Although the importance of the oral health of the organ transplant recipient is implicit, there is no treatment consensus among experts in the field (Hong et al., 2019).
Protocols for referral to and treatment by oral health providers is divided into four distinct treatment times, including (Priyanshi, 2018): 1. Pretransplantation. 2. Immediate posttransplantation. 3. Stable posttransplantation. 4. Posttransplant rejection period. additional restorative treatment can be continued. Again, coordination of care with the transplant center is essential. When consulting with the patient’s primary care physician or transplant center, the oral health provider should obtain the latest laboratory blood test values. A CBC with differential (of the white blood cells) and platelet count should be the minimum blood test results reviewed during all phases of care. It is possible that immunosuppression may render the patient thrombocytopenic and susceptible to excessive bleeding and/or neutropenia (abnormally low white blood cell count, which further impairs the immune system). In the patient who has neutropenia, there is some suggestion that antibiotic prophylaxis is indicated when an invasive surgical or periodontal procedure is being considered (Priyanshi, 2018). It is also extremely important to screen for oral and head and neck cancers at every appointment because the patient is more susceptible to these lesions as a result of lifelong immunosuppressant therapy (Priyanshi, 2018). The oral health of the solid organ transplant patient remains a critical part of overall care and can be readily enhanced and maintained by careful assessment and planning by the dentist and hygienist in coordination with the patient’s physicians.
Dental treatment implications In the pre-transplantation period, a patient who does not already have a dental home should immediately be referred to an oral health provider for evaluation. The dentist should consult with the primary care physician or transplant center to confirm the patient’s medical status and ability to undergo routine dental care. An oral prophylaxis, followed by treatment of active disease, is the priority. It is critical to remove all potential sources of infection that might prevent or delay the organ transplant. Additionally, the patient- specific caries risk assessment should be evaluated, and educational recommendations should be provided to the patient and family. These recommendations will include oral hygiene instruction, supplemental fluoride or antibacterial rinse, and/or diet modification. The immediate post-transplantation period covers the first 6 months after the transplant. Coordination of care with the transplant center should be arranged, emphasizing emergency treatment only. After the immediate post- transplantation period, the patient enters the stable post-transplantation phase. During this time, rejection of the organ is possible. The patient should be scheduled for frequent recall visits, and all indicated corrective and
THE CANCER PATIENT
In 2023, the National Cancer Institute (NCI) estimated that by the end of the year, approximately 15,190 children ages 0 to 19 years would be diagnosed with cancer in the U.S. and that 1,590 children would die of the disease in the U.S. (NCI, 2023). The oral complications of cancer treatment Medical considerations/current medical therapies Cancer treatment regimens are variable, based on whether the lesion is organ related or hematopoietic (blood related). Treatment may include a variety of bioactive agents, corticosteroids, nucleotide analogues, platinum-based agents, vinca alkaloids, and a number of other compounds. In addition to chemical agents, radiation therapy to control tumor growth may be employed in conjunction with these agents or on its own. Some oral complications are common to both radiation therapy and chemotherapy. The incidence of oral complications for radiation and chemotherapy patients is high. Cancer treatment may also result in myelosuppression. This condition is defined as the inhibition of white blood cells, red blood cells, and platelets. Myelosuppression may lead to excessive bleeding during surgery, spontaneous bruising, and susceptibility to opportunistic infections. (See Tables 4 and 5.) The dentist and treating physician should consider antibiotic prophylaxis if there is sufficient myelosuppression (absolute neutrophil count [ANC] of less than 1,000/mm3).
are debilitating. The oral cavity is highly susceptible to the effects of chemotherapy and radiation and is the most frequently documented source of sepsis in the immunosuppressed cancer patient (NCI, 2016).
Table 4: Normal Complete Blood Count Type of Cell Age of Patient
Normal Range
Red cells
2–6 years
3.9–5.3 million/mm 3
6–12 years
4.0–5.2 million/mm 3
12–18 years male 12–18 years female
4.5–5.3 million/mm 3 4.1–5.1 million/mm 3
Hemoglobin 6–12 years
11.5–15.5 g/dL
12–18 years male 12–18 years female
13.0–16.0 g/dL 12.0–16.0 g/dL
Hematocrit
6–12 years
35%–45%
12–18 years male 12–18 years female
37%–49% 36%–46%
Platelets
150,000–400,000/ mm 3
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