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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

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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