Organ transplantations is a type of medical procedure which involves the donation of tissues and organs from a living or deceased person to be transplanted into living recipients whom, in many instances are either very ill or dying. This form of treatment has been proven to be effective in improving health and saving lives. The oral health of a patients with an organ transplant can be affected either directly by the transplanted organ as in chronic graft versus host disease or indirectly from the side-effects of anti-rejection medication.

Chronic graft versus host disease is a condition that affects people who have received stem cell or blood-producing cells from donors. Anti-rejection medications are medications given to the recipients to prevent the recipients’ body from rejecting the organ that has been transplanted and these include immune-suppressants

There are two main types of organ transplantations, these are: –

• It is important to maintain good oral health before your transplant procedure and your mouth should be as healthy as possible.
• Decayed teeth, gum disease and any other mouth problems should be treated ahead of time.
• Getting these problems resolved earlier will prevent or reduce possible dental problems during or after your transplant.
• Germs from untreated dental conditions can complicate your transplant as they can cause an infection.
• The anti-rejection medications used after your transplant can further worsen untreated dental conditions. Hence it is important to ensure that your mouth is healthy before your transplant procedure.

Complete your dental treatment ahead of time before commencing your transplant treatment to avoid unnecessary problems.

Antibiotic cover

Your dentist will consult with your treating physician to determine the need of an antibiotic cover to prevent the spread of infection following your dental treatment.

Oral infection

If you have an abscessed tooth or gum abscess that needs treatment, your dentist will advise for antibiotics to be taken before and after the dental treatment to prevent the spread of infection. It is most advisable to eliminate all oral infection before the commencement of your transplant.

Excessive bleeding

Bleeding problems can occur in transplant candidates and is usually caused by the disease itself or by medications. For example, patients with liver failure may have excessive bleeding as the liver is not able to produce the required clotting factors to stop bleeding.
In patients on anti-platelet medication or anti-coagulants may bleed following dental treatment.
Before treatment, your dentist will take the necessary precautions required to prevent bleeding and this includes discussions with your physician on the best way possible for you to receive dental treatment safely.
Your dentist may order blood tests and use other medications to control bleeding. Based on your bleeding risk, your dentist might decide to refer you to hospital for dental treatment.

Medications

Patients planned for organ or stem cell transplants may be taking multiple medications. These may include anticoagulants, beta-blockers, calcium channel blockers, diuretics and others. You have to be aware of the possible side-effects of these medications which may range from dry-mouth (xerostomia), gum-overgrowth, bleeding tendencies, increased risk of mouth infections.

Before your transplant, all active dental disease should be eliminated as the use of immune-suppressant post-transplant will decrease your ability to resist infections. Hence, your dentist will need to: –

What if I develop a dental problem during my transplant?

If you do indeed develop a dental problem during your transplant, please inform your treating physician. Emergency dental treatment can be provided if it is medically permitted.

Routine dental treatment can commence after your transplant has stabilized. You will need to: –

Immunosuppressive medications or anti-rejection medication are used to prevent rejection of transplanted organs. The use of these medications is associated with several oral side effects and complications such as bacterial infections of the mouth, oral candidiasis, other viral and fungal infections, and aphtous ulcers.

Oral ulcers are caused by herpes simplex virus infection, or in patients with stem cell transplants, oral ulcers may be sign of graft-versus-host disease. In addition, progressive gum disease, delayed wound healing and excessive bleeding may be a problem.

Cyclosporine

Bleeding problems, poor wound healing and gum overgrowth. Gum overgrowth is more common in children and in patients taking calcium channel blockers. Conscientious daily oral hygiene is advised

Tacrolimus

An immunosuppressive medication that is commonly used in place of cyclosporine. Its causes lesser gum overgrowth but it is associated with oral ulceration and numbness or tingling sensation around the mouth.

Azathioprine

Causes bone marrow suppression and related mouth complications such as stomatitis and opportunistic infections.

Mycophenolate mofetil

This immunosuppressive medication is usually used as an alternative to azathioprine. It is associated with decreased white cell count, opportunistic mouth infections and gastrointestinal problems.

Corticosteroids

Steroids are medications that increases the risk infections in the mouth and the body. It also can increase blood pressure and blood sugar, cause delayed wound healing and mood changes of the person taking it.
Long-term consumption of this medications can inhibit your body’s own production of steroids hence the need to supplement steroid intake before a dental procedure.

Sirolimus

Side effects of this drug includes increased blood pressure, joint pains, reduced white blood cell count, and increased cholesterol levels. In addition, oral ulcers can occur if high levels of this medication is used.

Long term use of immunosuppressant medications and other treatments places the transplant patient at risk of developing cancers including the cancers of the mouth. Squamous cell carcinoma of the tongue, salivary glands, lip or throat, lymphomas and other malignancies can sometimes occur in the transplant patient. As the risk of developing these cancers are present, their early detection and treatment is vital hence the patients are advised to visit their dentist regularly.