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Integrity of the Oral Tissues in Patients with Solid-Organ Transplants

DOI: 10.1155/2012/603769

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Abstract:

The relationship between the use of immunosuppressants in solid-organ transplant patients and oral tissue abnormalities has been recognized. The objective of this study was to determine the state of oral tissue integrity in renal, heart, and liver transplant patients who are on continuous medical and dental control. Forty patients of both sexes were clinically evaluated at the Clinical Hospital of the University of Chile to identify pathologies of oral mucosa, gingival enlargement (GE), decayed, missing, filled teeth (DMFT) index, and salivary flow. The average age of the transplant subjects was 49.4 years, and the age range was 19 to 69 years. Most subjects maintained a good level of oral hygiene, and the rate mean of DMFT was 14.7. The degree of involvement of the oral mucosa and GE was low (10%). Unlike other studies, the frequency of oral mucosal diseases and GE was low despite the fact that these patients were immunosuppressed. Care and continuous monitoring seem to be of vital importance in maintaining the oral health of transplant patients. 1. Introduction Organ transplantation is a widely used treatment for the functional failure of an organ. The life expectancies of patients who have received heart, lung, kidney, liver, or bone marrow transplants have improved substantially in recent years [1], partly due to improvements in surgical techniques and the immunosuppressive drug therapies used to prevent transplant rejection [1]. From 1992 to 2009 in Chile, there have been a total of 4570 solid-organ transplants, including 3494 kidney transplants, 768 liver transplants, and 198 heart transplants [2]. Immunosuppressive therapy has a number of short- and long-term effects including infection, increased cardiovascular risk, and neoplasm that may threaten the patient’s life [3, 4]. This treatment depresses the cellular immune response [5]. Cyclosporin A, the most widely used immunosuppressive drug, acts selectively on T-cell-mediated immune responses [1]. Clinically, this effect means a high risk of oral infections and associated complications. In patients who are treated with immunosuppressants, oral pathogens can cause local destruction and opportunistic infections due to the inability of the immune system to suppress and destroy pathogens. Lesions in the oral cavity could develop as a result of these side effects or drug interactions [5]. At the periodontal level, gingival enlargement (GE) associated with immunosuppressive therapy with cyclosporin A usually appears within the first 12 months of use [6], and the risk is increased with the concomitant

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