Management, Pre-and Post-operative Health and Disease in Organ Transplant Recipients in Dental and Oralaspects, uncler receiving immuno-suppressant

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Recently the organ transplantations have been progressed in Japan. However there have no guideline for the dental and oral health management for pre- and post-transplant patients, especially in recipients under having immuno-suppresive agents. In this study, we tried to design the pre-transplant protocol for oral health and disease. Special attenion was paid for the management of chronic dental focus in an asymptomatic phase such as chronic apical periodontitis, gnanulative chronic inflammatory lesion, and common periodontitis.Representative clinical cases were reported ; a case of dental infection followed with severe sepsis, another case had failed the pre-transplant management for dental surgical intervention, and experience of simultaneous tooth extraction immediate after living liver transplant in the operation room. Also, dental and oral examination for 10 recipient patients with liver post-transplant was carried out on long-term having immuno-suppuressive agent. There was about 2.5-times higher incidence of dental caries of deciduous teeth as compared with the average of the common Japanese. Nevertheless the patients seems not to be susceptibl to severe gingivitis. Cyclosporin-induced gingival hyperplasia was recognized in one of two patients, but there was no gingival hyperplasia in the remaing group who having tacrolimus. In addition the patients showed no disorder in teeth eruption but tended to demonstrate the malocclusion such as Angle class III, crowding in the upper dental arch or open bite. There findings suggest that the liver transplant recipient taking immunosuppresive agents for long-term could be at risk for various dental problems and oral disease.