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Jagdish RK, Chappity P, Lata S. Dental and ENT Evaluation Before Liver Transplantation. J Clin Exp Hepatol 2024; 14:101431. [PMID: 38745755 PMCID: PMC11090062 DOI: 10.1016/j.jceh.2024.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
The assessment of dental and ear, nose and throat (ENT) conditions holds significant importance in the pre-transplantation evaluation for individuals undergoing liver transplantation. This evaluation aims to address concerns related to dental and ENT issues both before and after liver transplantation. These concerns include the risk of sepsis, the impact of post-transplantation immunosuppression, the detection of existing malignancies, including oral potentially malignant disorders (OPMDs), and identifying any contraindications to the transplantation procedure. However, it is worth noting that there exists a notable absence of clear guidelines and protocols in the existing literature regarding this practice. Moreover, recent studies have presented conflicting results, and concerns have arisen regarding the cost-effectiveness of these evaluations. It is crucial to perform these investigations judiciously to avoid unnecessary testing burdens and delays in placing patients on waiting lists, particularly when considering live donor liver transplantation (LDLT) evaluations. A comprehensive examination of the oral and ENT regions, in conjunction with relevant laboratory tests, can play a pivotal role in identifying and managing oral and ENT diseases before the liver transplantation procedure. Timely recognition and treatment of potential issues are essential for minimizing perioperative morbidity and mortality. There is an evident need for prospective trials and studies to further explore and establish guidelines in the critical area of dental and ENT evaluation in liver transplantation recipients. Such research efforts would contribute significantly to enhancing our understanding and management of oral and ENT conditions in the pre-transplantation setting, ultimately improving patient care and outcomes.
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Affiliation(s)
- Rakesh K. Jagdish
- Hepatology, Gastroenterology and Liver Transplant Medicine, Pan Metro Group of Hospitals, Delhi and NCR, India
| | - Preetam Chappity
- Department of Otorhinolaryngology and Head & Neck Surgery, A.I.I.M.S, Bhubaneswar, Odisha, 751019, India
| | - S. Lata
- Department of Conservative Dentistry and Endodontics, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, 751019, India
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Olander AE, Helenius-Hietala J, Nordin A, Savikko J, Ruokonen H, Åberg F. Association Between Pre-Transplant Oral Health and Post-Liver Transplant Complications. Transpl Int 2023; 36:11534. [PMID: 37767526 PMCID: PMC10520246 DOI: 10.3389/ti.2023.11534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Oral disease is linked with systemic inflammation and various systemic conditions, including chronic liver disease. Liver transplantation (LT) candidates often need dental infection focus eradication, and after LT, there is high risk of many inflammation-related complications. We studied whether pre-LT dental status is associated with the occurrence of post-LT complications. This study included 225 adult LT recipients whose teeth were examined and treated before LT, and 40 adult LT recipients who did not have pre-LT dental data available. Data on post-LT complications were collected from the national liver transplant registry and followed up until the end of July 2020. Worse pre-LT dental status was associated with a higher risk of acute rejection post-LT compared to patients with good dental status. Worse dental status was also associated with higher 1-year-post-LT ALT levels and lower albumin levels. In conclusion, poor pre-LT oral health seems to associate with an increased risk of post-LT acute rejection and with elevated ALT levels and decreased albumin levels, suggesting an effect on post-LT liver health. Therefore, prevention and treatment of oral and dental diseases should be promoted early in the course of liver disease.
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Affiliation(s)
- Annika Emilia Olander
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jaana Helenius-Hietala
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Savikko
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hellevi Ruokonen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Fredrik Åberg
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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3
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Göbel P, Forsting C, Klüners A, Knipper P, Manekeller S, Nattermann J, Kalff JC, Kramer FJ, Strassburg CP, Lutz P. Persisting dental foci increase the risk for bacterial infections before and after liver transplant. Clin Transplant 2023; 37:e14857. [PMID: 36372930 DOI: 10.1111/ctr.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 10/18/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients awaiting liver transplant are usually assessed for presence of dental foci to prevent bacterial infection post-transplant, but evidence to support dental examination and treatment is limited. We investigated if treatment of dental foci decreased bacterial infections before and after transplant. METHODS Patients transplanted at the university hospital of Bonn were retrospectively assessed for occurrence of bacterial infections before and after transplant according to presence and treatment of dental foci. RESULTS 35/110 patients showed good oral health, 39/110 patients received dental care and 36/110 patients did not receive dental care despite poor oral health. Patients with alcohol-associated liver disease presented with the highest rate of dental foci. Bleeding complications due to oral care occurred in five patients with poor coagulation. After transplant, the number of infections per patient was higher in patients with poor oral health (2.9) compared to patients after dental care (1.9) or with good oral health (1.8) (p = .02), with streptococcal infections being more frequent in patients with poor oral health. Before transplant, bacterial infections, in particular bacteraemia and spontaneous bacterial peritonitis, were also more common in patients with untreated dental foci. Streptococci and Staphylococci were more often detected in patients with dental foci. Dental treatment was associated with a reduction in bacterial infections. CONCLUSION Presence of dental foci is associated with an increased risk for bacterial infections not only after but also before liver transplant. Dental treatment might be a safe and effective procedure to mitigate this risk.
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Affiliation(s)
- Philipp Göbel
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Christiane Forsting
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Alexandra Klüners
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Petra Knipper
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner-Site Cologne-Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Franz-Josef Kramer
- Department of Oral, Maxillofacial and Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner-Site Cologne-Bonn, Bonn, Germany
| | - Philipp Lutz
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner-Site Cologne-Bonn, Bonn, Germany
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Salivary Assessments in Post-Liver Transplantation Patients. J Clin Med 2022; 11:jcm11113152. [PMID: 35683539 PMCID: PMC9181838 DOI: 10.3390/jcm11113152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Saliva is in the first line of the body's defense mechanism. In order to better understand how liver transplantation impacts salivary biochemistry, the aim of this cross-sectional study was to explore variations of salivary markers for oral health in post-liver transplantation patients, as compared with systemically healthy dental outpatients (controls). In this case, 26 patients were enrolled in each group, with similar socio-demographic characteristics. Unstimulated whole saliva was collected; total protease activity and total protein content were measured. The oral health in both groups was assessed using a self-report oral health questionnaire. Data were analyzed using parametric and nonparametric tests. Comparable results were recorded in terms of salivary protein and protease activity assessments. In post-liver transplantation group, positive correlation was found between the salivary pH level and the salivary secretion rate (r = 0.39; p = 0.04). With respect to self-reported oral health, there were no significant differences between the two groups, except for dental and oral care habits, the controls reporting more frequently use of dental floss and mouthwash (p = 0.02, and p = 0.003, respectively). Considering the high risk for developing systemic complications after liver transplantation, oral health care is an important issue to be addressed, salivary investigations representing powerful tool for disease changes monitoring.
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Albuquerque-Souza E, Sahingur SE. Periodontitis, chronic liver diseases, and the emerging oral-gut-liver axis. Periodontol 2000 2022; 89:125-141. [PMID: 35244954 PMCID: PMC9314012 DOI: 10.1111/prd.12427] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The liver carries out a wide range of functions ranging from the control of metabolites, nutrient storage, and detoxification to immunosurveillance. While inflammation is essential for the tissue remodeling and maintenance of homeostasis and normal liver physiology, constant exposure to dietary and microbial products creates a niche for potentially prolonged immune activation and unresolved inflammation in susceptible host. Failure to restrain inflammation can lead to development of chronic liver diseases characterized by fibrosis, cirrhosis and eventually liver failure. The liver maintains close interactions with numerous organs which can influence its metabolism and physiology. It is also known that oral cavity microenvironment can influence the physiological conditions of other organs and emerging evidence implicates that this could be true for the liver as well. Presence of chronic inflammation and dysbiotic microbiota is a common feature leading to clinical pathology both in periodontitis and chronic liver diseases (CLDs). In fact, known CLDs appear to have some relationship with periodontitis, which impacts the onset or progression of these conditions in a bidirectional crosstalk. In this review, we explore the emerging association between oral‐gut‐liver axis focusing on periodontitis and common CLDs including nonalcoholic fatty liver disease, chronic viral hepatitis, liver cirrhosis, and hepatocellular cancer. We highlight the immune pathways and oral microbiome interactions which can link oral cavity and liver health and offer perspectives for future research.
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Affiliation(s)
- Emmanuel Albuquerque-Souza
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sinem E Sahingur
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Oral diseases after liver transplantation: a systematic review and meta-analysis. Br Dent J 2021; 231:117-124. [PMID: 34302095 DOI: 10.1038/s41415-021-3219-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Objective To conduct a systematic review and meta-analysis to evaluate the impact of liver transplantation on the occurrence and frequency of oral diseases in humans.Data sources The study query was performed on Medline/PubMed, Ovid, Cochrane Library and Embase databases, including the grey literature.Data selection Observational studies comparing the frequency of oral manifestations in post-liver transplantation patients versus reference population were eligible for inclusion.Data extraction and analysis The article selection, data extraction and quality assessment were executed by three independent investigators. A random-effects meta-analysis was carried out for computation of relative risks of oral malignancies (standardised incidence ratio [SIR] and 95% confidence interval [CI]).Data synthesis Among 248 studies identified, 11 met the eligibility criteria and six were included in the meta-analysis. Opportunistic fungal infections (Candida spp.) and lesions with malignant potential were reported to be more frequently prevalent after liver transplantation. Calculations indicated that after liver transplantation, the patients have a fivefold increased risk for oral cancer occurrence compared to the general population (SIR = 5.006; 95% CI 2.803 to 8.94; p <0.001).Conclusions The findings suggest that liver transplantation increases the risk of oral malignancies and the frequency of other mucosal lesions.
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7
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Wu JH, Lee CY, Chang WT, Wu PH, Chen LA, Huang JW, Su WL, Kuo KK. The association between oral health status and the clinical outcome of cirrhotic patients on the waiting list for liver transplantation. Kaohsiung J Med Sci 2021; 37:910-917. [PMID: 34288387 DOI: 10.1002/kjm2.12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation (LT) candidates often present with poor oral hygiene, which could potentially lead to systemic infections and sepsis owing to their cirrhotic state. In this study, we investigated the oral health status of LT candidates and propose guidance for the detection and treatment of encountered oral lesions among these patients. The decayed, missing, and filled teeth (DMFT) index was determined through oral examination. The presence of dental calculus was detected using panoramic radiography and defined by the radiopaque dental calculus (RDC). From January 2011 to August 2018, 56 LT candidates were enrolled with a median follow-up of 39 months. The overall mean numbers of decayed, missing, and filled teeth among these patients were 2.7 ± 2.8, 10.9 ± 8.3, and 5.4 ± 4.5, respectively. Eighteen patients (32.1%) had RDC. The 5-year survival rates of all 56 patients was 57.7%, while that of those who either received LT (23 patients) or not were 82.1% and 39.8%, respectively. A Cox regression model revealed better overall survival of patients after LT (adjusted hazard ratio [aHR] = 0.067, p = 0.001), worse survival among patients with RDC (aHR = 3.468, p = 0.010), at Child-Pugh stages B and C (aHR for stage B = 11.889, p = 0.028; aHR for stage C = 19.257, p = 0.013) compared to patients at Child-Pugh stage A, and those with a model for end-stage liver disease (MELD) score ≥25 (aHR = 13.721, p = 0.018). This study demonstrates that RDC was associated with worse prognosis in LT candidates. We therefore recommend that interprofessional collaboration should be a routine preoperative procedure for the evaluation of oral hygiene among LT candidates.
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Affiliation(s)
- Ju-Hui Wu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chen-Yi Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Tsan Chang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Hsuan Wu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Lin-Ann Chen
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Jian-Wei Huang
- Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Wen-Lung Su
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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8
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Santos-Lins LS, Aguiar IL, Codes L, Evangelista MA, de Oliveira Castro A, L. Bittencourt P, Cavalcanti A, Paraná R, Lins-Kusterer L. Poor Oral Health-Related Quality of Life in Pre- and Post-Liver Transplantation Patients. Open Dent J 2021. [DOI: 10.2174/1874210602115010196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background:
Oral health is associated with Chronic Liver Disease (CLD) and may play a relevant role in oral (OHRQoL) and general health-related quality of life (HRQoL) among people with chronic liver disease (CLD).
Objective:
To explore the correlations between OHRQoL and HRQoL in pre- and post-liver transplantation (LT) patients.
Methods:
A cross-sectional study with 189 patients: 63 per group (pre-LT, post-LT, and without liver disease). The Oral Health Impact Profile-14 (OHIP-14), the 36-Item Short-Form Health Survey, and the Work Ability Index (WAI) were used to measure oral health-related quality of life, health-related quality of life, and work ability, respectively. Oral health was evaluated according to the World Health Organization criteria. The relationship between the OHIP-14 and independent variables was analysed by multiple linear regression.
Results:
Pre-LT group presented the highest OHIP-14 total mean score, followed by the post-LT group, compared to the group without liver disease (p=0.001). All HRQoL and WAI mean scores were lower in the pre-LT group than in the other groups (p≤0.013). In the pre-LT group, the OHIP-14 total mean score was negatively correlated with the Mental Health, Physical Functioning, and General Health mean scores (p=0.01) and negatively and significantly (p<0.05) associated with decayed teeth and with poor workability. In the post-TL group, OHRQOL of life was associated with decayed and missing teeth, lower educational level, and poor workability.
Conclusion:
Patients in the pre- and post-LT groups presented poorer OHRQoL compared to patients without liver disease. OHRQoL was strongly correlated with HRQoL in the pre-LT group.
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Salivary Biomarkers and Oral Health in Liver Transplant Recipients, with an Emphasis on Diabetes. Diagnostics (Basel) 2021; 11:diagnostics11040662. [PMID: 33916950 PMCID: PMC8067605 DOI: 10.3390/diagnostics11040662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/12/2022] Open
Abstract
Salivary biomarkers have been linked to various systemic diseases. We examined the association between salivary biomarkers, periodontal health, and microbial burden in liver transplant (LT) recipients with and without diabetes, after transplantation. We hypothesized that diabetic recipients would exhibit impaired parameters. This study included 84 adults who received an LT between 2000 and 2006 in Finland. Dental treatment preceded transplantation. The recipients were re-examined, on average, six years later. We evaluated a battery of salivary biomarkers, microbiota, and subjective oral symptoms. Periodontal health was assessed, and immunosuppressive treatments were recorded. Recipients with impaired periodontal health showed higher matrix metalloproteinase-8 (MMP-8) levels (p < 0.05) and MMP-8/tissue inhibitor of matrix metalloproteinase 1 (TIMP1) ratios (p < 0.001) than recipients with good periodontal health. Diabetes post-LT was associated with impaired periodontal health (p < 0.05). No difference between groups was found in the microbial counts. Salivary biomarker levels did not seem to be affected by diabetes. However, the advanced pro-inflammatory state induced by and associated with periodontal inflammation was reflected in the salivary biomarker levels, especially MMP-8 and the MMP-8/TIMP-1 molar ratio. Thus, these salivary biomarkers may be useful for monitoring the oral inflammatory state and the course of LT recipients.
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Cruz AJSD, Castilho LSD, Contarini LCS, Silva MEDSE, Abreu MHNG. Dental Findings of Kidney and Liver Transplantation Patients from a Brazilian Oral Health Care Service. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Schmalz G, Garbade J, Kollmar O, Ziebolz D. Does oral health-related quality of life of patients after solid organ transplantation indicate a response shift? Results of a systematic review. BMC Oral Health 2020; 20:356. [PMID: 33298051 PMCID: PMC7726902 DOI: 10.1186/s12903-020-01350-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background The physical oral health and dental behaviour of patients after solid organ transplantation (SOT) has repeatedly been reported as insufficient. The objective of this systematic review was to detect whether the oral health-related quality of life (OHRQoL) of patients after SOT is reduced compared to that of healthy individuals. Methods A systematic literature search was performed by two independent individuals based on the PubMed, Web of Science and Scopus databases by using the following search terms: “transplantation” AND “oral health-related quality of life”. The findings were checked to determine eligibility, whereby publication prior to 31 October 2020, examination of adult patients (age at least 18 years) with SOT, reporting of an OHRQoL outcome and full text in English language were the prerequisites for inclusion in the qualitative analysis. Quality appraisal of the included studies was performed using the Agency for Healthcare Research and Quality methodology checklist. Results Seven of 25 studies that examined patients after kidney (3), heart (2), liver (1) and lung transplantation (1) were included. Four studies included healthy controls, and five studies included a cohort of patients before transplantation for comparison. Clinical oral health examinations were heterogeneous between groups. The majority of studies (5/7) applied the short form of the “Oral Health Impact Profile” (OHIP 14) to assess OHRQoL. The OHIP 14 values ranged between 1.7 and 8.9 across studies, indicating an unaffected or just slightly reduced OHRQoL. Only one study found better OHRQoL in patients after SOT compared to a group before SOT, and one study confirmed worse OHRQoL of SOT recipients compared to a healthy control. Only two studies revealed an association between OHRQoL and oral health parameters. Furthermore, two studies each found a relationship between OHRQoL and general health-related quality of life or disease-related parameters. Conclusions Patients after SOT show an unaffected or only slightly reduced OHRQoL, which was mainly independent of the insufficient oral status. This might indicate a shift in the perception threshold for oral diseases and conditions caused by the general health burden related to the SOT.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Otto Kollmar
- Universitäres Bauchzentrum Basel, Universitätsspital Basel, Basel, Switzerland
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
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Oliveira CDS, Galdino TM, Limeira FIR, Moreira AN, de Magalhães CS, Abreu LG. Is dental caries associated with liver transplantation? A systematic review and meta-analysis. Oral Dis 2020; 27:1346-1355. [PMID: 32469441 DOI: 10.1111/odi.13439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the experience of dental caries in individuals pre- or postliver transplant. MATERIALS AND METHODS Searches in PubMed, Scopus, Web of Science, Ovid, and Lilacs from databases' inception date up to April 2020 were undertaken. Gray literature and manual searches were also conducted. Observational studies were eligible. The retrieved references were evaluated by two independent reviewers. Meta-analysis and risk of bias assessment using the University of Adelaide tool were conducted. The strength of the evidence was assessed with GRADE. RESULTS The search retrieved 1990 references. Twenty-four cross-sectional studies were included. One subgroup analysis demonstrated no significant difference in the number of teeth with dental caries between pre-liver transplant and healthy individuals (mean difference = 1.65, confidence interval = -0.87 to 4.17). The prevalence of dental caries among pre-liver transplant individuals was 73.82% and in the post-transplant individuals was 72.83%. In the included studies, the main concern regarding risk of bias was the absence of control for confounding variables. The strength of the evidence was very low. CONCLUSIONS Dental caries may be a relevant issue in pre- and postliver transplant individuals. Oral health counseling should be included in the care of pre- and/or postliver transplant individuals.
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Affiliation(s)
- Carla de Souza Oliveira
- Post-Graduate Program in Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tuélita Marques Galdino
- Post-Graduate Program in Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Allyson Nogueira Moreira
- Department of Restorative Dentistry, Faculty of Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cláudia Silami de Magalhães
- Department of Restorative Dentistry, Faculty of Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, Faculty of Dentistry, University Federal de Minas Gerais, Belo Horizonte, Brazil
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13
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Clinical periodontal and dental findings in liver transplant patients: a systematic review and meta-analysis. Br Dent J 2020; 228:108-116. [PMID: 31980788 DOI: 10.1038/s41415-020-1196-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives This systematic review aimed to investigate the oral health of post-liver transplant recipients (postLTx), in terms of dental and periodontal clinical results.Data sources Pubmed/MEDLINE and Cochrane Library databases were searched electronically.Data selection Prospective, cross-sectional and case-control studies comparing periodontal and dental health of postLTx patients with healthy and/or pre-liver transplant patients.Data extraction This was performed independently by two authors. Quality assessment was done by using tools from the National Heart, Lung, and Blood Institute.Data synthesis Nine studies were eligible for inclusion in the systematic review. A meta-analysis was performed on gingival inflammation, expressed by scores, on four studies including healthy controls. The gingival index scores were significantly higher in postLTx patients compared with healthy controls (p <0.001). The weighted mean difference was 0.91 (95% confidence interval, 0.44 to 1.38, heterogeneity I2 = 99.5%). Increased tendency of gingival enlargement was noticed in postLTx patients, especially after immunosuppression with Cyclosporine A. Controversial results were reported for the prevalence of caries in postLTx recipients, but there seems to be an increase.Conclusion The results suggest that patients with liver transplants, due to systemic condition and immunosuppressive therapy, exhibit a higher degree of gingival inflammation compared with unexposed patients.Prospero registration number: CRD42019121893.
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14
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Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10040184. [PMID: 32230707 PMCID: PMC7235754 DOI: 10.3390/diagnostics10040184] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.
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Zarei F, Hashemi SJ, Salehi M, Mahmoudi S, Zibafar E, Ahmadinejad Z, Rahimi Foroushani A, Ardi P, Daie Ghazvini R. Molecular characterization of fungi causing colonization and infection in organ transplant recipients: A one-year prospective study. Curr Med Mycol 2020; 6:30-35. [PMID: 32420505 PMCID: PMC7217253 DOI: 10.18502/cmm.6.1.2505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents. Materials and Methods: This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods. Results: A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of Candida albicans both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of Candida (i.e., C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei), Aspergillus (i.e., A. oryzae and A. candidus), Rhizopus (i.e., R. oryzae and R. microsporus), Trichosporon asahii, and Trichophyton interdigitale. The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; P=0.043). Conclusion: Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.
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Affiliation(s)
- Fereshteh Zarei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Mahmoudi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ensieh Zibafar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Ardi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Garbade J, Rast J, Schmalz G, Eisner M, Wagner J, Kottmann T, Oberbach A, Lehmann S, Haak R, Borger MA, Binner C, Ziebolz D. Oral health and dental behaviour of patients with left ventricular assist device: a cross-sectional study. ESC Heart Fail 2020; 7:1273-1281. [PMID: 32027102 PMCID: PMC7261540 DOI: 10.1002/ehf2.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
Aims The aim of this cross‐sectional study was the assessment of dental behaviour, oral health, as well as oral health‐related quality of life of patients with left ventricular assist device (LVAD). Methods and results Patients (128) with LVAD were recruited from the University Department for Cardiac Surgery at Heart Center, Leipzig, Germany. A healthy control group (HC, n = 113) was included. Dental behaviour was assessed with a standardized questionnaire, and to evaluate oral health‐related quality of life, the German short form of oral health impact profile was applied. The presence of decayed, missing, and filled teeth; dental treatment need; periodontitis severity; and periodontal treatment need were assessed. These findings were correlated to disease‐related and device‐related factors. The minority of patients used aids for interdental hygiene (16.4%). For the LVAD patients, a German short form of oral health impact profile sum score of 4.96 ± 8.67 [0.5; 0–6] was assessed. The LVAD group suffered from more missing teeth (11.91 ± 9.13 vs. 3.70 ± 3.77; P < 0.01) than HC. More severe periodontitis was found in LVAD group (LVAD = 41.4% and HC = 27.4%; P < 0.01). Periodontal treatment need was high in both groups, without a significant difference (LVAD = 84.4% vs. HC = 86.7%; P = 0.71). LVAD therapy as bridge to transplantation was correlated with periodontal treatment need (odds ratio = 11.48 [1.27; 103.86]; P = 0.03). Further correlations between treatment need and disease specific factors were not detected. Conclusions Patients with LVAD suffer from a high periodontal treatment need and a lack in oral behaviour. Interdisciplinary special care concepts appear recommendable to improve oral health in LVAD patients.
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Affiliation(s)
- Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Josephine Rast
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Mirjam Eisner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Justus Wagner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | | | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Leipzig, Germany
| | - Sven Lehmann
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Christian Binner
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, Leipzig, D 04103, Germany
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Ziebolz D, Friedrich S, Binner C, Rast J, Eisner M, Wagner J, Schmickler J, Kottmann T, Haak R, Borger MA, Lehmann S, Oberbach A, Garbade J, Schmalz G. Lack in Periodontal Care of Patients Suffering from Severe Heart Diseases-Results after 12 Months Follow-Up. J Clin Med 2020; 9:jcm9020352. [PMID: 32012698 PMCID: PMC7073650 DOI: 10.3390/jcm9020352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To assess whether the standardized recommendation of patients with heart failure (HF), left-ventricular assist device (LVAD) and heart transplantation (HTx) to visit their dentist leads to improved oral conditions after 12 months. METHODS Patients from the Department of Cardiothoracic Surgery, Leipzig Heart Centre, Germany were examined at baseline and after 12 months. A dental (decayed-, missing-, and filled-teeth index (DMF-T)) and periodontal examination (periodontal probing depth, clinical attachment loss) was performed. At baseline, patients received a standardized recommendation to visit their dentist. At follow-up, a standardized questionnaire regarding the dental consultation was applied. RESULTS Eighty-eight participants (HTx: 31, LVAD: 43, HF: 14) were included. The majority of patients (79.5%) followed the recommendation to visit their dentist. Within the total cohort, periodontal treatment need was significantly reduced from 91% (baseline) to 75% (follow-up; p < 0.01). Only 10% of total cohort stated that they received periodontal treatment. The outcome in periodontal and dental treatment need at follow-up appointment revealed no statistically significant associations to the questionnaire regarding dentist consultation (p > 0.05). Conclusions: The simple recommendation to visit the dentist appears not enough to obtain sufficient dental and periodontal conditions in patients with severe heart diseases. Thereby, a lack in periodontal treatment of patients with HF, HTx and LVAD was identified, making interdisciplinary dental special care programs recommendable.
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Affiliation(s)
- Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
- Correspondence: ; Tel.: +49-341-97-21211
| | - Sylvia Friedrich
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Christian Binner
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Josephine Rast
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Mirjam Eisner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Justus Wagner
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Jan Schmickler
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Tanja Kottmann
- CRO Dr. med. Kottmann GmbH & Co. KG, 59077 Hamm, Germany;
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
| | - Michael A. Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Sven Lehmann
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, 04103 Leipzig, Germany;
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany; (C.B.); (M.A.B.); (S.L.); (J.G.)
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (S.F.); (J.R.); (M.E.); (J.W.); (J.S.); (R.H.); (G.S.)
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Sezgin Y, Sezgin A. Periodontal status and dental behaviour of heart transplant recipients and healthy controls. Acta Odontol Scand 2020; 78:20-25. [PMID: 31661343 DOI: 10.1080/00016357.2019.1683889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: The aim of this study was to compare the periodontal status and dental behaviour of heart transplant recipients with systemically healthy controls.Material and Methods: Forty heart transplant recipients and 40 systemically healthy patients were included. A questionnaire was used to record demographic, systemic health and dental behaviour data, and the following clinical parameters were recorded: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level.Results: Mean probing depth (p = .045), mean gingival recession (p = .016), mean clinical attachment level (p = .021) and mean plaque index scores (p = .001) were higher in heart transplant recipients than the systemically healthy group. However, bleeding on probing was similar in both groups (p > .05). Tooth brushing frequency and number of participants who used dental floss/interdental brush was lower in the heart transplant group.Conclusion: Considering the poor oral hygiene and high clinical periodontal parameters of heart transplant recipients, periodontal evaluation should be done regularly before and after transplantation. The patient's daily oral hygiene regimens should be evaluated carefully in this evaluation session and modified based on their gingival health, manual skill and motivational levels. The importance of oral health and its effects on systemic health should also be explained to the transplant recipients in detail.
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Affiliation(s)
- Yasemin Sezgin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Atila Sezgin
- Department of Cardiovascular Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
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Insufficient Oral Behaviour and the High Need for Periodontal Treatment in Patients with Heart Insufficiency and after Heart Transplantation: A Need for Special Care Programs? J Clin Med 2019; 8:jcm8101668. [PMID: 31614807 PMCID: PMC6832627 DOI: 10.3390/jcm8101668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 01/09/2023] Open
Abstract
Background: The aim of this cross-sectional study was the assessment of dental behaviour and oral health condition of heart transplant recipients (HTx) in comparison to patients with heart insufficiency (HI). Methods: Patients attending the Department for Cardiac Surgery, Leipzig Heart Center, Germany were recruited. Standardized questionnaires regarding dental behaviour and periodontal complaints were applied. A dental (decayed-, missing- and filled-teeth index) and periodontal examination (periodontal probing depth (PPD) and clinical attachment loss (CAL)) was performed. Based on the oral findings, dental and periodontal treatment need was determined. Statistics: T-test, Mann-Whitney U test, Chi-square test, and Fisher-test (p < 0.05). Results: A total of 201 patients (HTx: 112, HI: 89) were included. HTx patients were significantly more often allocated to dentists (p < 0.01). Furthermore, the HTx patients rated feeling informed appropriately about oral health more often (p < 0.01). HTx patients used interdental cleaning (p < 0.01) and mouth rinse (p = 0.02) more often than HI patients. No differences between groups were present regarding dental status and periodontitis severity (p > 0.05). Periodontal treatment need was high, showing prevalence of 79.5% (HTx) and 87.6% (HI, p = 0.14), respectively. Conclusions: Both groups show insufficient oral behaviour and a high need for periodontal treatment. Special care programs for HTx candidates and recipients appear recommendable.
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Abstract
BACKGROUND Liver transplantation has become commonplace for patients with end-stage liver disease. The liver is a bodily organ of great importance, and its dysfunction can cause significant complications throughout the body. Patients with hepatic disease should be able to acquire knowledge of the physiology of the liver via the dental profession, and it is also necessary to modify some aspects of dental treatment even in healthy patients. Problems such as excessive bleeding and hepatotoxicity caused by some of the drugs used in dental treatment can lead to a decrease in systemic health. Otherwise, patients with liver disease will have poorer oral health than the general population. Thus, it is important to have well-established routine dental care in this patient group and offer management of oral health in view of the effects of liver disease. METHODS The objective of this work was to undertake a bibliographic review of the dental approaches to patients with liver disease and liver transplant recipients and to propose a dental care routine for such patients in an outpatient setting. RESULTS A search was carried out on the main scientific databases (PubMed, Medline, and SciELO) for publications related to this subject and, particularly those published after 2010. The articles selected describe poor oral hygiene among patients, independent of the etiology of their liver disease. These patients also had a high index of xerostomia, caries, periodontal disease, apical lesions, and fungical infections. To control bleeding during and after surgery, hemostatic measures must be understood and adopted. CONCLUSION There are no data about routine dental care among liver disease/transplantation patients. Thus, our findings will hopefully encourage other services to structure their approaches and consider enhancing their dental care protocols for patients with liver-related complications.
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Schmalz G, Berisha L, Wendorff H, Widmer F, Marcinkowski A, Teschler H, Sommerwerck U, Haak R, Kollmar O, Ziebolz D. Association of time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected bacteria of patients after solid organ transplantation. Med Oral Patol Oral Cir Bucal 2018; 23:e326-e334. [PMID: 29680846 PMCID: PMC5945244 DOI: 10.4317/medoral.22238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/18/2017] [Indexed: 02/03/2023] Open
Abstract
Background Aim of this study was to investigate the association of the time under immunosuppression and different immunosuppressive medication on periodontal parameters and selected periodontal pathogenic bacteria of immunosuppressed patients after solid organ transplantation (SOT). Material and Methods 169 Patients after SOT (lung, liver or kidney) were included and divided into subgroups according their time under (0-1, 1-3, 3-6, 6-10 and >10 years) and form of immunosuppression (Tacrolimus, Cyclosporine, Mycophenolate, Glucocorticoids, Sirolimus and monotherapy vs. combination). Periodontal probing depth (PPD) and clinical attachment loss (CAL) were assessed. Periodontal disease severity was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were investigated for eleven selected potentially periodontal pathogenic bacteria using polymerasechainreaction. Results The mean PPD and CAL as well as prevalence of Treponema denticola and Capnocytophaga species was shown to be different but heterogeneous depending on time under immunosuppression (p<0.05). Furthermore, only the medication with Cyclosporine was found to show worse periodontal condition compared to patients without Cyclosporine (p<0.05). Prevalence of Porphyromonas gingivalis, Tannerella forsythia and Fusobacterium nucleatum was reduced and prevalence of Parvimonas micra and Capnocytophaga species was increased in patients under immunosuppression with Glucocorticoids, Mycophenolate as well as combination therapy. Conclusions Time under and form of immunosuppression might have an impact on the clinical periodontal and microbiological parameters of patients after SOT. Patients under Cyclosporine medication should receive increased attention. Differences in subgingival biofilm, but not in clinical parameters were found for Glucocorticoids, Mycophenolate and combination therapy, making the clinical relevance of this finding unclear. Key words:Immunosuppression, organ transplantation, periodontitis, periodontal bacteria.
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Affiliation(s)
- G Schmalz
- University Leipzig, Dept. of Cariology, Endodontology and Periodontology, Liebigstr. 12, D 04103 Leipzig, Germany,
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Schmalz G, Wendorff H, Berisha L, Meisel A, Widmer F, Marcinkowski A, Teschler H, Sommerwerck U, Haak R, Kollmar O, Ziebolz D. Association between the time after transplantation and different immunosuppressive medications with dental and periodontal treatment need in patients after solid organ transplantation. Transpl Infect Dis 2018; 20:e12832. [PMID: 29359871 DOI: 10.1111/tid.12832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/10/2017] [Accepted: 10/07/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Horst Wendorff
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Lisa Berisha
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Anja Meisel
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Florian Widmer
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Anna Marcinkowski
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Helmut Teschler
- Department of Pneumology; West German Lung Center; Ruhrlandklinik; University Hospital Essen; University Duisburg-Essen; Essen Germany
| | - Urte Sommerwerck
- Department of Pneumology; West German Lung Center; Ruhrlandklinik; University Hospital Essen; University Duisburg-Essen; Essen Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
| | - Otto Kollmar
- Department of General and Visceral Surgery; HELIOS Dr. Horst Schmidt-Kliniken; Wiesbaden Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology; University of Leipzig; Leipzig Germany
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Ziebolz D, Reiss L, Schmalz G, Krause F, Haak R, Mausberg RF. Different views of dentists and general medical practitioners on dental care for patients with diabetes mellitus and coronary heart diseases: results of a questionnaire-based survey in a district of Germany. Int Dent J 2017; 68:197-203. [PMID: 29274083 DOI: 10.1111/idj.12353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this questionnaire-based study was to evaluate the views of dentists (Ds) and general medical practitioners (GPs) on different aspects of dental care for patients with diabetes mellitus (DM) or coronary heart disease (CHD). METHODS Reliable and comparable questionnaires for Ds and GPs, with 23 questions, were sent to 1,000 randomly selected Ds and 1,000 randomly selected GPs. Questions were asked about patients with DM or CHD regarding their dental care and potentially related issues (e.g. antibiotic prophylaxis). The responses received within 12 weeks were evaluated and statistically analysed using chi-square and Mann-Whitney U tests (P < 0.05). RESULTS The response rate was 39% (n = 391) for Ds and 18% (n = 181) for GPs. Both groups stated that they used the medical history as well as patient interviews to assess patients. However, only 55% of Ds assumed correct identification of every at-risk patient compared with 100% of GPs (P < 0.01). Furthermore, Ds speculated that they inform their patients more often about their at-risk status than do GPs (P < 0.01). Neither Ds nor GPs appeared to be confident in their knowledge about adequate antibiotic prophylaxis. Interdisciplinary collaboration was considered insufficient, although Ds had a higher rate of regular collaboration (68% for Ds vs. 40% for GPs; P < 0.01). CONCLUSION Ds and GPs have differing views on dental care of patients with DM or CHD, and Ds showed more interest in this issue. These results might partially explain the insufficient collaboration between Ds and GPs.
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Affiliation(s)
- Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Lucie Reiss
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Felix Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer F Mausberg
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Goettingen, Goettingen, Germany
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Oral health-related quality of life depending on dental and periodontal health in different patients before and after liver transplantation. Clin Oral Investig 2017; 22:2039-2045. [DOI: 10.1007/s00784-017-2298-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/06/2017] [Indexed: 12/12/2022]
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