Oral disease burden and utilization of dental care patterns among pediatric solid organ transplant recipients.

Department of Orofacial Sciences, School of Dentistry, University of California San Francisco (UCSF), Box 0422, Room S612, 513 Parnassus Avenue, San Francisco, CA 94143-0422, USA.
Journal of Public Health Dentistry (Impact Factor: 1.64). 07/2008; 69(1):48-55. DOI: 10.1111/j.1752-7325.2008.00092.x
Source: PubMed

ABSTRACT We conducted a study among pediatric renal (RTRs) and liver transplant recipients (LTRs) to determine: a) the overall burden of oral disease; and b) the frequency with which this population utilizes dental care services in relation to sociodemographic factors and oral disease burden.
In this cross-sectional survey, study procedures included the completion of a standardized questionnaire (by parents/guardians), oral mucosal examination, assessment of caries, gingival enlargement, and plaque index.
The 142 children (82 RTRs and 60 LTRs) enrolled from April 2002 to November 2005 were predominantly Latino (41 percent) and Caucasian (34 percent). Forty-three percent had at least one carious surface (in either a deciduous or permanent tooth), 19 percent had five or more carious surfaces, and 25 percent had gingival enlargement. We found only one case of oral candidiasis. Even though 72 percent of parents/guardians reported their child had a regular source of dental care, only 49 percent had a dental cleaning and 44 percent had dental radiographs in the past year, reflecting a low prevalence of preventive dental care. Among children with no regular source of dental care, there were statistically significantly higher proportions of Latinos, younger children, and families with an annual household income <$35,000.
While the prevalence of oral mucosal disease and gingival enlargement was low, the prevalence of children with caries was high, and there was low use of preventive dental care. Strategies to improve this population's utilization of preventive dental care are needed.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Oral health and dental maintenance have become part of the standard of care for pediatric liver transplant recipients. These individuals tend to suffer particularly from dental problems, such as gingival enlargement, gingivitis, poor oral hygiene, dental hypoplasia, and caries. Saliva composition influences oral hygiene and disease states. We investigated saliva composition and its association with the oral health of young recipients of liver transplants. METHODS: In 70 patients, 36 liver transplant recipients (ages 2-23 years) and 34 healthy controls (ages 4-21 years), we measured the following variables: (a) oral hygiene, (b) gingival inflammation, (c) caries status, (d) dental calculus formation, (e) oral mucosal pH, and (f) salivary protein composition. RESULTS: Lower mean decayed, missing, and filled teeth index (P=0.0038), higher mean gingival index (P=0.0001), and higher mean calculus score (P=0.003) were found in the transplanted study group compared with the control. The mean mucosal pH for seven intraoral sites was higher in the transplant group (P=0.0006). The median salivary albumin concentration was significantly lower in the transplant group (P=0.01), as was the median salivary albumin/total protein ratio (P=0.0002). CONCLUSIONS: In post-liver transplant pediatric recipients, low incidence of caries, together with high incidence of dental calculus, could be attributed to elevated oral mucosal pH. Salivary albumin and immunoglobulin A levels were relatively low in these patients. Clinicians should pay particular attention to the oral health and dental care of liver transplanted children.
    Transplantation 05/2013; DOI:10.1097/TP.0b013e3182962c58 · 3.78 Impact Factor
  • Source
    Hepatology 07/2014; 60(1). DOI:10.1002/hep.27191 · 11.19 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Oral-source infections are a potential threat for transplant candidates because oral diseases tend to be more severe and untreated in people who have received transplants. Although not yet scientifically proven, evaluation and dental treatment during the pre-transplantation period is recommended in order to prevent infections and resultant odontogenic-origin sepsis during the post-transplant period, when patients receive immunosuppressive therapy. Aim: To evaluate the invasive dental procedures for removing dental foci performed in patients scheduled for liver transplantation and its accompanying complications. Methods: The medical records of 33 preliver transplant recipients who were undergoing invasive dental procedures were reviewed, including their laboratory tests, special handling needs and resulting complications. Results: Fifty invasive dental procedures were carried out on the 33 patients. Three of them were subjected to basic periodontal treatment and 47 were subjected to multiple or simple extractions. Three surgical procedures resulted in postoperative complications. Conclusions: Surgical intervention to remove dental foci in liver disease patients requires careful clinical evaluation, laboratory tests, knowledge and skills in the use of local and systemic hemostatic procedures, and a partnership approach between dentists and physicians, in order to reduce the risk of complications.
    Brazilian Journal of Oral Sciences 12/2011; 10(4):254-257.

Full-text (2 Sources)

Available from
Jul 25, 2014