Frequency of Pathologic Changes in the Oral Cavity in Patients Subjected to Long-term Pharmacologic Immunosuppressive Therapy After Kidney, Liver, and Hematopoietic Cell Transplantation

Unusual oral presentation of HSV-1 lesions in an adult liver transplant recipient

“…Risk factors for reactivation include stay in critical care as suggested by the prevalence of HSV reactivation in critical care patients, as well as a high level of immunosuppression 7. For example, as described in the literature, use of mycophenolate mofetil in OLTx has shown an increased risk of HSV reactivation 4 8. Anti-viral prophylaxis is often recommended to prevent reactivation of common viral infections such as CMV after solid organ transplants, which in turn prevents HSV and VZV.…”

Oral changes in patients before and after transplantation of solid organs and hematopoietic stem cells

“…Long-term immunosuppressive therapy, most often after two years, caused appearance of granulomatous changes in the oral mucosa and dorsal surface of the tongue, enlargement of the lips, the appearance of angular cheilitis and fissures on the lips, pigmentation on the oral mucosa and erythroplakia. Patients complain of dry mouth, mouth sores, bad odor from mouth, and bleeding gums during tooth washing [21]. An unusual proliferation of lymphocytes in the post-transplant period leads to lymphoproliferative changes in the paranasal cavities, in the oral cavity, on the larynx and salivary glands [22].…”

“…Also, a greater presence of Herpes simplex virus type 1, Epstein-Barr virus, and Cytomegalovirus was evidenced in sputum in these patients. In addition to the fact that these microorganisms are causes of numerous oral changes and disruption of the integrity of the oral mucous membranes, there is the possibility of their dissemination, onset of systemic infection and the risk of rejection of the transplanted organ [21,23,24,25].…”

Estudo do crescimento e desenvolvimento craniofaciais em pacientes pediátricos transplantados de células-tronco hematopoiéticas

“…Alterações dentárias são mais prevalentes em pacientes transplantados antes dos cinco anos de idade (Frascino et al, 2014). Esses pacientes apresentam maior risco de desenvolver doença periodontal agressiva e perda dentária precoce (Osiak et al, 2018). Juntamente com o aumento da sobrevida dos pacientes pediátricos transplantados de medula, ocorre o aumento da demanda por tratamentos odontológicos comuns aos pacientes adultos, como os tratamentos periodontais, tratamentos ortodônticos e a reabilitação estética e funcional por meio de implantes metálicos.…”

“…As alterações dentárias mais comuns são a agenesia, a microdontia, a perda da proporção coroa/raiz e o fechamento precoce dos ápices radiculares, com maior incidência nos dentes pré-molares superiores e segundos molares inferiores permanentes (Frascino et al, 2014). Também são descritos: aumento do risco de doenças periodontais, perdas dentárias precoces, xerostomia, halitose, sangramentos gengivais e disgeusia (Osiak et al, 2018). As oportunidades de tratamento odontológico para pacientes com câncer são limitadas (Da Fonseca, 2004;Frascino et al, 2018).…”