Assessment and management of oral health in liver transplant candidates. Gallottini III. Liver transplantation has become a standard treatment for end-stage liver disease and the number of recipients has grown rapidly in the last few years. Dental care during pre-transplant workup is important to reduce potential sources of infection in the drug-induced immunosuppression phase of liver transplantation. Objectives: The objectives of this study were to document the prevalence of oral abnormalities in patients on a liver transplant waiting list presenting to an urban dental school clinic, discuss the appropriate dental treatment according their systemic conditions and compare their oral manifestations with those of healthy individuals.
These individuals were assessed for their dental status presence of oral disease or abnormalities , coagulation status, and dental treatment indications. Coagulation abnormalities reflecting an increased risk of bleeding were found in However, no bleeding complications occurred after dental treatment. Conclusions: The patients with chronic liver diseases evaluated in this study exhibited a higher incidence of oral manifestations compared with the control group and had at least one oral disease or abnormality which required dental treatment prior to liver transplantation.
Careful oral examination and evaluation of the patient, including laboratory tests, will ensure correct oral preparation and control of oral disease prior to liver transplantation. Key words: Oral health.
Dental care. Liver transplantation. There several liver conditions that cause chronic or continuing liver inflammation, and the most common causes of end-stage liver disease are chronic viral hepatitis B and C, alcohol-related liver disease, autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis, steatohepatitis, liver disorders inherited or present at birth, and drug-induced liver damage 2.
In Brazil, since , donor liver allocation has been based on the model for end-stage liver disease MELD scoring system. At present, the MELD has been validated on a broad series of patients with liver diseases of various etiologies and severity 1. The relationship between the introduction of the MELD allocation system in Brazil and a reduction of donor organ waiting list mortality is controversial.
However, the number of recipients of liver transplants has grown dramatically in the last few years and is likely to continue to do so in the future 1. The improved survival rates and transplant outcomes is predicated upon proper screening and evaluation, as well as breakthroughs in surgical techniques and immunosuppressive therapies. Despite these breakthroughs, infection continues to be a leading cause in graft loss or death of transplant recipients.
Although evaluation for chronic systemic infections in transplant recipients is standard, this cannot be said of pre-transplantation dental evaluation 2,9. A study performed by the Starzl Transplant Institute involving candidates for liver transplantation conducted between January and March , reported that oral health attributes i. Candidates for liver transplantation who have not had a dental evaluation for more than 1 year were significantly more likely to present with neglected oral health, untreated dental conditions or habits e.
Providing oral health care pre- and post-liver transplantation is essential for a better prognosis and quality of life of transplant recipients. The main concern before the transplantation is to eliminate oral foci of infection, such as those of periapical and periodontal origin. During the post-transplant period, the dental professional must be aware of the increased susceptibility to infection in the patient, and the risk for organ rejection, both of which emphasize the importance of vigilant oral health maintenance. Patients are severely immunocompromised and must be well-educated and treated for the rest of their post-transplant lives 9.
The objectives of this study were to document the prevalence of oral disease and abnormalities in patients on a liver transplant waiting list presenting to an urban dental school clinic, discuss the appropriated dental treatment, according their systemic conditions and compare the oral manifestations with those of healthy individuals.
All patients signed an informed consent form. SG was formed by all patients with end-stage liver disease that had been referred to the Special Care Dentistry Center for routine dental treatment. Medical history review and physical examination, with data recorded on a form specifically designed for this study, were compiled in a special form for all the patients. All patients were questioned about variables such as demographics and history of liver disease.
Coagulation studies [i. The dental status of each patient was evaluated at the initial visit by two trained oral medicine dentists. The patient evaluation consisted of a clinical examination of the hard and soft oral tissues and a radiographic examination which consisted in panoramic and periapical radiography.
All abnormalities detected in each patient were recorded using a special form designed for this study.
Among 16 individuals from SG, 13 were male and 3 were female, ranging in age from 37 to 68 median age of 51 years. Of the 16 individuals from CG, 13 were male and 3 were female, ranging in age from 34 to 70 median age to 50 years. Gingival overgrowth was associated with severe periodontal disease and poor oral hygiene. The petechiae were associated in the three cases with thrombocytopenia.
Figure 3 summarizes the oral conditions found in all individuals enrolled in this study. Table 1 shows the oral manifestations from SG and abnormalities coagulation. After the initial exam and diagnosis of oral diseases, indicated dental treatment procedures were performed on all patients SG and CG by the same dentists and included 20 restorations, 21 periodontal scaling and root planning procedures, 6 extractions, 1 incisional biopsy, 3 brush exfoliative cytology exams, 2 prosthetic rehabilitations 1 removable prosthesis and fixed prosthesis and 2 endodontic treatments.
Although the majority of patients showed abnormal coagulation values, none of them exhibited critical values that would represent a contraindication for invasive dental treatment. For this reason, the dental treatments were conducted in our outpatient clinic.
Procedures that involve bleeding, such as dental extraction, biopsy and periodontal treatment, were conducted using hemostatic local measurements, such as tranexamic acid paste and absorbable gelatin sterile sponge, as recommended by Ramstrom, et al. Add to Basket. Book Description Condition: New. US edition. Perfect condition. Customer satisfaction our priority. More information about this seller Contact this seller. Book Description Condition: Brand New. Customer Satisfaction guaranteed!!. Excellent Customer Service.
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Liver Transplantation: Clinical Assessment and Management is the perfect tool for all gastroenterologists, hepatologists and transplant surgeons managing patients with liver disease awaiting and undergoing transplantation. Led by James Neuberger, world experts in hepatology and. Editorial Reviews. From the Back Cover. Liver Transplantation: Clinical Assessment and Management is the perfect tool for all gastroenterologists, hepatologists.
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Perfect Condition. Excellent Quality,fast shipping Service and customer satisfaction guaranteed! Book Description Wiley-Blackwell, Never used! This item is printed on demand. Language: English. Brand new Book. Liver Transplantation: Clinical Assessment and Management is the perfect tool for all gastroenterologists, hepatologists and transplant surgeons managing patients with liver disease awaiting and undergoing transplantation.