Location and sanitation of dental foci in liver transplantation.
The literature describes various treatment concepts for the pre-operative sanitation of septic foci in the oromaxillofacial area prior to liver transplantation. There are no uniform guidelines, and so far, a connection between dental foci and postoperative infection after transplantation has not yet been proven. Taking into account the complications occurring during focus sanitation, the appropriate extent of, and the most suitable point of time for, focus sanitation have to be ascertained. The clinical and radiological findings from 80 patients were analyzed, with particular attention being paid to dental foci prior to liver transplantation. The complications performed in 39 sanitations and the oral hygiene status of 37 patients were included in the analysis. All the obtained findings were correlated to the etiology of the liver disease and the Child-Pugh stage. Former alcoholics had significantly poorer oral hygiene and more foci than non-alcoholics. After sanitation, complications occurred more frequently in alcoholics (43.8%) and patients in Child-Pugh stage C (41.2%) than in the other groups. Secondary bleeding, severe in some cases, occurred in a total of 15.4% of all patients, despite coagulatory preparations. We can conclude that, given the high rate of complications found in this study after sanitation prior to transplantation, the demand for radical prophylactic dental sanitation should be reconsidered. Rather, it would appear more appropriate for only absolutely necessary sanitation to be carried out prior to transplantation and for the definitive measures to be postponed until after transplantation when liver function has stabilized.
Niederhagen
Bernd
B
Department of Oral and Maxillofacial Surgery, University Hospital, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany. niederhagen@uni-bonn.de
Wolff
Martin
M
Appel
Thorsten
T
von Lindern
Jens-Jörg
JJ
Bergé
Stefaan
S
D000437:Alcoholism / Q000473:pathology; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D009059:Mouth Diseases / Q000453:epidemiology; D009910:Oral Hygiene / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D016896:Treatment Outcome