Optimum oral health should be a key goal for those undergoing organ/tissue transplantation. Being able to eat without discomfort enhances our quality of life and helps to ensure adequate nutrition to support the healing process.
After transplant the immune system is suppressed, so the body does not reject its new organ. During the period of intense immune suppression (approximately three months post transplant and tapering off thereafter), oral complications are common. These complications are associated with the side effects of immunosuppressive drugs and with the immune suppression itself. They include oral mucositis (red and painful tissues), gingival hyperplasia (overgrowth of gums), ulcers, infections (viral, fungal, and bacterial), dry mouth, which facilitates dental decay, and certain types of oral cancer.
It is normal for the mouth to host an abundance and variety of microorganisms that can serve as a source for infection. Poor oral care combined with immunosuppression can quickly lead to devastating infection both in the mouth and in remote organs and tissues when infection is transported via the circulatory system. Studies that have investigated the source of septic episodes (infective organisms transported throughout the bloodstream) in immuno-compromised patients have demonstrated a very common relationship to oral infection.
Because of these possible complications and the high risk of infection for any invasive dental treatment while immunosuppressed, it is important that existing and likely future sites of oral infection and irritation be eliminated before transplant surgery. A dental examination and cleaning should be scheduled as early as possible prior to the transplant to allow time for completion of any needed treatment and subsequent healing.
Daily oral hygiene is vitally important. Well before transplant surgery, patients should maintain a meticulous and comprehensive daily oral care regimen. Such a regimen is best developed with the help of the patient’s dentist to meet individual requirements and would likely include many of the following:
• Thorough and frequent tooth brushing with a soft, polished bristle brush
• Daily brushing in the periodontal pockets around each tooth with a soft, polished bristle brush
• Daily flossing
• Rinsing with one or more of the following: fluoride solutions, chlorhexidine gluconate, baking soda solutions, and diluted hydrogen peroxide
• Brushing with a high-concentration fluoride toothpaste
• Daily application of fluoride gel in custom-fitted trays
• Frequent cleansing of dentures and changing of cleaning solutions
During the months of intense immunosuppression after the transplant, a twice-weekly self-inspection of the inside of the mouth should be performed using a small dental mirror. The signs and symptoms of infection are often minimal due to an inactive immune response; they become readily apparent only when the infection is in an advanced state. Any unexplained pain or change in the color or texture of the tissues inside the mouth should be brought to the attention of your dentist promptly to rule out infection or early malignancies. Early detection is key to their effective management.
Routine oral exams should be scheduled with your dentist every 2-3 months during the period of immunosuppression.
— William M. Henderson, D.D.S., Division of Oral and Dental Medicine, Dept of Otolaryngology
Editor’s Note: Post-transplant patients are often advised to take an antibiotic before they have dental work performed, even routine cleaning. Check with your coordinator before visiting your dentist.
