaken. 124,125 Periodontal health should be stabilized, and the source of infection eliminated. 124 For patients who require regular blood transfusions (eg, thalassemia major) or red cell exchange transfusions (eg, sickle cell anemia), the dental visit should be scheduled soon after their routine transfusions.…”

Oral health of adult patients undergoing hematopoietic cell transplantation. Pre-transplant assessment and care

“…Possible protocol for minimally invasive treatment of caries/non carious lesions in adult patients prior to HCT, based on the literature and the experience of the authors (considering the severity of lesion, time for completing the dental treatment, and the medical status of the patient) [ 3 , 15 , 22 , 26 , 36 , 46 , 47 , 49 , 50 ]. …”