Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation

Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation

World J Stomatol. May 20, 2015; 4(2): 96-102
Published online May 20, 2015. doi: 10.5321/wjs.v4.i2.96

Paulo Sérgio da Silva Santos, Cassia Maria Fischer Rubira, Héliton Spíndola Antunes, Fabio Luiz Coracin, Cristiane Miranda França

Graft vs host disease (GVHD) is a complication of patients who are treated by hematopoietic cell transplantation. National Institutes of Health in 2005 by Working Group on Diagnosis and Staging Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD (cGVHD) established 2 principal categories of oral GVHD, acute and chronic. The oral mucosa may be the first site of manifestation of the disease. Clinical diagnosis needs to be confirmed by a biopsy of oral mucosa and minor salivary glands. Microscopic results have played a major role in the diagnosis and management of acute and chronic oral GVHD. Development of second malignancies is the greatest risk of oral cGVHD patients, mostly regarding squamous cell carcinoma. The focus of oral GVHD therapy is to improve symptoms and maintain oral function. The aim of this review article is to update the information on the oral GVHD in its clinical, microscopic features and their complications.

acesso ao artigo: http://www.wjgnet.com/2218-6263/abstract/v4/i2/96.htm

17° Simpósio de Odontologia em Hematologia

Luiz Alberto Valente soares Jr. - coordenador/coordinator 8:30 - 8:45 Luiz Alberto Valente Soares Jr. Abertura/Opening Políticas públicas: a participação dos cirurgiões dentistas nas associações médicas: experiências e valores agregados à classe odontológica/Public policies: participation of dental surgeon in medical associations: experience and principles added to the dental profession Luiz antônio de Souza - moderador/moderator 8:45 - 9:05 Marco Antonio Manfredini Palestrante/Speaker 9:05 - 9:15 Discussão/Discussion Educação / Ensino: experiências bem sucedidas do ensino na área de pacientes com necessidades especiais (oncologia/hematologia) na odontologia/Education: successful experiences in the dentistry teaching for patients with special needs (oncology/hematology) Luiz Alberto Valente soares Jr. - moderador/moderator 9:15 - 9:35 Carina Domaneschi Palestrante/Speaker 9:35 - 9:55 Karin Sá Fernandes Palestrante/Speaker Abordagem odontológica ambulatorial ao paciente hemofílico: novo panorama do uso fator nas profilaxias/ Outpatient dental approach to hemophilia patients: new scenario of the use of factor in prophylaxis célia Maria Bolognese Ferreira - moderador/moderator 9:55 - 10:15 Paula Ribeiro Villaça Palestrante/Speaker 10:15 - 10:35 Eduardo Lima Pádua Palestrante/Speaker 10:35 - 10:55 Discussão/Discussion 10:55 - 11:10 Intervalo/Break Geisa Badauy Lauria silva - moderador/moderator 11:10 - 11:30 Luis Carlos Marques Fitoterapia na cavidade oral/Phytotherapy in oral cavity 11:30 - 11:50 Fábio Coracin Efeitos da quimioterapia sobre as glândulas salivares/Effects of chemotherapy on salivary glands 11:50 - 12:10 José Tadeu Tesseroli de Siqueira Manejo da dor orofacial no paciente onco-hematológico/ Orofacial pain management in onco-hematological patient 12:10 - 12:30 Discussão/Discussion

http://hemo.org.br/?page_id=32

A SYSTEMATIC REVIEW OF THE LONG-TERM EFFECTS OF DENTAL DEVELOPMENT DISTURBANCES AFTER HEMATOPOIETIC STEM-CELL TRANSPLANTATION IN PEDIATRIC PATIENTS

A SYSTEMATIC REVIEW OF THE LONG-TERM EFFECTS OF DENTAL DEVELOPMENT DISTURBANCES AFTER HEMATOPOIETIC STEM-CELL TRANSPLANTATION IN PEDIATRIC PATIENTS

Alexandre Viana Frascino, Fábio Luiz Coracin, Paulo Sérgio da Silva Santos

ABSTRACT

The purpose of this systematic review was to evaluate published data and to update our current knowledge about the impact on dental development of childhood hematopoietic stem-cell transplantation (HSCT), as well as the late effects of preparative regimens, for the treatment of onco-hematological malignancies. A systematic literature research was conducted to assess articles published since January 1980 until the present day that fi tted the predetermined inclusion/exclusion criteria. Data compilation was divided into qualitative and quantitative dental development disturbances. Demographic records were also gathered. First and second premolars and second molars were signifi cantly more affected in HSCT children. There was a positive correlation between age at the time of anticancer therapy administration and qualitative and quantitative dental development disturbances. The association of total body or head and neck radiation mieloablative treatments was shown to enhance the magnitude of dental development disturbances. Dental development disturbances due to childhood HSCT are commonly seen in long-term survivors. The knowledge of these alterations may help improve dental care and elevate the quality of life of these patients. Further studies are needed to understand the long-term effects of dental development disturbances in this group of patients.

http://www.revistas.usp.br/clrd/article/view/84385

Assessing the relationship between oral chronic graft-versus-host disease and global measures of quality of life

Summary

Objective

Chronic GVHD (cGVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (HSCT) and affects multiple organ systems, with the oral cavity being one of the most frequently affected sites. Patients with cGVHD experience reduced quality of life (QOL), yet the specific impact of oral cGVHD on QOL is poorly understood. The objective of this study was to characterize the impact of oral cGVHD on global measures of QOL.

Materials and methods

QOL data were collected using the FACT-BMT and SF-36 instruments for 569 patients enrolled in the Chronic GVHD Consortium, with a total of 1915 follow-up visits. At study enrollment, patients were categorized as isolated oral cGVHD (n = 22), oral and concomitant extra-oral cGVHD (n = 420), and only extra-oral cGVHD (n = 127). Utilizing all longitudinal data, QOL scores were compared using a multivariable linear model controlling for demographic, transplant, and cGVHD characteristics.

Results

Patients with isolated oral cGVHD reported better physical well-being (P = 0.009), BMT well-being (P = 0.01), and decreased bodily pain (P = 0.01) compared to patients with oral and concomitant extra-oral cGVHD, but the differences in scores did not reach the defined threshold for clinical significance (6 points for FACT-BMT domains and 5 points for SF-36 domains).

Conclusions

Global QOL scores are similar in patients with isolated oral cGVHD and patients with oral and concomitant extra-oral cGVHD.

http://www.sciencedirect.com/science/article/pii/S1368837515002882

Grupo de pesquisa estuda transplantados através de videoconferência

Despontavam os anos 2000 quando um grupo de cirurgiões dentistas da Faculdade de Odontologia da Universidade de São Paulo (FOUSP) decidiu se reunir para debater os casos, cada vez mais frequentes, de pacientes transplantados que frequentavam o Cape (Centro de Atendimento a Pacientes Especiais). Inaugurado dentro da USP e contando com cinco profissionais, hoje o grupo formado há 15 anos compreende cinco instituições de pesquisa no Brasil e realiza reuniões mensalmente. Como todos esses profissionais se encontram? Por meio  de videoconferências.

“Em cada reunião, cada instituição dá uma palestra”, explica Karin Sá Fernandes, pesquisadora da FO e membro do GEPT (Grupo de Estudos em Pacientes Transplantados) desde 2005. Durante uma hora por mês, das 17h às 18h, as instituições debatem sobre casos clínicos de pacientes em fase de transplante e pesquisas desenvolvidas no meio. O grupo, que reúne atualmente a FO, o Instituto Nacional do Câncer (Inca), o Hospital das Clínicas da Faculdade de Medicina da USP e as Faculdades de Odontologia de Bauru (FOB-USP) e de Ribeirão Preto (FORP-USP), desfruta da tecnologia das instituições para compartilhar seus conhecimentos e melhorar o atendimento dos pacientes em questão.

As reuniões acontecem de forma que os profissionais consigam expor suas novidades e dúvidas a respeito do tema. No dia agendado para cada instituição, o grupo ouve os cirurgiões-dentistas da vez falarem e logo em seguida debate sobre o tema em aberto. “Cinco horas inicia a reunião. A instituição responsável ministra a aula até às 17h40 e em seguida abrimos para discussão. É como se todos os participantes estivessem reunidos em uma sala, a diferença é que cada um está em um local diferente”, comenta Karin.

Segundo a pesquisadora, mais de um caso clínico já foi solucionado com a ajuda do grupo e, para que o conhecimento esteja disponível para pessoas de todo o país, o GEPT realiza a publicação de alguns dos casos estudados. Atualmente, as três faculdades envolvidas no grupo estão coletando informações para uma pesquisa em conjunto: questionários sobre o conhecimento dos estudantes de Odontologia em relação às doações e transplantes de órgãos  estão sendo utilizados para averiguar qual o contato dos alunos com o assunto.

 A iniciativa da agregação das cinco instituições partiu do coordenador do GEPT, Paulo Sérgio da Silva Santos. Tornando-se docente da Faculdade de Odontologia de Bauru,  Paulo entrou em contato com os técnicos da faculdade para checar as possibilidades de continuação do grupo mediante o uso da internet.Com o resultado positivo da experiência, os demais centros de pesquisa foram convidados a participar do grupo e de suas reuniões, ampliando com isso os debates sobre o tema.

A razão dos estudos

O número de transplantes no Brasil vem aumentando cada vez mais. Com a maior disponibilidade de recursos, médicos e doadores de órgãos no sistema público, em 2012 o Ministério da Saúde divulgou que, em comparação com o ano anterior, o aumento dessas operações foi de 12,7%.

De uma forma geral os pacientes transplantados têm uma baixa imunidade e necessitam de cuidados especiais, argumenta Karin. A pesquisadora diz que o GEPT tem uma ação importante nesse sentido porque, como são muitas as peculiaridades entre os transplantados, é necessário que os profissionais se auxiliem a fim de orientar o melhor atendimento odontológico para esses pacientes. “Eles [os pacientes] têm um tratamento peculiar pela imunossupressão, por todas as alterações bucais que eles apresentam antes e pós-transplante. Cada grupo é diferente”.

Como o corpo ainda não está forte o suficiente, sem os cuidados específicos a presença de  um foco de infecção na boca pode levar a diversas complicações, como a perda do transplante e a morte do paciente.

Tecnologia avançada

A FO é uma das instituições que mais investem na tecnologia de informações. Segundo uma pesquisa de mestrado sobre teleodontologia divulgada esse ano, todos os docentes da instituição utilizam diariamente a internet para fins pessoais e profissionais. Karin diz que nenhuma vez, desde que o grupo começou com as videoconferências, houve cancelamento de uma reunião por problemas técnicos da Faculdade.

Os resultados da pesquisa apontam um caminho próspero para a teleodontologia, setor que cresce dentro do SUS e recebe atenção especial da USP. Buscando o uso das tecnologias da informação e comunicação como auxiliares para atividades relacionadas à saúde à distância, a telessaúde é um eixo que possibilita a interação entre profissionais de saúde ou entre estes e seus pacientes, bem como o acesso remoto a recursos de apoio diagnósticos ou até mesmo terapêuticos.

Fonte: Faculdade de Odontologia 

http://www.usp.br/aun/exibir.php?id=6998&edicao=1223

Graft-versus-host disease affecting oral cavity. A review

Abstract

Graft versus host disease (GVHD) is one of the most frequent and serious complications of hematopoietic stem cell transplantation, and is regarded as the leading cause of late mortality unrelated to the underlying malignant disease. GVHD is an autoimmune and alloimmune disorder that usually affects multiple organs and tissues, and exhibits a variable clinical course. It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract and liver. The chronic form is characterized by the involvement of a number of organs, including the oral cavity. Indeed, the oral cavity may be the only affected location in chronic GVHD. The clinical manifestations of chronic oral GVHD comprise lichenoid lesions, hyperkeratotic plaques and limited oral aperture secondary to sclerosis. The oral condition is usually mild, though moderate to severe erosive and ulcerated lesions may also be seen. The diagnosis is established from the clinical characteristics, though confirmation through biopsy study is sometimes needed. Local corticosteroids are the treatment of choice, offering overall response rates of close to 50%. Extracorporeal photopheresis and systemic corticosteroids in turn constitute second line treatment. Oral chronic GVHD is not considered a determinant factor for patient survival, which is close to 52% five years after diagnosis of the condition. Key words:Chronic graft-versus-host disease, oral chronic graft-versus-host disease, pathogenics, management, survival.

https://www.researchgate.net/publication/272431394_Graft-versus-host_disease_affecting_oral_cavity._A_review

Cytomegalovirus infection in transplant recipients

Cytomegalovirus infection in transplant recipients

Luiz Sergio Azevedo, Lıgia Camera Pierrotti, Edson Abdala, Silvia Figueiredo Costa, Tania Mara Varejao Strabelli, Silvia Vidal Campos, Jessica Fernandes Ramos, Acram Zahredine Abdul Latif, Nadia Litvinov, Natalya Zaidan Maluf, Helio Hehl Caiaffa Filho, Claudio Sergio Pannuti, Marta Heloisa Lopes, Vera Aparecida dos Santos, Camila da Cruz Gouveia Linardi, Maria Aparecida Shikanai Yasuda, Heloisa Helena de Sousa Marques

Cytomegalovirus infection in transplant recipients.. Available from: https://www.researchgate.net/publication/280586630_Cytomegalovirus_infection_in_transplant_recipients [accessed Aug 4, 2015].

Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia.


https://www.researchgate.net/publication/280586630_Cytomegalovirus_infection_in_transplant_recipients

A case of upper gingiva carcinoma with chronic graft-versus-host disease after allogenic bone marrow transplantation

A case of upper gingiva carcinoma with chronic graft-versus-host disease after allogenic bone marrow
transplantation
F Tsushima,* J Sakurai,* H Harada*
*Oral and Maxillofacial Surgery, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and
Dental University, Tokyo, Japan.
ABSTRACT
Oral squamous cell carcinoma (OSCC) is one of the most common solid tumours occurring after haematopoietic stem cell transplantation (HSCT), especially in patients with chronic graft-versus-host-disease (cGVHD). We describe a case of OSCC that developed in a 51-year-old male 22 years after he had received allogeneic HSCT from his human leukocyte antigen-identical sister as a treatment for acute myelocytic leukaemia. The patient had presented with multiple white patchy lesions on the palatal gingiva and mucosa 16 years after HSCT; these lesions were consistent with the clinical features of cGVHD. Six years later, oral examination and biopsy revealed upper gingival squamous cell carcinoma (SCC) in areas of cGVHD, and he underwent tumour excision. Follow-up examination at 2 years and 4 months after the operation revealed no evidence of recurrence of local SCC or metastasis of the cervical lymph node. The current case highlights the susceptibility of patients with cGVHD to the development of OSCC even two decades after HSCT. Therefore, we recommend careful long-term follow-up of the oral cavity for patients with cGVHD.

http://onlinelibrary.wiley.com/doi/10.1111/adj.12343/full

XVIII ENCONTRO DE ENFERMAGEM E EQUIPE MULTIDISCIPLINAR EM TRANSPLANTE DE MEDULA ÓSSEA

XVIII ENCONTRO DE ENFERMAGEM E EQUIPE MULTIDISCIPLINAR EM TRANSPLANTE DE MEDULA ÓSSEA

http://www.sbtmo2015.com.br/

Dent Res J (Isfahan). 2015 May-Jun;12(3):199-208.

Oral manifestations in transplant patients.

Nappalli D1, Lingappa A2.

Author information

Abstract

Organ transplantation is a widely undertaken procedure and has become an important alternative for the treatment of different end-stage organ diseases that previously had a poor prognosis. The field of organ transplant and hematopoietic stem cell transplant is developing rapidly. The increase in the number oftransplant recipients also has an impact on oral and dental services. Most of the oral problems develop as a direct consequence of drug-induced immunosuppression or the procedure itself. These patients may present with oral complaints due to infections or mucosal lesions. Such lesions should be identified, diagnosed, and treated. New treatment strategies permit continuous adaptation of oral care regimens to the changing scope of oral complications. The aim of this review is to analyze those oral manifestations and to discuss the related literature.

http://www.ncbi.nlm.nih.gov/pubmed/26005458

XIV Congresso Brasileiro de Transplantes

Veja na programação o 3º Simpósio de Odontologia em Transplantes e participe!
http://www.congressoabto.org.br/2015/programa/24/

Grupo de Odontologia em Transplantes no Facebook

Caros colegas seguidores do blog,
Temos postado informações atualizadas e dinâmicas em nosso grupo do Facebook. Se você ainda não faz parte do grupo solicite sua participação que será prontamente aceita.
https://www.facebook.com/groups/640402326010595/

Congresso Português de Transplantação de 2014

http://www.spt.pt/congresso/

Bem vindos

Caros Colegas,
O Congresso Português de Transplantação de 2014 realizar-se-á em Lisboa, no Sana Lisboa Hotel, de 09 a 11 de Outubro. A Sociedade Portuguesa de Transplantação (SPT) e a Associação Brasileira de Transplante de Órgãos (ABTO) juntam-se novamente, pelo décimo terceiro ano consecutivo, para o congresso conjunto. Este ano, contaremos também com a participação da Sociedade Espanhola de Transplantação (SET).

Como habitualmente será uma ocasião de excelência para a permuta de ideias, combinação de estratégias de trabalho e apresentação do trabalho científico desenvolvido pelos profissionais de saúde ligados a todas as áreas de transplante.

O sucesso do Congresso dependerá, naturalmente, do empenho e participação de todos. O prazo limite para o envio de trabalhos sob a forma de posters ou comunicações orais para o Congresso de Transplantação será 31 de Maio de 2014.

Participem!

Com os nossos cumprimentos,

Domingos Machado		Fernando Macário
Presidente do Congresso		Presidente da SPT

Comissão de Odontologia ABTO - 2014

Em outubro de 2010 foi aprovada junto à diretoria da ABTO a formação da Comissão de Odontologia da Associação Brasileira de Transplante de Órgãos cujos objetivos são as ações de suporte de informação sobre saúde bucal aos pacientes junto ao GAT (Grupo de Apoio ao Transplantado), suporte e orientação aos profissionais da Odontologia e demais membros da equipe multiprofissional com relação aos temas relacionados à boca e suas respectivas repercussões no grupo de pacientes transplantados, além do desenvolvimento de pesquisas científicas no campo da Odontologia em Transplantes.
A Comissão de Odontologia é composta por especialistas que atuam ativamente na área de Odontologia em Transplantes e trabalha em colaboração com colegas que atuam no manejo dos pacientes transplantados. Para o desenvolvimento de suas atividades, conta com parcerias nacionais e internacionais de referência na área.

Membros
FABIO LUIZ CORACIN (COORDENADOR)

Especialista em Patologia Bucal, Doutor em Odontologia e Mestre em Clínica Médica. Patologista Assistente do Serviço de Transplante de Células Tronco Hematopoiéticas do Hospital das Clínicas de São Paulo e Professor Doutor da Diretoria de Saúde da Universidade Nove de Julho – São Paulo.


ISABELA SOARES DE CASTRO

Especialista em Odontopediatria, 2005, Odontoclinica Central do Exército (OCEX); Especialista em Pacientes Especiais, 2013, Universidade de São Paulo USP – SP; Mestre em Odontopediatria, 2010, Universidade do Estado do Rio de Janeiro (UERJ).


LILIANE ELZE FALCÃO LINS KUSTERER

Especialista em Estomatologia e Cirurgia e Traumatologia Bucomaxilofacial
Doutora em Patologia Humana-FIOCRUZ-FMB-UFBA; Livre-Docente em Bioética- FMB-UFBA


PAULO SÉRGIO DA SILVA SANTOS

Mestre e Doutor em Patologia Bucal. Professor Doutor do Departamento de Estomatologia e Docente do Curso de Pós-Graduação em Ciências Odontológicas Aplicadas da Faculdade de Odontologia de Bauru, USP – SP.


RENATO COSTA FRANCO BALDAN

Mestre em Estomatologia UNESP, Especialista em Periodontia APCD, Residência pelo Hospital do Câncer de São Paulo - AC Camargo.

WALMYR RIBEIRO DE MELLO

Mestrando em Ciências Médicas – FMUSP, Coordenador da Equipe de Odontologia Hospitalar do Hospital Samaritano de São Paulo.

http://www.abto.org.br/abtov03/default.aspx?mn=560&c=1069&s=0&friendly=comissao-de-odontologia-abto

16° Simpósio de Odontologia em Hematologia

16° Simpósio de Odontologia em Hematologia
Data: 8 de novembro de 2014 (Sábado)
Multidisciplinar
Sala: Tapera
8:30 – 18:00 Luiz Antonio de Souza Coordenador
Luiz Antonio de Souza Moderador
8:30 – 8:40
Wellington do Espírito Santo
Cavalcanti e Maria de Fátima
Pombo Montoril
Abertura Oficial do 16º
Simpósio
8:40- 8:45 Discussão
8:45 – 9:05 Maria Infante
Por que mudar? O caso da gestão
de unidades de saúde no Brasil
9:05 – 9:25 Walmyr Mello
Gestão em Odontologia:
Diferença entre o público e o
privado
9:25- 9:35 Discussão
9:35 – 10:00 Inês Beatriz da Silva Rath
Atendimento odontológico a
pacientes da onco-hematologia
do HU/UFSC
10:00 – 10:30 Intervalo
Geisa Badauy Lauria da Silva Moderador
10:30 – 11:00 Silvia Inês Ferreira
Imunofenotipagem por
citometria de fluxo: Utilização em
onco-hematologia
11:00 – 11:15 Discussão
11:15 – 11:45 Lee I Ching
Utilização da imuno-histoquímica
no diagnóstico das lesões bucais
11:45 – 12:00 Discussão
12:00 – 12:50
Denise Linhares Gerent e
Frederico Medeiros
Novos anticoagulantes orais na
prática médica e odontológica
12:50 – 13:00 Discussão
13:00 – 14:30 Almoço
Eduardo de Pádua Moderador
14:30 – 14:55 Liliane Grando
Boca seca e ardência bucal: uma
epidemia?
14:55 – 15:20 Cassius Torres Pereira
Acompanhamento da cavidade
oral dos pacientes com anemia
de Fanconi
15:20 -15:30 Discussão
15:30 – 16:00 Intervalo
Luiz Alberto Valente Soares
Junior Moderador
16:00 – 16:25 Glauco de Oliveira
Como socializar o conhecimento
em odontologia
16:25 – 16:45 Luiz Antonio de Souza
Ações para capacitar a contrareferência
em hematologia
16:45 – 17:00 Discussão
17:00 – 17:45
Héliton Spíndola Antunes
(moderador) Apresentação Oral
17:45 – 18:00
Perla Porto Leite Shitara
(moderador) Assembléia

http://hemo.org.br/?page_id=1019

Oral complaints and dental care of haematopoietic stem cell transplant patients: a qualitative survey of patients and their dentists

Abstract

Purpose

Little is known about the understanding of the oral and dental needs of haematopoietic stem cell transplant (HSCT) patients or about dentists’ views and experiences regarding this patient group. This information is essential if we want to improve the standard of peri-HSCT dental care.

The primary objective of this qualitative survey was to explore the following:

1. The understanding of dental care pre- and post-HSCT
2. The subjective oral complaints of HSCT patients both short- and long-term
3. The relationship of these oral complaints to the severity of oral mucositis during hospitalization

The secondary objective was to explore the opinions of dentists regarding dental care before and after HSCT.

Patients and methods

All adult patients who survived HSCT at the Radboud University Medical Centre between 2010 and 2011 (n = 101) received a questionnaire. During hospitalization, mucositis scores were recorded daily in the patient’s chart. The patients’ dentist (n = 88) was also sent a questionnaire after permission of the patient.

Results

Ninety-six out of 101 patients (95 %) responded. The average period since HSCT was 19 months (range 8–31 months). The overall mean maximum mucositis score was 6.6 (sd = 3.3). Only eight patients reported not having visited a dentist pre-HSCT. The majority of the patients (59 %) reported short-term oral complaints, and 28 % reported long-term oral complaints. Fifty-two dentists responded (59 %). Nine had not performed pre-HSCT screening and eight dentists reported screening their patients but could not complete the necessary treatments. Only 44 dentists succeeded in completing the required treatments. The most important advice of the dentist was to reinforce the importance of regular dental care.

Conclusion

Most patients report short-term and/or long-term oral complaints after HSCT. Most dentists stress the importance of regular dental care before and after HSCT but report not being familiar with the particular dental care needs of this patient group. The high response rate and the high rate of HSCT-related oral complaints emphasize the need of further research in this area.

Supportive Care in Cancer

June 2014

Jacolien Bos-den Braber, 

Carin M. J. Potting, 

Ewald M. Bronkhorst, 

Marie-Charlotte D. N. J. M. Huysmans, 

Nicole M. A. Blijlevens

http://link.springer.com/article/10.1007/s00520-014-2297-x

Manifestações Bucais associadas à imunossupressão em pacientes submetidos a transplante de Coração

Manifestações Bucais associadas à imunossupressão em pacientes  submetidos a transplante de Coração
Oral manifestations associated with immunosuppression  in patients undergoing heart transplant

Rev Soc Cardiol Estado de São Paulo. 2014;24(1 Supl A):39-43
RSCESP (72594)-2097

Paulo sérgio da silva santos
Paola Ferreira teixeira
karin sá Fernandes

A condição de imunossupressão de pacientes transplantados  cardíacos possibilita o surgimento de manifestações bucais  importantes que representam risco para o sucesso do  transplante cardíaco. A avaliação e o acompanhamento  odontológico desses pacientes são fundamentais na prevenção
dessas manifestações bucais e infecções sistêmicas. Por meio  do relato dos casos clínicos de três pacientes transplantados  cardíacos, apresentamos e discutimos as condições clínicas e  as opções terapêuticas das manifestações bucais mais comuns  neste grupo de pacientes.

Oral care of the patient with liver failure, pretransplant—a retrospective study

Oral care of the patient with liver  failure, pretransplant—a retrospective study
Jeffery L. Hicks, DDS*
Professor, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Special Care in DentistryEarly View, Article first published online: 19 MAY 2014

Liver failure patients seeking liver transplant in our teaching hospital undergo dental clearance by our Hospital Dentistry Department. A retrospective analysis of 500 patient dental charts was performed. All patients were evaluated previously by physicians and the medical diagnosis of liver failure for each patient was determined. Patients were examined and a treatment plan was formed consisting of the oral care required prior to dental clearance for liver transplant. An oral care treatment algorithm was constructed that, along with clinical parameters, guided the oral care in the pretransplant period. The oral care necessary to clear the patient for transplant was completed for each patient. Besides computing the average cost of oral care necessary to clear patients, analyses were performed to look for correlations among laboratory tests required before oral surgical procedures.

Curso de Aperfeiçoamento em Odontologia Hospitalar - FUNBEO

Julho está chegando e com ele a 3ª turma do Curso de Aperfeiçoamento em Odontologia Hospitalar da FUNBEO junto à Faculdade de Odontologia de Bauru, Universidade de São Paulo. Ainda há vagas!!!! Acesse o site da FUNBEO e conheça mais detalhes e informações sobre o curso:
http://www.funbeo.com.br/do/Curso_view/128/aperfeicoamento_em_odontologia_hospitalar

Viral Opportunistic Infections in Organ and Tissue Transplanted Patients: Comparison between Clinical Examination and PCR

International Journal of Clinical Dentistry ISSN: 1939-5833
Volume 7, Number 1 © Nova Science Publishers, Inc.
VIRAL OPPORTUNISTIC INFECTIONS IN ORGAN
AND TISSUE TRANSPLANTED PATIENTS:
COMPARISON BETWEEN CLINICAL EXAMINATION
AND PCR
Paulo Sérgio da Silva Santos, DDS, MSc, PhD1,
José Endrigo Tinoco-Araujo, MSc, PhDc2, Ana Paula Bloise, DDS3,
and José Roberto Pereira Lauris, MSc, PhD4
1Professor, Stomatology Department, Bauru School of Dentistry,
University of São Paulo, Bauru, Brazil
2Graduate student, Stomatology Department, Bauru School of Dentistry,
University of São Paulo, Bauru, Brazil
3Paulista University, São Paulo, Brazil
4Professor, Department of Paedodontics, Orthodontics and Public Health of Dentistry,
Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
ABSTRACT
Purpose: To evaluate correlation between clinical suspicion and laboratory diagnosis
of viral opportunistic infections in transplanted patients.
Methods: We assessed 29 patients with oral infections with a clinical aspect of viral
lesions. We scraped the oral lesions, collected secretions using swab and sent samples to
the molecular biology laboratory for PCR according to the clinical diagnostic hypotheses.
Results: We found 44.8% of cases suspected of having HSV, 6.9% of CMV and in
48.3% there was doubts about the diagnosis. The PCR was positive for HSV in 34.5% of
cases, for CMV in 6.9%, for both HSV and CMV in 10.3% and negative in 46.7% of the
cases.
The sensitivity of clinical examination was 100% for both HSV and CMV, but the
possibility of having the infection by HSV or CMV was respectively 44% and 25%. We
suggest that clinical examination is not sufficient to establish the final diagnosis of viral
lesions in transplanted patients, making it necessary for exams of high reliability as the
PCR.

Oral Mucositis: Prevention and Treatment

Héliton Spindola Antunes1, Paulo Sérgio da Silva Santos2,
Fábio Luiz Coracin3, Geisa Badauy Lauria Silva4,
Luiz Antonio de Souza5, and Luiz Alberto Soares Valente Jr.6*
1DDS, PhD of the Clinical Research Coordination,
National Cancer Institute of Brazil (INCA)
2DDS, PhD, Professor of the Stomatology Department, Bauru School of Dentistry,
University of Sao Paulo, Brazil
3DDS, PhD of the Bone Marrow Transplant Service,
Clinicas Hospital from School of Medicine – University of Sao Paulo;
Professor of Pathology and Oral Medicine in Nove de Julho University, Sao Paulo, Brazil
4DDS, MSc of the Bone Marrow Transplant Service and of Pediatric Oncology in Araújo
Jorge Hospital (HAJ/ACCG)
5DDS of the Blood Center in Santa Catarina (HEMOSC)
6DDS, MSc of the Dentistry Division in Clinicas Hospital,
School of Medicine – University of Sao Paulo, Brazil
ABSTRACT
Oral Mucositis (OM) is one of the main complications of patients submitted to the
oncologic treatment. The incidence of oral mucositis varies, and is intimately related to
the toxicity of chemotherapy and radiotherapy protocol. Prolonged or profound oral
mucositis leads to significant pain and morbidity and depending on its progression, it may
be necessary to interrupt the treatment followed or not by hospitalization.
OM occurs approximately in seven to ten days after chemotherapy and from the
second week of radiotherapy. Although it is a toxic reaction and inflammation that is
studied for a long time, the molecular and cell mechanisms described recently may
contribute for the appearance of new protocols of prevention. In the context of options
studied in the prevention of OM, there are efficient alternatives as cryotherapy, growth
factor of keratinocytes and the low-level lasers that promote a reduction in the incidence
of OM and pain during the period of the oncologic treatment.
The aim of this chapter was to investigate the available literature regarding OM,
searching relevant articles and eligible clinical trials in order to obtain additional
information about prevention and treatment interventions to OM.

 Members of the Committee of Dentistry from the Brazilian Association of Hematology and Hemotherapy.

Oral Health Status of Cirrhotic Patients in List of Liver Transplantation and of Viral Hepatitis Carriers

Oral Health Status of Cirrhotic Patients in List of Liver Transplantation 
and of Viral Hepatitis Carriers
Liliane Lins1,2* and Antônio Fernando Pereira Falcao

http://www.omicsonline.org/2161-0991/2161-0991-2-116.pdf

ASSOCIE-SE: ASSOCIAÇÃO BRASILEIRA DE TRANSPLANTE DE ÓRGÃOS.

Dispositivo Intraoral

Dispositivo intraoral de odontologiaemtransplantes.blogspot.com é licenciado sob uma Licença Creative Commons Atribuição-NãoComercial-SemDerivados 3.0 Não Adaptada.

II SIMPÓSIO DE ODONTOLOGIA EM TRANSPLANTES - ABTO /CRORJ

II SIMPÓSIO DE ODONTOLOGIA EM TRANSPLANTES - ABTO /CRORJ
TRANSPLANTES: TCTH, RENAL, HEPÁTICO, CARDÍACO, OSSOS

PROGRAMAÇÃO

13h00 - 14h00	Tx célula tronco hemat - Biologia / Indicações Toxidades e Manejo / Infecções Efeitos tardios
14h00 - 15h00	Tx Renal - Preparo e Indicações Preparo Bucal Infecções bucais e repercussões
15h00 - 15h30	COFFEE-BREAK
15h30 - 16h30	Tx Hepático - Critérios e indicações Preparo Bucal / Complicações
16h30 - 17h30	Sucessos e Insucessos em Transplante de Ossos Transplante cardíaco Abordagem odontológica

XIII Congresso Brasileiro de Transplantes 2013

Do Patients with Solid Organ Transplants or Breast Implants Require Antibiotic Prophylaxis before Dental Treatment?

Eric T. Stoopler, DMD; Ying Wai Sia, DMD; Arthur S. Kuperstein, DDS

J Can Dent Assoc 2012;78:c5

Human solid organ transplantation has evolved into a predictable therapeutic modality due to advances in medical and surgical care and improved understanding of the immune system. At its peak in 2007, the Canadian Organ Replacement Register documented 1042 organ donors (living and deceased) and 2127 completed organ transplants.¹ The overwhelming majority of donated organs were deceased donor kidneys.¹ Records from the United States show that, between 1999 and 2008, patient and graft survival improved for almost every organ type.²*

With the large number of people receiving organ transplants and those who have already received a transplant living longer, dental professionals will be providing oral health care to an increasing number of patients in this specific population. The question of administering antibiotic prophylaxis to these patients, as well as to patients with breast implants, before invasive dental treatment is addressed in this article.

Solid Organ Transplants

The oral health care provider plays an important role in overall management of the solid organ transplant patient. At many transplant centres, examination of both the hard and soft tissues of the oral cavity is often carried out by a dental professional to determine oral and dental health status before transplantation.³ As the patient's immune system is often significantly suppressed in the weeks to months following the transplant to prevent organ rejection, the risk of infection (viral, bacterial or fungal) is a concern and dental treatment during that time is recommended only on an emergency basis.^3,4 As the patient moves into the stable post-transplantation period, risk of infection generally decreases and oral health care may be sought more routinely.

Evidence supporting the use of antibiotic prophylaxis among patients with solid organ transplants before dental treatment is extremely limited.^3-6 In 2003, Guggenheimer and colleagues³ reported that postoperative guidelines for recipients of solid organ transplants frequently advise treatment with antibiotics before dental procedures, but there are no data from controlled clinical trials to support this recommendation, nor is a consensus evident. However, the authors state that because bacteremia arising from invasive dental procedures represents a significant risk in the immunocompromised patient, premedication is usually recommended.

In a 2005 survey of dental care protocols at organ transplant centres in the United States, 239 out of 294 centres (83%) reported recommending antibiotic prophylaxis for dental treatment following an organ transplant.⁷ However, because the overall response rate to this survey was only 38%, these results do not represent a consensus. The authors of the study reiterated that, at that time, there was no documentation of transient bacteremia from an invasive dental procedure posing another threat to the immunosuppressed organ transplant recipient.

In 2007, a systematic review by Lockhart and colleagues⁵ concluded that it is difficult to determine the likelihood that invasive dental procedures will cause morbidity or mortality in immunosuppressed patients and classified the finding as Class IIB (usefulness/efficacy less well-established by evidence/opinion) and Level C (based on expert opinion, case studies or standard of care).

In a recent article, Scully and colleagues⁸ recommend administering antibiotic prophylaxis to organ transplant patients before invasive dental procedures (particularly during the 6 months after transplantation) without citing evidence-based research to support their recommendation.

In 2007, the American Heart Association (AHA) published revised guidelines for the prevention of infective endocarditis using a stronger evidence-based approach. In relation to organ transplants, these guidelines recommend providing antibiotic prophylaxis before specific dental procedures in cardiac transplantation recipients with cardiac valvulopathy to prevent infective endocarditis.⁹ The guidelines have been endorsed by members of the Canadian Cardiovascular Society.¹⁰

Breast Implants

First described by Czerny in 1895, breast augmentation is now the most common cosmetic procedure among American women.¹¹ Infections after breast augmentation are relatively uncommon, with most occurring within the early postoperative period (i.e., 4 weeks).¹² Endogenous breast flora, such as Propionibacterium acnes and coagulase-negative Staphylococcus, have been implicated in the etiology of these types of infections.¹² Ellenbogen¹³ postulated a causal relation between dental prophylaxis and rapid breast encapsulation within weeks of the surgical procedure based on personal experience. Late infections (months to years after implantation) are even less common at a reported rate of 1:10 000.^12,14 Bacteremia, as a consequence of an invasive procedure or distant antecedent infection, is thought to cause seeding of the breast implant capsule or periprosthetic space.¹²

Few articles in the literature implicate bacteremia secondary to dental procedures as the etiology for late breast implant infection. In a survey, Brand¹⁴ found 2 cases of late infection thought to have originated after an episode of bacterial stomatitis and after extensive dental treatment. In both cases, the identified cause was Staphylococcus aureus, an organism considered part of normal oral microflora.¹⁵ S. aureus has been implicated as the most common microbiological agent responsible for periprosthetic breast implant infections.¹⁶ Hunter and colleagues¹⁷ reported a case in which a woman developed a late breast implant infection associated with Clostridium perfringens after completion of extensive dental therapy, including abscess drainage, endodontic treatment and crown placement. Most recently, Chang and colleagues¹² reported a late breast infection with coagulase-negative Staphylococcus and Streptococcus viridians, which developed after periodontal surgery to treat recurrent periodontitis.

Clinical Recommendations

Antibiotic Prophylaxis and Solid Organ Transplants

Based on current evidence-based research, we do not recommend routine administration of antibiotic prophylaxis to patients with solid organ transplants before invasive dental treatment.^5,18 Oral health care providers should discuss the patient's overall health status and planned dental procedures with the patient's physician or transplant surgeon or both, and the decision to administer antibiotic prophylaxis should be made on a case-by-case basis.^6,18 If antibiotic prophylaxis is recommended, the patient's physician should prescribe the medication (type, dose, instructions). Regarding patients with cardiac transplants, we recommend providing antibiotic prophylaxis to patients according to the 2007 AHA guidelines.^9,10

Antibiotic Prophylaxis and Breast Implants

Based on current evidence-based research and scant case reports, we do not recommend routine administration of antibiotic prophylaxis to patients with breast implants before invasive dental treatment.^6,18-20 However, patients with a history of complications after breast implant surgery, especially infection, may warrant antibiotic prophylaxis before invasive dental treatment, and this decision must be made in consultation with the patient's surgeon. If antibiotic prophylaxis is recommended, the patient's surgeon should prescribe the medication (type, dose, instructions).

*The data and analyses reported in the 2009 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by UNOS and Arbor Research under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. Government.

References:

1. 2009 Annual report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: transplant data 1999–2008. Rockville, Md: United States Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2009. Available: www.ustransplant.org/annual_reports/current
   /default.htm (accessed 2011 Nov. 10).
2. Guggenheimer J, Eghtesad B, Stock DJ. Dental management of the (solid) organ transplant patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(4):383-9.
3. Goldman KE. Dental management of patients with bone marrow and solid organ transplantation. Dent Clin North Am. 2006;50(4):659-76, viii.
4. Lockhart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. J Am Dent Assoc. 2007;138(4):458-74; quiz 534-5, 437.
5. Little JW, Falace DA, Miller CS, Rhodus NL. Antibiotic prophylaxis in dentistry: an update. Gen Dent. 2008;56(1):20-8.
6. Guggenheimer J, Mayher D, Eghtesad B. A survey of dental care protocols among US organ transplant centers. Clin Transplant2005;19(1):15-8.
7. Scully C, Kumar N, Diz Dios P. Hot topics in special care dentistry. 5. Transplant patients. Dent Update. 2009;36(7):445.
8. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc. 2008;139 Suppl:3-24S.
9. Embil JM, Chan KL. The American Heart Association 2007 endocarditis prophylaxis guidelines: a compromise between science and common sense. Can J Cardiol. 2008;24(9):673-5.
10. Pelosi MA 3rd, Pelosi MA 2nd. Breast augmentation. Obstet Gynecol Clin North Am. 2010;37(4):533-46, viii.
11. Chang J, Lee GW. Late hematogenous bacterial infections of breast implants: two case reports of unique bacterial infections. Ann Plast Surg. 2011;67(1):14-6.
12. Ellenbogen R. Breast implant encapsulation in association with dental work. Plast Reconstr Surg. 1986;78(4):541.
13. Brand KG. Infection of mammary prostheses: a survey and the question of prevention. Ann Plast Surg. 1993;30(4):289-95.
14. Smith AJ, Jackson MS, Bagg J. The ecology of Staphylococcus species in the oral cavity. J Med Microbiol. 2001;50(11):940-6.
15. Khan UD. Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration. Aesthetic Plast Surg. 2010;34(1):42-7. Epub 2009 Oct 20.
16. Hunter JG, Padilla M, Cooper-Vastola S. Late Clostridium perfringens breast implant infection after dental treatment. Ann Plast Surg.1996;36(3):309-12.
17. Baker KA. Antibiotic prophylaxis for selected implants and devices. J Calif Dent Assoc. 2000;28(8):620-6.
18. Pittet B, Montandon D, Pittet D. Infection in breast implants. Lancet Infect Dis. 2005;5(2):94-106.
19. Davenport J. Breast implants & premedication for dental work. Hawaii Dent J. 2006;37(6):16.