Oral Biosci Med 2 (2005), No. 4 27. Jan. 2006
Oral Biosci Med 2 (2005), No. 4 (27.01.2006)
Organ Transplantation - Assessment of Dental Procedures
Melkos, A. B./Massenkeil, G./Neuhaus, R./Hummel, M./Arnold, R./Reichart, P. A.
Purpose: Organ transplantation is now an established therapeutic strategy for treating many end-stage organ diseases and dysfunctions. The obligatory lifetime immunosuppressive therapy, which is necessary to prevent graft failure, predisposes the patient to infection. Because the oral cavity represents an important port of entry for systemic infections, a comprehensive clinical and radiographic oral examination and dental management of patients prior to transplantation will ensure the elimination of any active infection and minimize the possibility of infection after the transplantation. The aim of this retrospective study was to evaluate the significance of dental management prior to organ transplantation and to determine its relationship with graft rejection, morbidity and mortality of the patients.
Materials and Methods: A total of 102 patients (67 men, 35 women, median age: 42.8 years) who had undergone an organ transplantation were studied. 58 patients received allogeneic or autologous stem cell transplantation (SCT) and 44 patients had undergone liver (LTx) or heart (HTx) transplantation. Seventy of these received dental treatment prior to surgery. Lack of time and the individual health condition of the other 32 patients made possible only the initiation or reinforcement of a preventive dental and oral hygiene program. Prior to any invasive procedures screening laboratory tests were performed in order to reveal the coagulation status; additionally the need for antibiotic coverage was always discussed with the transplant surgeon.
Results: Postoperative complications such as infections, rejection of the transplant, GvHD, relapse of the malignancy and oral mucositis occurred in 80% of the patients who had undergone organ transplantation without dental interventions and only in 45.8% of the patients with completed dental treatment. Statistical analysis of data showed significant correlations (p<0,05), between complications and semi-impacted or impacted teeth making obvious the need for dental management before transplant surgery. A causative relationship between dental foci and life-threatening infections, graft rejection, morbidity and mortality could not be established in our study, a fact, which is probably the result of the great advances in immunosuppressive therapy.
Conclusions: Thus, it can be concluded that the dental concept prior to SCT, LTx and HTx does not have to be a radical one. Further research should clarify the causative association between oral and dental foci and the transplantation outcome.
Keywords: dental focus, organ transplantation, dental evaluation, dental treatment