Essay 10 Dental Issues before and after Organ Transplantation

Peter Hurst

Despite the dramatic reduction in dental disease over the past three decades, resulting principally from fluoridation of public water supplies and increased public education, the mouth remains the most commonly infected site in the body. Almost all adults have some subacute, asymptomatic source of oral infection, arising most frequently as a result of chronic periodontal disease. Added to this is the fact that less than half the population chooses to receive regular maintenance care and instead seek treatment only episodically when pain or other acute symptoms force them to see a dentist. This means that a vast amount of untreated, often asymptomatic dental pathology exists in the population at large. For patients in robust health even well established, chronic oral infections can be tolerated with few, minor systemic symptoms. This, however, is not true of organ transplant patients who following successful immunosuppression can quickly and easily be overwhelmed by a fulminating oro-facial infection of odontogenic origin.

To reduce the possibility of serious oral problems arising during and after organ transplantation, it is prudent that all candidates for whom transplantation of any organ is proposed, should be first screened and, if necessary, treated by a dentist who is familiar with the specific problems facing this group of patients. Ideally, the best person to care for transplant patients is a hospital based dentist who works closely with the transplant team, and who understands fully the oral complications which can arise following organ transplantation and immuno-suppression. This individual can best ensure that any necessary oral care is carried out in a safe, timely and efficient manner. Once the transplant patient has been stabilized, there is no reason why the patient cannot return to the care of a dental general practitioner in the community, provided he/she understands their special status and needs.

The dentist's role in the care of organ transplant patients can be broadly divided into two phases, the pretransplant evaluation and treatment and post-transplant evaluation, maintenance and treatment.

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