Dental management in transplant
patients
Transplant
is the replacement with therapeutic purposes, of
organs, tissues or cellular material, 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.
Oral manifestations in transplant patients
As a result of the long term immunosuppressive therapy that
these patients are submitted to, their immune response is
reduced, which it makes them more susceptible to develop
infections; fungal ,bacterial and viral infections.
General dental management in
transplant patients
Before performing any transplant we must consider general
dental management
• A consultation with the physician is recommended to discuss overall
condition of the patient.
• We must educate, inform and motivate the patient to maintain a
proper oral hygiene and to be aware of the risk and problems that
may arise in the oral cavity after transplant. We must give oral
hygiene instructions and antiseptic mouthwashes such as
chlorhexidine.
•
Dental status should be evaluated. For dental treatment
planning, we must carry out a radiographic study.
The main objectives of dental treatment are:
-To maintain adequate periodontal health. We must remove
supra- and subgingival plaque with dental scaling and curettage.
- Filling of teeth with caries with favorable prognosis.
- Endodontic treatments.
- Implant treatment must be postponed until the stable
period of the transplant and when the patient’s condition
has improved.
- Extraction of teeth with poor prognosis.
• Patients who have been treated with corticosteroids for a
long time require supplementation of corticosteroids to
prevent adrenal crisis.
a
After organ transplant has been carried out, we
must consider several aspects.
the period of time after transplant can be
divided into:
•
1
. Immediate
(first three months after surgery):
• this is the maximum life threatening period, so it is
recommended that emergency dental treatment be carried
out in a hospital, and that specialist be consulted and
treated with antibiotic prophylaxis.
•
Stable
(more than three months).
• when no signs of rejection have been observed. After three
months after transplant, elective dental treatment can be
performed.
However, six months after transplant is the best time
considered for dental treatment.
•
Transplant rejection
:
•
It may be acute or chronic.
• Acute
rejection usually occurs during the first months
• chronic
rejection usually occurs over a period of years(over 5 years).
If this occurs, dental treatment should be postponed. Only
emergency dental treatment should be performed