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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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2
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Olsson J, Wolf E, Ljunggren A. Pre-medical assessment of root-canal-filled teeth with asymptomatic apical periodontitis-A multifaceted balancing act. Int Endod J 2023; 56:1063-1076. [PMID: 37269098 DOI: 10.1111/iej.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023]
Abstract
AIM Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision-making process regarding the pre-medical management of root-canal-filled teeth with asymptomatic apical periodontitis (AAP). METHODOLOGY Hospital-affiliated dentists in Sweden were contacted for a semi-structured, in-depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root-canal-filled teeth with AAP-one case having resulted in pre-medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open-ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach. RESULTS A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes-difficult risk-benefit-estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub-categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference. CONCLUSIONS The current interview study found pre-medical decision-making regarding root-canal-filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence-based treatment guidelines, is suggested necessary.
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Affiliation(s)
- Jenny Olsson
- Department of Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Eva Wolf
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anna Ljunggren
- Department of Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
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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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GÜMRÜ B, TARÇIN B. Solid Organ Transplant Candidates and Recipients: Dentists’ Perspective. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.915422] [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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5
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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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Oral Health-Related Quality of Life in Chronic Liver Failure Patients Measured by OHIP-14 and GOHAI. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8835824. [PMID: 33426077 PMCID: PMC7781717 DOI: 10.1155/2020/8835824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/28/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
Background Oro-dental diseases are prevalent in chronic liver failure (CLF) patients. The aim of this study was to evaluate the quality of life associated with oral health in candidates for liver transplant surgery. Materials and Methods The demographic information of 105 end-stage liver cirrhotic patients was collected. All patients were ordered a panoramic view for pretransplant dental evaluation. The DMFT (decayed-missing-filled tooth) index was calculated for dental examination. The model for end-stage liver disease (MELD) was used for the severity of liver disease. The OHIP-14 (Oral Health Impact Profile) questionnaire and GOHAI (Geriatric Oral Health Assessment Index) questionnaire were applied to evaluate the impact of oral disease on the quality of life. Results A total of 79 patients thoroughly completed the questionnaires; 79.7% were male, 32.9% were over 50, and 25.3% were less than 30 years old. Further, 12.7% smoked, 2.5% were illiterate, 64.6% had not finished school, and 10.1% had university degrees. Almost half of the cirrhotic patients were suffering from the disease for more than 3 years. Most complaints reported by the patients as “very often” were becoming self-conscious (13.9%) and being uncomfortable when eating any foods (13.9%) followed by feeling tense (12.8%). There was no significant difference between gender, smoking, age, and MELD score based on quality of life (OHIP and GOHAI) (P > 0.05). The level of education (P = 0.020), duration of disease (P = 0.017), and DMFT index (P = 0.039) had a significant impact on oral health-related quality of life in CLF patients. An inverse relationship was seen between the DMFT index and the quality of life. Conclusion Oral health has a high impact on the quality of life of cirrhotic patients. The psychological dimension of oral health is the most debilitating factor affecting the quality of life. This shows the importance of professional oral care, oral health, and self-care education in this group of patients.
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Cocero N, Frascolino C, Berta GN, Carossa S. Is It Safe to Remove Teeth in Liver Transplant Patients Without Antibiotics? A Retrospective Study of 346 Patients. J Oral Maxillofac Surg 2019; 77:1557-1565. [PMID: 31026420 DOI: 10.1016/j.joms.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Eradication of oral infectious foci is essential for liver transplant candidates. The main issue is whether antibiotic prophylaxis is necessary for all dental extractions despite the possible fostering of resistant bacteria. To overcome the scarcity of evidence-based data, our study analyzed the background and outcomes of a large number of routine extractions performed in our institution without antibiotic prophylaxis in patients with different liver pathologies. MATERIALS AND METHODS In this retrospective cohort study, the outcome of interest was the occurrence of local infections and minor complications during the 7-day follow-up period after extraction; the predictors were the demographic and clinical variables of the patients (age, gender, liver pathology, Model for End-Stage Liver Disease score, international normalized ratio) and the extraction variables (single vs multiple extractions, isolated vs contiguous teeth, single-rooted vs multirooted teeth). The statistical analysis used univariate nonparametric tests and binary multivariate logistic regressions. RESULTS The 346 liver transplant candidates (mean age, 53 ± 8 years; 24% women) underwent 662 routine extraction sessions involving 1,329 teeth. The 7-day dental follow-up detected no signs of postoperative wound infection (rate = 0% [95% confidence interval (CI), 0 to 0.9%]). Accordingly, the 2-week post-extraction clinical monitoring excluded symptoms of systemic infection attributable to the dental procedure. Minor complications (mild bleeding, slow healing, inflamed socket) occurred in 50 patients (rate = 14% [95% CI, 11 to 18%]) in the 3 days after extraction. Significant risk factors for minor complications were refractory ascites (P < .0001; OR = 8 [95% CI, 3 to 20]), extraction of multirooted contiguous teeth (P < 0.0001; OR = 5 [95% CI, 2.5 to 9]), and a Model for End-Stage Liver Disease score greater than 18 (P = 0.01; OR = 2.4 [95% CI, 1.2 to 5]). CONCLUSIONS Our study showed that routine extractions without antibiotic prophylaxis can be performed safely in liver transplant candidates, even in the presence of 1 or more non-controllable risk factors. Using atraumatic techniques, we achieved satisfactory healing of the gingiva and socket in all patients in a week, without any signs of local infection. The few minor complications were readily managed and resolved within 3 days after extraction.
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Affiliation(s)
- Nadia Cocero
- Senior Consultant, Oral Surgery Section, Dental School, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Caterina Frascolino
- Trainee, Oral Surgery Section, Dental School, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giovanni Nicolao Berta
- Aggregate Professor on Pharmacology, Department of Clinical and Biological Sciences, Dental School, University of Torino, Turin, Italy
| | - Stefano Carossa
- Department Head, Department of Surgical Sciences, Dental School, University of Torino, Turin, Italy
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Di Profio B, Inoue G, Marui VC, de França BN, Romito GA, Ortega KL, Holzhausen M, Pannuti CM. Periodontal status of liver transplant candidates and healthy controls. J Periodontol 2018; 89:1383-1389. [DOI: 10.1002/jper.17-0710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/14/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Bruna Di Profio
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Gislene Inoue
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Vanessa Costa Marui
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Bruno Nunes de França
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | | | - Karem Lopez Ortega
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Marinella Holzhausen
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Claudio Mendes Pannuti
- Department of Stomatology; School of Dentistry; University of São Paulo; São Paulo Brazil
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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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Kauffels A, Schmalz G, Kollmar O, Slotta JE, Weig M, Groß U, Bader O, Ziebolz D. Oral findings and dental behaviour before and after liver transplantation – a single-centre cross-sectional study. Int Dent J 2017; 67:244-251. [DOI: 10.1111/idj.12290] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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12
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Di Profio B, Villar CC, Saraiva L, Ortega KL, Pannuti CM. Is periodontitis a risk factor for infections in cirrhotic patients? Med Hypotheses 2017; 106:19-22. [PMID: 28818265 DOI: 10.1016/j.mehy.2017.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/09/2017] [Accepted: 06/26/2017] [Indexed: 02/08/2023]
Affiliation(s)
- B Di Profio
- Department of Estomatology, School of Dentistry, University of São Paulo, Brazil
| | - C C Villar
- Department of Estomatology, School of Dentistry, University of São Paulo, Brazil
| | - L Saraiva
- Department of Estomatology, School of Dentistry, University of São Paulo, Brazil
| | - K L Ortega
- Department of Estomatology, School of Dentistry, University of São Paulo, Brazil
| | - C M Pannuti
- Department of Estomatology, School of Dentistry, University of São Paulo, Brazil.
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Oral health in patients with renal disease: a longitudinal study from predialysis to kidney transplantation. Clin Oral Investig 2017; 22:339-347. [DOI: 10.1007/s00784-017-2118-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/11/2017] [Indexed: 01/05/2023]
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Cocero N, Bezzi M, Martini S, Carossa S. Oral Surgical Treatment of Patients With Chronic Liver Disease: Assessments of Bleeding and Its Relationship With Thrombocytopenia and Blood Coagulation Parameters. J Oral Maxillofac Surg 2016; 75:28-34. [PMID: 27677683 DOI: 10.1016/j.joms.2016.08.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Cirrhotic patients awaiting liver transplantation require eradication of infectious oral foci to prevent septic episodes after transplantation; however, cirrhosis can hinder hemostasis and can result in severe bleeding. The present study assessed the bleeding risk factors connected with the clinical history of these patients and the characteristics of the extractions. MATERIALS AND METHODS We retrospectively analyzed 1183 extractions in 318 patients, including 47 with severe end-stage liver disease who were outside of our intention-to-treat bracket (ie, platelet count [PLT] >40 × 103/μL and international normalized ratio [INR] <2.5). Follow-up examinations included inspection of the oral cavity on the first, third, and seventh days, with reparatory surgery in the case of severe bleeding. Continuous variables were compared using the Mann-Whitney U and Kruskal-Wallis tests, and categorical variables were compared using Fisher's exact test. Binary logistic regression analysis was also performed. RESULTS Within the intention-to-treat bracket, 1 of the 271 patients (0.4%) required surgical repair. The bleeding rate for an INR of 2.5 or more was significantly greater than that for a PLT of 40 × 103/μL or less (4 of 10 [40%] versus 2 of 34 [6%]; P = .02]. All 3 patients with both an INR of 2.5 or more and a PLT of 40 × 103/μL or less exhibited severe bleeding. No significant association between the occurrence of bleeding with either liver disease etiology or the number of molars extracted was found. No patient required hospitalization. CONCLUSIONS Patients with a PLT greater than 40 × 103/μL and an INR of less than 2.5 can be considered relatively low-risk patients. However, an INR of 2.5 or more and, to a minor degree, a PLT of 40 × 103/μL or less represent significant risk factors.
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Affiliation(s)
- Nadia Cocero
- Consultant, Oral Surgery Section, Dental School, University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Torino, Italy.
| | - Marta Bezzi
- Consultant, Oral Surgery Section, Dental School, University of Torino at the Azienda Ospedaliera Città della Salute e della Scienza of Torino, Torino, Italy
| | - Silvia Martini
- Resident, Gastrohepatology, Molinette Hospital, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano Carossa
- Department Head, Department of Surgical Sciences, Dental School, University of Torino, Torino, Italy
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Helenius-Hietala J, Åberg F, Meurman JH, Nordin A, Isoniemi H. Oral surgery in liver transplant candidates: a retrospective study on delayed bleeding and other complications. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:490-5. [DOI: 10.1016/j.oooo.2016.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/18/2016] [Accepted: 01/24/2016] [Indexed: 02/07/2023]
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Periodontal pathogenic bacteria and aMMP-8 findings depending on periodontal conditions of patients before and after liver transplantation. Clin Oral Investig 2016; 21:745-752. [DOI: 10.1007/s00784-016-1821-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/03/2016] [Indexed: 12/28/2022]
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Söder B, Andersson LC, Meurman JH, Söder PÖ. Unique database study linking gingival inflammation and smoking in carcinogenesis. Philos Trans R Soc Lond B Biol Sci 2015; 370:20140041. [PMID: 25533098 DOI: 10.1098/rstb.2014.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We investigated statistical association between gingival inflammation and cancer in a group of patients followed up for 26 years with the hypothesis that gingival inflammation affects carcinogenesis. Altogether, 1676 30- to 40-year-old subjects from Stockholm were clinically examined in 1985. In 2011, we compared the baseline oral examination and follow-up data with cancer diagnoses sourced from the Swedish national hospital register databases. Of 1676 individuals, 89 (55 women, 34 men) had got cancer by the year 2011. Women were found to be at higher risk for cancer than men. Smoking (expressed in pack-years) had been more prevalent in the cancer group than in those with no cancer diagnosis. Gingival index, marker of gingival inflammation, was higher in the cancer group than in subjects with no cancer. There were no significant differences between the groups regarding age, education, dental plaque and calculus index scores, or in the number of missing teeth. In multiple logistic regression analysis with cancer as the dependent variable and several independent variables, pack-years of smoking appeared to be a principal independent predictor with odds ratio (OR) 1.32 while gingival inflammation showed OR 1.29. Hence, our present findings showed that together with smoking, gingival inflammation indeed associated with the incidence of cancer in this cohort.
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Affiliation(s)
- Birgitta Söder
- Department of Dental Medicine, Karolinska Institutet, 141 04 Huddinge, Sweden
| | - Leif C Andersson
- Department of Pathology, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland
| | - Jukka H Meurman
- Department of Oral Maxillofacial Diseases, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Per-Östen Söder
- Department of Dental Medicine, Karolinska Institutet, 141 04 Huddinge, Sweden
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Helenius-Hietala J, Ruokonen H, Grönroos L, Rissanen H, Vehkalahti MM, Suominen L, Isoniemi H, Meurman JH. Oral mucosal health in liver transplant recipients and controls. Liver Transpl 2014; 20:72-80. [PMID: 24142471 DOI: 10.1002/lt.23778] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/11/2013] [Indexed: 02/07/2023]
Abstract
Immunosuppressive drugs and other medications may predispose patients to oral diseases. Data on oral mucosal health in recipients of liver transplantation (LT) are limited. We, therefore, recruited 84 LT recipients (64 with chronic liver disease and 20 with acute liver failure) for clinical oral examinations in a cross-sectional, case-control study. Their oral health had been clinically examined before transplantation. The prevalence of oral mucosal lesions (OMLs) was assessed in groups with different etiologies of liver disease and in groups with different immunosuppressive medications, and these groups were compared to controls selected from a nationwide survey in Finland (n = 252). Risk factors for OMLs were evaluated with logistic regression. OMLs were more frequent in LT recipients versus controls (43% versus 15%, P < 0.001), and the use of steroids raised the prevalence to 53%. Drug-induced gingival overgrowth was the single most common type of lesion, and its prevalence was significantly higher for patients using cyclosporine A (CSA; 29%) versus patients using tacrolimus (TAC; 5%, P = 0.007); the prevalence was even higher with the simultaneous use of calcium channel blockers and CSA (47%) or TAC (8%, P = 0.002). Lesions with malignant potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions, leukoplakias, and ulcers occurred in 13% of the patients with chronic liver disease and in 6% of the controls. Every third patient with chronic liver disease had reduced salivary flow, and more than half of all patients were positive for Candida; this risk was higher with steroids. In conclusion, the high frequency of OMLs among LT recipients can be explained not only by immunosuppressive drugs but also by other medications. Because dry mouth affects oral health and OMLs may have the potential for malignant transformation, annual oral examinations are indicated.
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Affiliation(s)
- Jaana Helenius-Hietala
- Institute of Dentistry, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland
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Song M, Liu K, Abromitis R, Schleyer TL. Reusing electronic patient data for dental clinical research: a review of current status. J Dent 2013; 41:1148-63. [PMID: 23603087 PMCID: PMC4141471 DOI: 10.1016/j.jdent.2013.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/04/2013] [Accepted: 04/10/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The reuse of electronic patient data collected during clinical care has received increased attention as a way to increase our evidence base. The purpose of this paper was to review studies reusing electronic patient data for dental research. DATA SOURCES 1527 citations obtained by searching MEDLINE and Embase databases, hand-searching seven dental and informatics journals, and snowball sampling. STUDY SELECTION We included studies reusing electronic patient data for research on dental and craniofacial topics, alone or in combination with medical conditions, medications and outcomes. Studies using administrative or research databases and systematic reviews were excluded. Three reviewers extracted data independently and performed analysis jointly RESULTS The 60 studies reviewed covered epidemiological (32 studies), outcomes (16), health services research (10) and other (2) topics; were primarily retrospective (58 studies); varied significantly in sample size (9-153,619 patients) and follow-up period (1-12 years); often drew on other data sources in addition to electronic ones (25); but rarely tapped electronic dental record (EDR) data in private practices (3). Type of research was not associated with data sources used, but research topics/questions were. The most commonly reported advantages of reusing electronic data were being able to study large samples and saving time, while data quality and the inability to capture study-specific data were identified as major limitations. CONCLUSIONS Dental research reusing electronic patient data is nascent but accelerating. Future EDR design should focus on enhancing data quality, begin to integrate research data collection and implement interoperability with electronic medical records to facilitate oral-systemic investigations. CLINICAL SIGNIFICANCE Measuring and improving the quality of dental care requires that we begin to reuse electronic patient data collected in practice for clinical research. Practice data can potentially serve as a useful complement to data collected in traditional research studies.
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Affiliation(s)
- Mei Song
- Center for Dental Informatics, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA 15261, United States.
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Castellanos-Cosano L, Machuca-Portillo G, Segura-Sampedro JJ, Torres-Lagares D, López-López J, Velasco-Ortega E, Segura-Egea JJ. Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates. Med Oral Patol Oral Cir Bucal 2013; 18:e773-9. [PMID: 23722148 PMCID: PMC3790651 DOI: 10.4317/medoral.19148] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/27/2013] [Indexed: 12/13/2022] Open
Abstract
Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects.
Material and Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression.
Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects.
Key words:Apical periodontitis, endodontics, hepatic cirrhosis, liver disease, liver transplant, oral health, root-canal treatment.
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