Effect of the aetiology and severity of liver disease on oral health and dental treatment prior to transplantation

Abstract

Summary Elimination of dental infection foci has been recommended before liver transplantation (LT) because lifelong immunosuppression may predispose to infection spread. Association between pre‐LT oral health and the aetiology and severity of chronic liver disease (CLD) was investigated retrospectively. A total of 212 adult patients (median age 51.1) who had received LT during 2000–2006 in Finland were included. Their oral health had been pre‐operatively examined. Patients were divided into seven different CLD groups. Common indications for LT were primary sclerosing cholangitis (PSC 25.5%), alcohol cirrhosis (ALCI 17.5%) and primary biliary cirrhosis (PBC 14.6%). Patients were also categorized by the Model for End stage Liver Disease (MELD) scoring system. Medical, dental and panoramic jaw x‐ray data were analysed between groups. PBC patients had the lowest number of teeth with significant difference to PSC patients (19.7 vs. 25.6, P < 0.005, anova, t‐test). ALCI patients had the highest number of tooth extractions with significant difference in comparison to PSC patients (5.6 vs. 2.5, P < 0.005). Lower MELD score resulted in fewer tooth extractions but after adjusting for several confounding factors, age was the most important factor associated with extractions (P < 0.005). The aetiology of CLD associated with the oral health status and there was a tendency towards worse dental health with higher MELD scores.

Evaluation of mandibular inferior cortex changes in patients candidate for liver and kidney transplantation using panoramic view

“…Most authors in the field of organ transplantation agree that teeth with obvious infections, and all non-restorable teeth, must be extracted prior to transplantation. Therefore, patients should be reminded of earlier dental treatment and the importance of good oral hygiene habits (30). Owing to oral complications, these patients require to visit a dentist before and after transplantation (10).…”

Dental Management of Patients with Upcoming Liver Transplantation

“…Managing of the oral health before organ transplantation includes several factors that must be considered (14,15,16,17,18,19): …”

“…Therefore oral and dental foci of infection should be managed radically if they are present, especially in medically compromised patients (14,15,16).…”

“…Some literary sources (16,28) contain descriptions of febrile conditions of unclear etiology following transplantation surgery. The lack of precise diagnosis also results in inappropriate treatment related to the prescription of unnecessary antibiotic consumption.…”

Oro‐hepatic link, endotoxemia, and systemic inflammation: The role of chronic periodontitis

“…As concluded by the researchers, patients with periodontitis may have greater salivary dysbiosis. We have shown that, after careful oral examination, on average, one to two teeth needed extraction because of severe periodontitis in patients with alcoholic liver cirrhosis under evaluation for liver transplantation (LT) (2) ; this demonstrates high prevalence of periodontitis in advanced liver cirrhosis.…”