out. A thorough head and neck examination is also necessary to detect any problems associated with the surrounding structures. A full series of intra-oral x-rays and, a panoramic survey is also essential.

The list below outlines the most frequently identified problems that require treatment:

1. Decayed, broken-down teeth should be evaluated as to their restorability.

2. Nonvital teeth and those with periapical pathology should be assessed as to their potential for successful endodontic treatment.

3. Periodontal disease with associated pocketing and bone loss should be evaluated as to the possibility of successful long-term treatment. It should be borne in mind that periodontal disease can be notoriously difficult to control in an otherwise healthy patient, let alone in an immunosuppressed transplant patient.

4. Impacted and partially erupted teeth with associated soft tissue infection should be considered for extraction.

5. Traumatic ulceration arising from ill-fitting dentures or other appliances should be evaluated and the appliances adjusted accordingly.

6. Dental implants with evidence of infection should be removed.

7. Oral ulcerations and other oral mucous membrane disease should be evaluated, biopsied as necessary and treated appropriately.

8. Nonodontogenic, radiolucent lesions of the jaws should be identified, evaluated and, if necessary, treated.

In treatment planning for this group of patients, the goal is not simply to identify existing pathology, but rather to assess all areas for any potential future problems. The treatment planning process, therefore, should be more, rather than less, aggressive. In this way, it is anticipated that the oral cavity will remain stable for many years without further invasive treatment being necessary.

In general, patients who have shown little interest in their dental health in the past should not be treatment planned for heroic reconstructions, but rather should have problematic teeth extracted and dentures made. The same is true for those patients with established, progressive, periodontal disease where future treatment following immunosuppression is likely to have poor and unpredictable results.

Patients with healthy dentitions should be told of the need for extra vigilance in the care of their mouths after transplantation. All patients should be placed on a frequent recall protocol which includes regular, professional cleanings, fluoride treatments, antibacterial rinses, and frequent, complete and comprehensive examinations b a dentist to detect any new changes in their oral status.

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