Dental Treatment recommendations before organ transplantation (german guideline)

This information is primarily intended for practitioners (physicians, dentists) involved in organ transplantation to facilitate coordinated care by the otherwise separate disciplines. The text is an abridged version of a detailed German guideline (here).
Find recommendations for patients after transplantation here.
In all patients in whom an organ transplant is planned, a dental examination should take place prior to organ transplantation.
Early education of patients prior to organ transplantation about the relationship between dental health and possible infections should be performed. At the beginning of the planning of organ transplantation and in the course before organ transplantation, a dental examination should be performed at least every six to twelve months to exclude odontogenic causes.

At the same time as the dental examination, oral hygiene instructions should be carried out.
Depending on the patients’ oral hygiene, the removal of
orthodontic brackets before organ transplantation may be considered.
To keep the endogenous stress for patients during dental procedures as low as possible, treatment should take place without waiting times.
Depending on the planned procedure, monitoring can be performed, and sedation if required.
Dental and periodontal findings should be treated at an early stage.
If the patient is at increased risk of bleeding and rebleeding, the wounds should be treated with adaptive sutures after dentoalveolar procedures have been performed.
Perioperative antibiotic prophylaxis should be administered in accordance with the patient’s own risks and the risks of the procedure to avoid postoperative
infections one hour before the start of therapy with an aminopenicillin, in case of penicillin allergy with clindamycin. should be performed.

Kidney transplantation
In patients undergoing kidney transplantation, the kidney function should be determined in order to be able to adjust pain therapy/antibiotic administration, for example, after consultation with the attending transplant physician.
Paracetamol can be used as an analgesic.
In dental treatments of patients prior to kidney transplantation
local anesthetics with a low-dose vasoconstrictor (1:200,000) should be used
to ensure adequate analgesia and to avoid endangering patients with arterial hypertension.
In patients undergoing renal transplantation, blood coagulation (INR, Quick value, prothrombin time, partial prothrombin time, platelets) should be available prior to surgical dental rehabilitation.
For patients on dialysis, dental rehabilitation should be performed on dialysis-free days to avoid bleeding complications and stress for the patient.Liver transplantation
In patients undergoing liver transplantation, liver function should be assessed in order to initiate any necessary bleeding prophylaxis or to adjust pain therapy in consultation with the attending specialist.
In patients with cirrhosis of the liver, the administration of metamizole for a short period of time may be be considered for pain therapy.
Before a surgical procedure, blood coagulation and liver values should be determined and a blood count taken.
In patients prior to liver transplantation, depending on the patient’s platelet count and blood clotting, blood transfusion or Fresh Frozen Plasma administration may be indicated after consultation with the
transplant center prior to dental surgical procedures.
In patients prior to liver transplantation with a high risk of bleeding and
bleeding risk, multimorbid patients or very extensive rehabilitation
rehabilitations, dental rehabilitation under inpatient conditions may be indicated.
In consultation with the transplant center, the antibiotic therapy should be
done, if possible without hepatotoxic agents (e.g., clavulanic acid).

Lung Transplantation
Depending on the restriction of pulmonary function and the associated
associated dyspnea, it may be indicated to administer oxygen during dental
therapy and to check the oxygen saturation oxymetrically.
The use of narcotic analgesics (opioids) should only be discussed with the transplant center, as they may trigger respiratory depression in patients with lung disease.

Heart Transplantation
If mechanical circulatory support (cardiac circulatory support systems/artificial hearts) is necessary prior to heart transplantation, dental treatment should be carried out in consultation with the transplant center.
For patients undergoing cardiac transplantation, mepivacaine (3%) or articaine (4%) without epinephrine can be used for procedures in which a vasoconstrictor is required.
In the case of local anesthesia with vasoconstrictor, this should be dosed as low as possible possible.

Author(s) Source
Heider J, Al-Nawas B et al. S2k-Leitlinie AWMF-Registernummer 083-035, Oct 2021 – Oct 2026 (german original)
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