Chapter 34: Oral Health Considerations during Transplant Surgery

INTRODUCTION

Dental caries and periodontal disease are some of the most common infectious diseases in the United States.² All transplant patients should be considered to have these diseases to some extent. Both dental caries and periodontal disease are chronic in nature, but they can have acute episodes that can be serious. In the acute phase, the infectious process follows facial planes and can be life threating if the swelling restricts the airway (see Figs. 34-1 and 34-2).

In addition to dental caries and periodontal disease, there are lesions of the oral mucosa that should be evaluated prior to surgery. Close to 40,000 Americans will be diagnosed with oral or pharyngeal cancer this year. Oral cancer has a 5-year survival rate of 52%, a higher death rate than ovarian, brain, testicular, kidney, cervical, skin and liver cancer.³ Any suspicious lesions should be resolved prior to transplantation.

PRETREATMENT EVALUATION

For the transplant surgeon seeking to optimize the patient’s overall health prior to surgery, there are several potential problems from the oral cavity that must be considered:

• Acute episode of an odontogenic infection prior to surgery may result in a delay in the surgery and further compromise the patient’s health. The more severe and extensive the dental caries, the more likely this event may occur.

• Severe periodontal disease decreases the bony support for the tooth, and the tooth gradually becomes mobile and presents an aspiration risk, especially during intubation for general anesthesia.

• Chronic dental infections can cause transient bacteremia, especially during dental treatment. A bacteremia could be a potential risk to the transplanted organ.

Oral evaluation, consisting of a complete oral examination and dental radiographs, should be performed prior to surgery. The oral evaluation should be focused on potential problems that dental infections may cause in the period prior to the surgery and the immediate postoperative recovery period. Not only should the presence of dental disease be noted but the severity and extent of the disease should also be assessed. Oral examination consists of an evaluation for dental caries, periodontal disease, and intraoral lesions:

• Dental caries: Dental caries can be visible clinically, appearing as dark spots (see Fig. 34-3). As the disease progresses there is more destruction of the tooth structure.⁴ If this destruction is visible on clinical examination, the dental caries is advanced and there is a greater potential for an acute episode of an odontogenic infection (see Figs. 34-4 through 34-6).

• Periodontal disease is widely prevalent and can first be seen as redness around the teeth (see Fig. 34-7). As the disease progresses there is a ...