Organ Transplants Shelbey Watts

Disease Description Organ transplants are the transplanting of solid organs (the heart, intestines, kidneys, liver, lung and pancreas) in patients with end-stage renal disease, severe diabetes, advanced heart disease, and/or liver disease. Being an organ transplant recipient suppresses your immune system, and there are even more severe systemic problems if your body tries to reject the transplant.

Common Medications All organ transplant patients take anticoagulant medications and/or immunosuppressant drugs, beta blockers, calcium channel blockers and/or diuretics. Oral side effects could include xerostomia, gingival hyperplasia, orthostatic hypotension and hyperglycemia; HOWEVER, if the patient is only taking the immunosuppressant drug and they experience overgrowth of the gums, this is a dangerous side effect!

Assessment Open, frequent communication with an organ transplant patient’s physician is extremely important. These patients require pre-operative medication. These patients should have their teeth cleaned before their transplant, and not again until AT LEAST three months after their transplant.

Oral Manifestations Looking into an organ transplant patient’s mouth oral candidiasis, herpes simplex/herpes zoster, hairy leukoplakia, aphthous ulcers, and uncommon viral and fungal infections are common. Progressive periodontal disease, delayed wound healing, and excessive bleeding are other problems that arise in organ transplant patients. Oral candidiasis in an organ transplant patient’s mouth.

Treatment Planning Considerations This disease has very strict rules as to how we can/when we can treat the patient. Prescribing NSAIDS, opiates, and some antimicrobials would harm the patient; these medications are metabolized by the liver or kidney and if they have a bad liver or kidney, the medication would not be able to leave the circulation. Pay special attention to anxiety and pain tolerance in organ transplant patients!

Implementation Pre-med is required for organ transplant patients. After the transplant, it should be at least three months before the patient’s appointment. Cleanings will proceed like normal; however, talking to the patient’s physician is extremely important. Check for current medications and contraindications for those; this will be the most important task during the appointment.

References "Dental Management of the Organ Transplant Patient." National Institute of Dental and Craniofacial Research. National Institutes of Health, 07 Feb Web. 10 Feb h/OrganTransplantProf.htm h/OrganTransplantProf.htm Little, James W., Donald A. Falace, Craig S. Miller, and Nelson L. Rhodus. Dental Management of the Medically Compromised Patient. 8th edition. Missouri: Elsevier Mosby, Print.