Dental Treatment recommendations after organ transplantation (german guideline)

• Dental surgical procedures should only be performed in the first six months after organ transplantation in case of urgent indication, if necessary inhouse and after consultation with the transplant center.
• Quarterly plaque checks and remotivation to oral hygiene can help during the first six months after organ transplantation to avoid periodontal inflammation and improve oral health-related quality of life.

Dental therapies more than six months after organ transplantion.

• After organ transplantation, dental checkups should be performed every six months.
• During dental consultations, patients with ineffective individual oral hygiene should be continuous guided with their home oral hygiene measures.
• The use of disinfectant mouth rinses to reduce the bacterial bacterial colonization of the oral mucosa can be used as a supportive measure after organ transplantation.
• At dental consultations, a diagnosis of the oral mucosa should be made after organ transplantation regarding viral, bacterial and mycological infections.
• Due to the increased risk of developing a malignancy in the head and neck region under immunosuppression, dental consultations with patients after organ transplantation should be done a diagnosis of the oral mucosa with regard to precancerous lesions and tumors – also with biopsy.
• If gingival hyperplasia develops during immunosuppression, conservative treatment is preferable to surgical treatment. In severe cases
  surgical therapy can be used.
• If patients require antiresorptive therapy as a result of the cortisone-induced osteoporosis, they should be protected with perioperative antibiotic prophylaxis and the alveoli should be covered after tooth extraction to prevent osteonecrosis.
• Perioperative antibiotic prophylaxis should be administered to patients after organ transplantation, depending on the planned dentoalveolar surgery procedures.
• For the treatment of odontogenic infections, for the antibiotic therapy can be used primarily an aminopenicillin, alternatively a cephalosporin or, in the presence of a penicillin allergy, clindamycin.
• Patients after organ transplantation can be treated with dental-implant-supported prosthetic dentures.

After Kidney Transplantation

• In patients after kidney transplantation, after six months, dental procedures can be done without an extremely increased risk of infection, such as professional tooth cleaning, curettage or endodontic therapy.
• After kidney transplantation, neutropenia may persist after six months. Then it is necessary to perform a blood count prior to surgical intervention.
• Oral mucosal changes are more common in patients after renal transplantation than in healthy patients. These include erythroplakia, hyperkerathosis, gingival hyperplasia and ulcers of the mucosa.
• Xerostomia and oral candidiasis may also occur.

After Liver Transplantation

• In patients after liver transplantation, depending on the frequency of dental visits, increased caries levels were found in patients who had not had dental checkups for more than one year.
• In addition, the incidence of dysphagia is more likely to occur after liver transplantation.
• This is especially true for patients who are also taking medications for diseases of the central nervous system, depression or sleep disorders. These contribute to reduced saliva production and can make swallowing more difficult.
  

After Lung and Heart Transplantation

• There are few isolated data on the dental management of patients after lung or heart transplantation.

At Rejection Reaction

• In patients undergoing therapy for a rejection reaction, dental treatment should only be performed in an emergency and in consultation with the transplant center under inpatient conditions.