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Concerns

Oral health care considerations for patients with organ or cell transplants

Drug actions and interactions

Side effects from immunosuppressive medications

Dental treatment for patients with HSCT

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Oral health care considerations for patients with organ or cell transplants:

  • For patients awaiting transplants, address the underlying end-stage disease.
  • Immediate posttransplant period – No elective dental care.
  • Presence of chronic rejection – No elective dental care.

Stable Graft:

  • Consult with patient’s transplant team surgeon/coordinator
  • Address possible immune suppression, bone marrow suppression, and adrenal suppression
  • Be aware of drug actions and drug interactions

Drug actions and interactions:

  • Azathioprine – Increased susceptibility to infections and increased bleeding tendencies when bone marrow suppression is present
  • Corticosteroids – Possible adrenal suppression and immunosuppression,
  • Cyclosporine – Gingival overgrowth Image; avoid medications metabolized by liver cytochrome P450 3A (eg, erythromycin, clarithromycin, metronidazole, azole antifungals)
  • Mycophenolate mofetil – Avoid broad-spectrum antibiotics
  • Sirolimus – Same as cyclosporine, but without gingival overgrowth
  • Tacrolimus – Same as cyclosporine, but without gingival overgrowth

Side effects from immunosuppressive medications

  • Azathioprine – Bone marrow suppression, hepatoxicity
  • Corticosteroids – Adrenal suppression, elevated BP, dyslipidemia, hyperglycemia, ocular changes, osteoporosis, exacerbation of PUD
  • Cyclosporine – Hepatoxicity, nephrotoxicity, elevated BP
  • Mono- and polyclonal antibodies – Leukopenia, pulmonary edema, nephrotoxicity, fever, chills
  • Mycophenolate mofetil – Leukopenia
  • Sirolimus – Hyperlipidemia, hypertriglyceridemia
  • Tacrolimus – Hepatoxicity, nephrotoxicity, neurotoxicity, hyperglycemia, elevated BP

Dental treatment for patients with HSCT:

  • HSCT conditioning (before the transplant) is associated with high dose chemotherapy and total body irradiation.
  • Address veno-occlusive liver disease.
  • Address Graft-Versus-Host Disease (GVHD), including oral complications.
  • Address possible salivary gland complications.

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