Association between the time after transplantation and different immunosuppressive medications with dental and periodontal treatment need in patients after solid organ transplantation

Abstract

Objective

Aim of this study was to investigate the association of time after transplantation and different immunosuppressive medications with dental and periodontal treatment needs in patients after solid organ transplantation (SOT).

Methods

After lung, liver or kidney transplantation, patients were included and divided into subgroups based on the time after SOT (0-1, 1-3, 3-6, 6-10 and >10 years) and immunosuppression (Tacrolimus, Cyclosporine, Mycophenolate, Glucocorticoids, Sirolimus and monotherapy vs. combination). Dental treatment need was determined by the presence of carious lesions, while periodontal treatment need was diagnosed based on a Periodontal Screening index score of 3-4. The overall treatment need included both the dental and/or periodontal treatment needs. Statistical analysis was performed using the Kruskal-Wallis test and Chi²-test (p<0 .05="" p="">

Results

A total of 169 patients were included after SOT. A dental treatment need of 44%, a periodontal treatment need of 71% and an overall treatment need of 84% were detected in the total cohort. Only patients with >10 years after SOT had a lower dental treatment need compared to the other groups (p=0.02). All other comparisons of dental, periodontal and overall treatment needs were comparable between subgroups depending on time since SOT. Furthermore, no statistically significant differences were found in terms of the dental, periodontal or overall treatment needs following the administration of different immunosuppressive medications.

Conclusion

The high treatment need of patients after SOT, irrespective of the time since transplantation, suggests insufficient dental and periodontal treatment before and maintenance after organ transplantation. Furthermore, immunosuppressive medication was not associated with the treatment need.

Transplant Infectious Disease

Acesso em: http://onlinelibrary.wiley.com/doi/10.1111/tid.12832/full

What is the role of the dentistry in organ transplants?

What is the role of the dentistry in organ transplants?

Infections of oral origin 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 resulting odontogenicorigin
sepsis during the post-transplant period, when patients receive
immunosuppressive therapy.1
Careful oral examination and evaluation of the patient, including
laboratory tests, is recommended in order to ensure correct oral preparation
and control of oral disease prior to organ transplantation (OT). Patients
with chronic diseases that lead to OT may present at any dental office for
treatment and therefore general dentists should be aware of the unique
concerns involving their assessment, education, treatment and maintenance
of oral health.2
The equilibrium between viral persistence and immune regulation of the
host is modified in many immunological conditions related to OT. Among
the opportunistic oral infections that can cause some impairment in these
patients, the most common are fungal infections, and viral infections
by CMV and HSV, and must be diagnosed early by a dentist.3 The use
of systemic medications can affect the periodontal tissues, modifying
their inflammatory and immune response, especially the gingiva. Some
immunosuppressive drugs used in OT may trigger gingival hyperplasia.4
Because of the conditions above described it is considered that the
communication between the organ transplant team and dentist is
important in formulating individualized care plans and transplant
patients need comprehensive and regular dental care during the pre
and post-transplant period and a doctor of oral medicine should be part
of a multidisciplinary team of medical specialists.5 Appropriate dental
care increases the survival of the transplanted organ.

http://www.joralres.com/index.php/JOR/article/view/388/373

Manual de Orientação ao Paciente em Transplante - Odontologia

Resultados das Eleições ABTO – Gestão 2018/2019

A Comissão de Odontologia da ABTO cumprimenta a Diretoria da ABTO  para a gestão 2018/2019 representados aqui pelos Presidente: Paulo Manuel Pêgo Fernandes e Vice-Presidente: Tainá Veras de Sandes Freitas e cumprimentar, dentre os demais, o colega Cirurgião Dentista Renato Costa Franco Baldan por ter sido eleito para o DEPARTAMENTO DE TRANSPLANTE DE TECIDOS.

Toda a nova diretoria pode ser vista em:

http://www.abto.org.br/abtov03/default.aspx?c=1109&mn=476

DYSTROPHIC CALCIFICATION OF MAXILLARY SINUS IN PEDIATRIC PATIENTS WITH LIVER TRANSPLANTATION AND PIGMENTATION OF DENTAL ORGAN

DYSTROPHIC CALCIFICATION OF MAXILLARY SINUS IN PEDIATRIC PATIENTS WITH LIVER TRANSPLANTATION AND PIGMENTATION OF DENTAL ORGAN

ABSTRACT

Objective:

To report a case of severe dystrophic calcification in maxillary sinus of a child with liver transplantation and dental organs pigmented by hyperbilirubinemia.

Case description:

female patient, 12 years old, with liver transplantation performed at the age of 7 due to extrahepatic biliary atresia (EHBA). The patient was receiving the immunosuppressant tacrolimus (2 mg daily). Intraoral clinical exam showed tooth green pigmentation by bilirubin. Cone-beam volumetric computed tomography (CT) was performed to verify radiographic density of pigmented dental elements. Hounsfield scale measurement did not show changes in radiographic density of dental structures. However, CT scan showed intense dystrophic calcification in the maxillary sinus region.

Comments:

CT scan indicated relevant radiographic findings, with radiopacity of the maxillary sinus due to fungal or non-fungal sinusitis. This case report highlights the presence of radiographic image associated with acute infectious processes that could compromise the systemic state of immunosuppressed patients.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-05822017005011102&lng=en&nrm=iso&tlng=en

Oral findings and dental behaviour before and after liver transplantation – a single-centre cross-sectional study

Authors

Anne Kauffels,

Gerhard Schmalz,

Otto Kollmar,

Jan E. Slotta,

Michael Weig,

Uwe Groß,

Oliver Bader,

Dirk Ziebolz

Abstract

Objective

The aim of this single-centre, cross-sectional study was to evaluate dental, periodontal and mycological findings, as well as oral behaviour, in patients before (pre-LTx) and after (post-LTx) liver transplantation.

Methods

A total of 47 patients pre-LTx and 119 patients post-LTx were asked to participate. Oral health behaviour was assessed using a standardised questionnaire. Oral examinations included dental [decayed, missing and filled teeth (DMFT) index] and periodontal [papillary bleeding index (PBI), periodontal probing depth (PPD) and clinical attachment loss (CAL)] findings. For Candidascreening, swabs from the oral mucosa were cultured. Statistical analysis was performed using the Student's t-test or the Mann–Whitney U-test, depending on whether or not the data followed a normal distribution; Fisher's exact test was also performed. The significance level was α = 5%.

Results

A total of 110 patients were included (pre-LTx, n = 35; post-LTx, n = 75). Different patients were investigated in the post-LTx and pre-LTx groups. Lack of use of supplemental oral-hygiene aids was noted. Between-group comparisons failed to find significant overall differences in DMFT and periodontal status. The post-LTx group showed fewer decayed teeth (P = 0.03). A total of 86% of patients pre-LTx and 84% of patients post-LTx were found to need dental treatment, and 60% of patients pre-LTx and 55% of patients post-LTx showed a need for periodontal treatment. The prevalence of Candida albicans was high; however, there were no statistically significant differences between the groups in regard to fungal infection.

Conclusion

Improved dental care pre- and post-transplant, including screening for fungal infections, is recommended to avoid systemic infections in LTx patients. Increased attention to oral health care, and interdisciplinary collaboration to provide guidance, is needed to improve the oral health of patients before and after LTx.

http://onlinelibrary.wiley.com/doi/10.1111/idj.12290/full

Manejo odontológico em paciente com Linfoma não Hodgkin submetido a transplante autólogo de células tronco hematopoiéticas - Dental care in patient with nonHodgkin lymphoma and autologous stem cell transplantation

Manejo odontológico em paciente com Linfoma não Hodgkin submetido a transplante autólogo de células tronco hematopoiéticas - Dental care in patient with nonHodgkin lymphoma and autologous stem cell transplantation

Sumário
O linfoma não Hodgkin (LNH) é o nome que se dá a um grupo heterogêneo de doenças, sendo uma neoplasia maligna de células B, T ou Natural Killer que se infiltram nessas células linfoides ou hematopoiéticas normais. Sua etiologia ainda permanece desconhecida, no entanto inúmeros fatores imunológicos e imunodeficiências parecem estar envolvidos em seu desenvolvimento. O tratamento varia de acordo com o subtipo do LNH, podendo dessa forma levar a cura dos pacientes em 50% dos casos. O Objetivo desse trabalho é relatar detalhadamente o manejo odontológico em uma paciente diagnosticada com LNH, submetida a tratamento quimioterápico concomitante ao radioterápico e posterior transplante autólogo de células tronco hematopoiéticas. A paciente foi submetida a diversos procedimentos odontológicos dentre eles endodôntico, restaurador dentário, reabilitador protético e cirurgia oral, posterior a anamnese e confirmação de condições clínicas e laboratoriais favoráveis que não contra indicavam o manejo odontológico. A atuação do cirurgião dentista sobre os pacientes oncológicos tem se mostrado ao longo dos anos primordial, sobretudo no que diz respeito as manifestações bucais que o tratamento pode gerar. No entanto, o cuidado com o paciente deve
ocorrer antes, durante e após o tratamento, com adequação do meio bucal, acompanhamento a intercorrências durante o tratamento e restabelecimento no pós tratamento.

Summary
The nonHodgkin's lymphoma (NHL) is the name given to a heterogeneous group of disorders, a malignancy of T, B, or natural killer cells. They are infiltrating these normal lymphoid or hematopoietic cells. Its etiology remains unknown. However, numerous immune factors and immune deficiencies appear to be involved in their development. The treatment varies depending on the subtype of NHL and it may thus lead to the cure of patients in 50% of cases. The aim of this work is to report in detail the dental management in a patient diagnosed with NHL, underwent chemotherapy as well as radiotherapy and subsequently autologous transplantation of hematopoietic stem cells. The patient was submitted to various dental procedures among them endodontics, dental restorative, rehabilitative prosthetics and oral surgery treatments. The subsequent history and confirmation of favorable clinical and laboratory conditions was not contraindicated for the dental management. The role of the dentist on cancer patients has been important over the primary years, especially regarding the oral manifestations that treatment can generate. However, patient care should take place before, during and after cancer treatment. It is possible with the adequacy of the oral environment,
monitoring the events during the treatment and the recovery in the post treatment.

artigo na íntegra: http://www.moreirajr.com.br/revistas.asp?fase=r003&id_materia=6330

PROGRAMAÇÃO - XV CONGRESSO BRASILEIRO DE TRANSPLANTES 2017

Confira a programação do 

XV CONGRESSO BRASILEIRO DE TRANSPLANTES 2017

LOCAL: Bourbon Cataratas - Foz do Iguaçu/PR - FOZ DO IGUAÇU/PR | 18 a 21 de Outubro de 2017

https://sistemaparaevento.com.br/evento/abto2017/programacao/gradeatividades/38

Transplante de Ossos versus Transplante de Órgãos - Posição oficial da Associação Brasileira de Transplante de Órgãos

Artigo RBM Transplantes - A equipe multidisciplinar e a ação do cirurgião dentista nos pacientes transplantados renais: uma revisão integrativa

Summary

Objective: To establish the major dental aspects in candidates to kidney transplantation (KT) or those who have received the transplant. Methods: Search through the PubMed database. The last articles were selected into five years (2011-2016) using the terms "oral" and "care" and "kidney transplantation" (26 articles) and "kidney transplant" and "oral health" (5 articles). We excluded studies that did not report dental approach, which were not in English and those who were not available to access, resulting in nine articles included. They were tabulated the main findings of interest to dentistry in the group pre / post KT patients as well as the conduct adopted by the authors. Results: Of the nine included articles, two articles were relevant to the pre-KT period, five for the post-KT, and two made a comparative study between the pre- and post-KT. Dental aspects in pre-KT period were: high DMFT index as well as tooth loss and gingival hyperplasia. In the post-KT period were: a poor oral hygiene that was related as a transplant rejection factor, an oral candidiasis and an osteonecrosis by bisphosphonates (OPB). In studies comparing patients on hemodialysis and post-KT patients was found: DMFT index was higher in pre-KT patients and periodontitis was higher in post-KT patients. Conclusions: A multidisciplinary team of renal transplant patients should have the participation of the dentist, as helps to reduce comorbidities related opportunistic infections, increasing the survival of the transplanted organ.

Artigo na íntegra

http://www.moreirajr.com.br/revistas.asp?fase=r002&id_edicao=854

XXI Congresso da SBTMO 2017

Programação

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Programação Científica: Em breve

Período: 17 a 19 de agosto das 8h30 às 18h00

Encontros Paralelos:

XI Curso de Atualização em Transplante de Medula Óssea: Board Review: Bone Marrow Transplantantion Hospital Albert Einstein: 17 a 19 de agosto (Quinta-feira a Sábado)

XVII Encontro de Histocompatibilidade e Imunogenética:
17 e 18 de agosto (Quinta e Sexta-feira)

XIX Encontro de Enfermagem e Equipe Multidisciplinar em TMO:
17 e 18 de agosto (Quinta e Sexta-feira)

XV Encontro de TMO em Pediatria da SOBOPE:
19 de agosto (Sábado)

http://sbtmo2017.com.br/

XV Congresso Brasileiro de Transplantes

A atividade de transplantes vem crescendo no Brasil ano a ano, sendo hoje uma das mais importantes do mundo.
A cada dois anos a ABTO realiza o Congresso Brasileiro de Transplantes, juntamente com o Congresso Luso Brasileiro de Transplantes, o Encontro Brasileiro de Enfermagem em Transplantes e o Fórum de Histocompatibilidade da Associação Brasileira de Histocompatibilidade.

A cidade sede escolhida para o próximo encontro foi Foz do Iguaçu, no estado do Paraná. Além da troca de conhecimento científico e da oportunidade de confraternização, estaremos próximo das Cataratas do Rio Iguaçu e de toda exuberância que esta proporciona, dentro de uma grande reserva natural.

	20/03/2017 Último dia para envio de Trabalhos
		19/04/2017 Relação dos Trabalhos aprovados
		24/04/2017 Data limite para inscrição com desconto
		29/09/2017 Último dia para inscrição antecipada

http://congressoabto.org.br/2017/

Bem vindos ao XIII Congresso Português de Transplantação, XV Congresso Luso-Brasileiro e II Encontro Ibérico!

Caros colegas,

Este ano o Congresso Luso- Brasileiro terá lugar no Porto, de 13 a 15 de Outubro.
Será um prazer recebê-los nesta bela e histórica cidade do Norte de Portugal, para mais uma vez nos reencontrarmos e estreitar os laços que nos unem desde há 15 anos.
Teremos um programa muito preenchido que abordará temas atuais e polémicos e temas que não sendo novos nos preocupam no dia a dia da transplantação.
Começaremos o Congresso pela apresentação do estado atual da transplantação apresentado pelas três Sociedades de Transplantação como forma de divulgar as nossas atividades e resultados.
A doação em vida e os problemas éticos associados, focando o dador altruísta, como tema polémico que é, merecerá com certeza da vossa parte, todo o interesse.
Uma das manhãs será dedicado à infecção. Focaremos os problemas que enfrentamos na nossa prática clínica como as infecções multirresistentes e infecções fúngicas.
Os novos fármacos disponíveis para o tratamento da hepatite C e o seu impacto no transplante será também do vosso interesse.
Contaremos com convidados nacionais e internacionais que com certeza contribuirão, para o que esperamos, seja o sucesso do nosso congresso.
As comunicações orais e breves continuarão a ser um ponto alto e que mostrará a atividade desenvolvida pelas várias unidades sendo um sinal de participação ativa!
Para além do programa científico com certeza que haverá tempo para o programa social que esperamos venha ao encontro das vossas expectativas.
Contámos com a vossa contribuição para o sucesso do Congresso.

Cá vos esperamos em Outubro!
Informações: http://www.spt.pt/clbt2016/

Hiperplasia gengival medicamentosa associada ao uso de Ciclosporina-A após transplante renal Gingival overgrowth induced by CsA after kidney transplantation

Resumo

Paciente mulher com 51 anos de idade apresentou-se à Clínica Multidisciplinar da Faculdade de Odontologia de Bauru-USP com a seguinte queixa: eu sou transplantada e tenho gengivite. O histórico médico incluía transplante renal, infecções urinárias recorrentes, diabetes pelo uso de corticoides, hipertensão e arritmia cardíaca. Relatou o uso de ciclosporina-A, metformina, omeprazol, imunossupressores e anti-hipertensivos. Ao exame clínico intraoral observou-se hiperplasia gengival inflamatória generalizada e língua saburrosa. A radiografia panorâmica indicou reabsorção óssea moderada, e lesões periapicais nos dentes 1ºMSE e 1ºMID. O hemograma apontou discreta leucocitose e série vermelha normal. A análise bioquímica revelou elevação de ferritina, creatinina, glicose e potássio. O plano de tratamento odontológico incluiu adequação bucal por meio de profilaxia de placa bacteriana dental com ultrassom, raspagem e curetagem subgengival e supragengival, exodontia do 1ºMSE, prescrição de bochecho com solução de clorexidina 0,12% aquosa e uso de escova dental de cerdas extra-macias. O objetivo deste relato de caso clínico é descrever a conduta odontológica sem necessidade de modificação da terapêutica imunossupressora em pacientes transplantados renais e o impacto desta ação na qualidade de vida.

acesso online: http://www.moreirajr.com.br/revistas.asp?fase=r003&id_materia=6303

Capacidade para o trabalho e relação com a saúde bucal de pacientes com doença hepática crônica Capacity of work and relationship with oral health of patients with chronic liver disease

Resumo

A formulação de políticas públicas de saúde depende de estudos que apresentem as reais necessidades de intervenções para alocação adequada de recursos que levem a uma atenção integral e consequentemente uma melhora na qualidade de vida dos indivíduos. Neste estudo são abordadas as características da Doença Hepática Crônica (DHC), sobretudo numa perspectiva da sua relação com doenças bucais e as consequências desta relação para a Capacidade Para o Trabalho.Esta série de casos foi composta por 42 pacientes com doença hepática crônica, realizada no período de agosto a dezembro de 2014 no Ambulatório Magalhães Neto do Complexo Hospitalar Universitário Professor Edgard Santos - UFBA. Embora esta tenha sido uma avaliação preliminar, foi observado uma tendência à diminuição da capacidade para o trabalho nos pacientes que apresentavam alguma doença bucal.

acesso disponível em: http://www.moreirajr.com.br/revistas.asp?fase=r003&id_materia=6304

26th International Congress of The Transplantation Society (TTS)

Dear Colleagues,

We would like to extend a warm invitation from the Transplant Infectious Diseases section to attend the 10th International Transplant Infectious Diseases Conference, to be held in the fascinating city of Hong Kong, just prior to the26th International Congress of The Transplantation Society (TTS).

The full day meeting will include lectures by 13 physician experts from 4 continents, covering relevant topics such as management of hepatitis C and B, respiratory viruses, multidrug resistant organisms, vaccination, arbovirus infections, and clinical recommendations on the management of common and emerging complications of transplantation.

This year the lectures will follow the chronology of the transplant timeline emphasizing the TID doctor approach to diagnosis and management of major syndromes in the transplant setting.
As a favored tradition of our meetings, we will finish the day with the popular five-minute case presentations from all speakers, encouraging challenging discussion.

Our annual TID conference always provides an excellent opportunity for colleagues to meet and for strangers to become friends. At the end of the day, the conference dinner seals the spirit of friendship and cordiality that has always characterized our meetings.

Please consider joining us in Hong Kong for an unforgettable meeting.

We look forward to a  wonderful conference,

Clarisse Machado, Conference Co-chair
Michele I. Morris, Conference Co-chair

http://www.tts.org/tid/tid-2016