Assessment and management of oral health in liver transplant candidates

Abstract

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. Material and Methods A pilot study was conducted involving 16 end-stage liver disease individuals (study group- SG) attending the Special Care Dentistry Center of the University of São Paulo and 16 control individuals (control group- CG) with no liver diseases, receiving dental care at the Dental School of the University of São Paulo. These individuals were assessed for their dental status (presence of oral disease or abnormalities), coagulation status, and dental treatment indications. Results The patients from SG exhibited a greater incidence of oral manifestations compared with CG (p=0.0327) and were diagnosed with at least one oral disease or condition that required treatment. Coagulation abnormalities reflecting an increased risk of bleeding were found in 93.75% of the patients. 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.

Microbiota, cirrhosis, and the emerging oral-gut-liver axis

“…Although studies on the interaction between cirrhosis and periodontitis are still too limited to make assumptions regarding a potential cause-and-effect relationship, a higher incidence of periodontitis (ranging from 25%-68%) has been reported in cirrhotic patients compared with healthy controls (81,82), an observation that warrants further investigation. In a retrospective study, Aberg and colleagues showed an association between periodontal disease and progression of chronic liver disease, suggesting that dental disease could play a role in cirrhosis (83).…”

“…In addition to periodontitis, cirrhotic patients exhibit numerous oral issues, such as petechiae (79), candidiasis (79), and xerostomia (79,80). Although studies on the interaction between cirrhosis and periodontitis are still too limited to make assumptions regarding a potential cause-and-effect relationship, a higher incidence of periodontitis (ranging from 25%-68%) has been reported in cirrhotic patients compared with healthy controls (81,82), an observation that warrants further investigation.…”

Dental Management of Patients with Upcoming Liver Transplantation

“…Three of them are subjected to basic periodontal treatment and 47 are subjected to multiple or simple extractions. Three surgical procedures result in postoperative complications (12).…”

“…Oral-source infections are a potential threat to transplant candidates because oral diseases tend to be more severe if left untreated in people who have received transplants (12).…”

“…Liver transplant recipients have a high risk of developing squamous cell carcinoma of the upper digestive tract, which is also associated with prolonged use of immunosuppressant drugs, but it is primarily attributed to smoking (4,12). Also a greater predisposition to epithelial dysplasia and carcinoma of the lip has been observed and Kaposi's sarcoma in areas of gingival hyperplasia induced by treatment with cyclosporine (25).…”