Posttransplantation Treatment

Immediate Posttransplant Phase

In the 4-6 months immediately following organ transplantation, dental treatment should only be carried out if an acute and serious oral emergency arises. During this time, the possibility of organ rejection is high and the adjustment of immunosuppressive drugs to optimal levels takes utmost priority. In this phase of treatment, the application of vigorous home oral hygiene measures by the patient should be monitored and encouraged.

In the unfortunate event of a patient who did not receive definitive treatment preoperatively developing an acute oro-facial odontogenic infection during this period then aggressive management is needed. Culture and sensitivity of the organism, surgical drainage and appropriate antibiotics will be needed to control the infection.

Stable Posttransplantation Phase

Once patients have stabilized following organ transplantation, they should be followed up closely for future dental problems and other changes arising as a result of their immunosuppressed status. Gingival hyperplasia, a particularly florid, hemorrhagic type of gingival overgrowth, can occur as a result of cyclosporine administration. This gingival overgrowth can be particularly troublesome and on occasion can cover the teeth almost completely obscuring them from view. A similar gingival overgrowth can occur with nifedipine often used to control hypertension arising from cyclosporine use.

The application of meticulous oral hygiene measures with brushing, flossing and regular professional cleaning, is the best method of preventing or reducing the incidence of this condition. The problem is however, that once the tissue overgrows, creating deep pseudopockets around the teeth, it becomes almost impossible to gain control of situation because the bacterial dental plaque that colonizes the pockets cannot be fully eliminated. It is often necessary therefore to surgically remove the excess tissue to recreate a normal gingival anatomy. It is for this reason that these patients must be motivated from an early stage to keep their mouths clean and free from plaque.

In evaluating the stable post-transplant patient for dental care it is always important to assess how "stable" in fact they are. At one end of the spectrum, patients who are maintained on only minimal immunosuppression pose fewer problems that those, for example, who are on high doses of immunosuppressants,

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