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

近年来，器官移植在日本取得了进展。然而，对于移植前后的患者，特别是在使用免疫抑制剂的情况下的受者，没有牙齿和口腔健康管理的指南。在这项研究中，我们试图设计口腔健康和疾病的移植前协议。重点介绍了慢性根尖周炎、肉芽肿性慢性炎性病变、普通型牙周炎等无症状期慢性牙源性病变的处理。1例牙齿感染伴严重脓毒症，另1例牙齿手术干预的移植前管理失败，以及活体肝移植术后在手术室内即刻拔牙的经验。同时对10例长期服用免疫抑制剂的肝移植受者进行了口腔和牙齿检查。乳牙龋齿的发病率比普通日本人的平均发病率高出约2.5倍。然而，患者似乎不容易患上严重的牙龈炎。2例患者中有1例出现环孢霉素引起的牙龈增生，而他克莫司组无牙龈增生。此外，患者的牙齿萌出没有障碍，但倾向于显示错牙合，如安氏III类，上牙弓拥挤或开牙合。这些发现表明，长期服用免疫抑制剂的肝移植受者可能有各种牙齿问题和口腔疾病的风险。

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.