Location and sanitation of dental foci in liver transplantation

Abstract

The literature describes various treatment concepts for the pre-operative sanitation of septic foci in the oromaxillofacial area prior to liver transplantation. There are no uniform guidelines, and so far, a connection between dental foci and postoperative infection after transplantation has not yet been proven. Taking into account the complications occurring during focus sanitation, the appropriate extent of, and the most suitable point of time for, focus sanitation have to be ascertained. The clinical and radiological findings from 80 patients were analyzed, with particular attention being paid to dental foci prior to liver transplantation. The complications performed in 39 sanitations and the oral hygiene status of 37 patients were included in the analysis. All the obtained findings were correlated to the etiology of the liver disease and the ChildPugh stage. Former alcoholics had significantly poorer oral hygiene and more foci than non-alcoholics. After sanitation, complications occurred more frequently in alcoholics (43.8%) and patients in Child-Pugh stage C (41.2%) than in the other groups. Secondary bleeding, severe in some cases, occurred in a total of 15.4% of all patients, despite coagulatory preparations. We can conclude that, given the high rate of complications found in this study after sanitation prior to transplantation, the demand for radical prophylactic dental sanitation should be reconsidered. Rather, it would appear more appropriate for only absolutely necessary sanitation to be carried out prior to transplantation and for the definitive measures to be postponed until after transplantation when liver function has stabilized.

Dialysis, Renal Transplantation and Oral Health—Many-Sided Nature of Dental Focal Doctrine

“…This imposes the need of dental help long before the surgery and not just prior the operation (3,5,6,10).…”

Dental Management of Patients with Upcoming Liver Transplantation

“…The authors mention that the main concern before the transplantation is to eliminate oral foci of infection, such as those of periapical and periodontal origin (1,4,13).…”

Oral health protocol for liver transplant patients

“…The risk of operating a cirrhotic patient should be considered more carefully, because of the possibility of bleeding and infection [25]. A German study with 80 liver transplant candidates reported poorer oral health among the alco holics.…”

“…High rate of complications after treatment prior to transplantation, frequently among alcoholic and Child-Pugh stage C patients, recommends extra care with radical prophylactic dental sanitation. According to these authors, only absolutely necessary sanitation should be carried out prior to transplantation [25].…”

“…The attention to oral complications in liver transplant candidates is justified by several reasons: cirrhotic patients generally use multi-drug therapy which can reduce salivary flow and contribute to periodontal disease, caries, candidiasis and other oral lesions [48]; the main cause of liver disease in Brazil and in many part of the world is cirrhosis due to Hepatitic C Virus (HCV) infection followed by Alcoholic liver disease (ALD) which are associated with reduced salivary flow and untreated dental conditions or personal behaviors that are risk factors for dental diseases [4,26,27,49]; oral infection may decompensate cirrhosis and may contribute to the development of PH complications such as hepatic encephalopathy and hepatorenal syndrome; if preventive actions for oral health are not effective, the treatment of oral foci generally requires hospitalization and transoperative blood requirements [4,25]; studies has demonstrated the relationship between oral health and systemic health [4,[6][7][8][9][10][11][12][13] and the economic impact of oral complications is too high in cirrhotic patients [4,47].…”