MANAGING ORAL HEALTH FOR ORGAN TRANSPLANTATION

MANAGING ORAL HEALTH FOR ORGAN TRANSPLANTATION

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ORAL HEALTH FOR ORGAN TRANSPLANTATION

For a successful transplant, all potential infections must be eliminated prior to transplantation. For a thorough dental risk assessment, we will require your medical record from your specialist. Following a thorough examination, we will discuss the current status of your health and immune system, and the degree of organ dysfunction with your physician. Decisions about the timing of treatment, the need for antibiotic prophylaxis, precautions to prevent excessive bleeding, and appropriate medication and dosage will be considered. We will also assess whether you can tolerate dental treatment or undergo extensive treatment after transplant as the new organ improves their health.
DENTAL TREATMENT
Whenever possible, all active dental disease should be aggressively treated before transplantation, since post-operative immunosuppression decreases a patient’s ability to resist systemic infection.
  • Eliminate or stabilize sites of oral infection. Patients with active dental disease who can tolerate treatment should receive indicated dental care. Depending on your condition, temporary restoration may be appropriate until his or her health improves.
  • Some patients receive cyclosporine after transplant and may develop gingival hyperplasia, which is an overgrowth of the gums. This can be minimized with good plaque control, and maintenance.
  • Our hygienists will explain that effective oral hygiene is crucial before and after transplantation, and more frequent dental appointments may be necessary if new dental disease develops.
  • You will need to bring a current list of your medications, including over-the-counter drugs, to every appointment and note those that may be problematic.
  • Antibiotic Prophylaxis: is often required to prevent systemic infection from invasive dental procedures. We will be in consultation with your specialist.
  • Excessive Bleeding: Before treatment, we will assess the patient’s bleeding potential with the appropriate laboratory tests and take precautions to limit bleeding. Manage bleeding sites with careful packing and suturing techniques.
  • Medication Considerations: Patients preparing to undergo organ transplantation usually take multiple medications. These include anticoagulants, beta-blockers, calcium channel blockers, diuretics, and others. We are aware of the side effects of these medications, which range from xerostomia and gingival hyperplasia to orthostatic hypotension and hyperglycaemia, and their interactions with drugs we may prescribe.
Prior to dental treatment, we may consult your physician on appropriate drug selection, dosage, and administration intervals.
MANAGING ORAL HEALTH AFTER ORGAN TRANSPLANTATION
Except for emergency dental care, patients should avoid dental treatment for at least 3 months following organ transplantation. Dosage of immunosuppressive medications is highest in the early post-transplant period, and patients are at greatest risk for rejection of the transplanted organ and other serious complications during that time. Once the graft has stabilized, typically 3 to 6 months post-surgery, patients can be treated in the dental practice with proper precautions.
PREPARING FOR DENTAL TREATMENT
Treatment after transplantation requires consultation with your patient’s physician. The medical consult can help us understand your general health and ability to tolerate treatment. Post-transplant patients vary widely in their ability to endure dental treatment and heal following invasive procedures.
  • Infection: Patients who have undergone organ transplant surgery are at increased risk for serious infection. Bacterial, viral, and fungal infections are more common, especially immediately after surgery. The decision to pre-medicate for invasive dental procedures and selection of the appropriate regimen will be done in consultation with your physician.
  • Medication Considerations: Organ transplant recipients may be taking one or more medications that affect dental treatment. Immunosuppressive agents can cause gingival hyperplasia, poor healing, and infections and may interact with commonly prescribed medications. Anticoagulant medications may contribute to excessive bleeding problems, whereas a patient taking steroids is at risk for acute adrenal crisis. your physician may want to adjust these medications several days before an invasive dental procedure.
All new dental disease should be treated after the patient’s transplant has stabilized. Conscientious oral hygiene routine is emphasized and the importance of oral health before and after transplantation.
ORAL COMPLICATIONS
Side effects from immunosuppressive drugs to prevent organ rejection are among the most frequent oral health problems affecting transplant recipients. Common immunosuppressive agents and their side effects include:
  • Cyclosporine: Changes in liver/kidney function, hypertension, bleeding problems, and poor wound healing are among the adverse effects of this potent agent, which also interacts with a number of other drugs. Gingival hyperplasia occurs in some patients; incidence varies and is dependent on each patient and his or her drug regimen. Calcium channel blockers, for example, may exacerbate the problem. Children tend to be more susceptible to gingival overgrowth than adults are. We emphasize conscientious daily oral hygiene to all patients.
  • Tacrolimus: An immunosuppressive agent used increasingly in place of cyclosporine, tacrolimus causes less gingival overgrowth but is associated with oral ulcerations and numbness or tingling, especially around the mouth.
  • Azathioprine: Bone marrow suppression and related complications such as stomatitis and opportunistic infections are significant side effects of this drug. A decrease in white blood cell counts and excessive bleeding may occur.
  • Mycophenolate mofetil: This immunosuppressant is commonly used as an alternative to azathioprine. Adverse effects include decreased white cell counts, opportunistic infections, and gastrointestinal problems.
  • Corticosteroids: Hypertension and high blood glucose (steroid-induced diabetes) are among the numerous side effects of these drugs, along with increased risk for infection, poor wound healing, and depression. Adrenal suppression may occur, making invasive dental and medical procedures more difficult for your patient. Corticosteroids may also mask the early signs of oral infection. The trend toward using lower doses of corticosteroids in combination with other immunosuppressants for post-transplant maintenance therapy has helped mitigate these side effects.
  • Sirolimus: Side effects of this anti-rejection drug can include hypertension, joint pain, low white cell count, hypercholesterolemia, and oral ulceration.
ORAL CANCER
We screen every patient for oral cancer at every appointment. Kaposi’s sarcoma, lymphoma, and squamous cell carcinoma of the lip are among the oral malignancies that sometimes occur in organ transplant patients. Oral cancer can occur decades earlier in transplant recipients than in people who are not immunosuppressed, but careful monitoring is required.
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