USC University of Southern California

Oral Care Key to Successful Organ Transplants

By Angelica Urquijo

 

Study after study point to the connection between oral health and a person’s general well-being.

However, for thousands of Americans waiting for an organ transplant each year, maintaining good oral health, free of infection, is critical for successful organ transplantation and requires specialized dental care.

In light of Organ Donor Awareness Month this April, the University of Southern California School of Dentistry is raising awareness about the importance of oral health for both organ donors and recipients.

According to the National Institutes of Health, more than 25,000 procedures are performed in the United States each year to replace organs, including, the heart, kidneys, liver, intestines, and the pancreas.

Transplant patients are prescribed numerous medications to prepare them physically and emotionally.

“Transplant patients are being given the gift of life, but with it comes a lifetime of taking medications before and after the transplant that can create a host of other complications,” said Dr. Hessam Nowzari, director of the School’s Advanced Periodontics program.

drjose1
  Dr. Jose Polido

Immunosuppressants such as cyclosporine, prednisone and azathioprine, are anti-rejection drugs intended to reduce the likelihood of transplant failure.  Such drugs also can suppress the formation of saliva, in turn creating a dry mouth, the perfect breeding ground for infection.

“Our research has shown that active viral infection is frequently associated with severe clinical complications including transplant failure.” said Nowzari.  “Stress, immunosuppressant- or immune-dysfunction may trigger viral activation, causing damage to the organ.”

He added that the human cytomegalovirus (HCMV) infection is specifically associated with renal transplant failure.

Investigators from the School and the National Institute of Transplantation, a professional affiliate of the Department of Urology and the Division of Nephrology at the USC Keck School of Medicine, conducted a joint research study on organ transplants and oral health.  The study was published in the December 2003 edition of “Transplantation Proceedings.”

“Kidney transplant patients affected by gum disease are at risk for viral replication within the gum tissues despite antiviral therapy prior to and after transplantation,” said Nowzari.

The study suggested that viral infection inside the gum tissue may further reduce the defense mechanisms and promote growth of bacteria.  In addition, researchers found that if patients are at great risk of developing viral activation from periodontal disease, periodontal treatment could considerably improve the patient’s quality of life.

Treatment includes standard periodontal therapy of nonsurgical scaling and root-planning alone or in combination with a surgical approach to access root surfaces along with periodontal maintenance care, oral hygiene promotion, antimicrobial therapy, and patient education.

Organ failure does not discriminate when it comes to age and ethnicity.  Yet, children face a very different set of issues than adults who are transplant recipients.

At Childrens Hospital Los Angeles, a team of doctors and dentists face the responsibility of caring for critically ill children.  For the team, addressing oral health concerns is vital when working to save the life of a sick child.

“We’ve treated children as young as six months old who have been diagnosed with congenital heart disease or have been affected by severe kidney or liver diseases and are now preparing to receive an organ transplant,” said José Polido, a USC School of Dentistry faculty member who also heads the Division of Dentistry at Childrens Hospital.

Systemic problems can affect the development of the teeth. Depending on the age of the child, such problems can damage the primary teeth, permanent teeth, or portions of those permanent teeth.

 Polido said both baby teeth and permanent teeth can develop problems such as generalized enamel hypoplasia and hypomineralization – poor formation and mineralization of the enamel.

“When we see these children in the hospital they have poorly formed teeth with a high incidence of caries and infection and now they are preparing to receive a transplant,” Polido said.

He added that after the transplants, they have to take anti-rejection medications that further compromise their immune systems and increase susceptibility to infections, which can include oral yeast infection (thrush), herpes and various aggressive types of bacteria.

Periodontal disease, though more common in adults, can be quite severe in immunocompromised children.

When treating adults, dentists concentrate on halting the progression of gum disease.
For children, the treatment plan may have to take on a more aggressive approach that can involve removing baby teeth to control the spread of the infection and prevent damage to the permanent teeth.

Ultimately, prevention holds the key to a successful transplantation.  Attention must be given to preventing infection in the mouth similarly to treating a sore or an ear or nail infection.

Periodontal treatment before transplantation and a regular periodontal follow up, such as every few weeks, in addition to excellent oral hygiene by the patients, will significantly prevent the incidence of oral infection associated transplant complications, Nowzari said.

Parents need daily vigilance with their children’s habits and with identifying oral health providers for their children. A parent of a “medically compromised” child can stem the damage to oral health by following these steps:
Provide your child with healthy food choices and curb the intake of sugary foods

  • Refrain from offering children candy because you feel guilty and want to pamper or please your child.
  • Make sure children are brushing twice a day and flossing if old enough
  • Talk to health-care professionals regularly
  • Always consult members of the transplant team before seeking dental treatment
  • Ask for credentials when selecting a dentist
  • Seek out dentists who specialize in periodontology, pediatric dentistry and compromised children with experience in hospital dentistry.

“I’m fortunate to be working in a hospital where physicians are aware of the importance of oral health toward systemic health,” Polido said.

Good oral health must become part of a person’s daily routine in order to ensure overall health whether you’re a child or adult.

For those waiting for a second chance at life–oral care is key to successful organ transplantation.