Dental care before lung transplantation: are we being too rigorous?
OBJECTIVE
Poor dental status is known to cause infections in severely sick and in elderly patients. In patients awaiting lung transplantation, rigorous dental treatment is a common prerequisite, although evidence-based data are lacking with regard to extent, necessity and effect on post-transplantation infectious status.


METHODS
In the present retrospective study, dental status [dental history (missing teeth, caries, tooth restorations and extractions, prevalence of periodontitis) and dental treatment prior transplantation] was assessed in 85 lung transplant candidates at the University Hospital of Freiburg, Germany and evaluated for infectious foci in the first 3 years following transplantation.


RESULTS
Forty-nine patients got transplanted in the observed timespan. Total tooth count differed significantly between chronic obstructive pulmonary disease (16 ± 9), pulmonary fibrosis (22 ± 7) or cystic fibrosis (30 ± 3) patients prior transplantation (P > 0.001). Periodontitis prevalence yielded no difference and was mainly not treated prior transplantation. No dental-related infectious focus could be diagnosed post-transplantation. However, 15% of post-transplantation infections were of unknown focus, and infection rate was increased in year 2 post-transplantation in patients without periodontitis.


CONCLUSIONS
No clearly defined dental foci were registered following transplantation. This raises the question of whether current dental treatment in these highly compromised patients is too rigorous with regard to tooth extractions. However, no focus could be detected in 15% of the registered infections. Therefore, controversially, post-transplantation dental care could also be insufficient with regard to undertreated periodontitis.
Department of Respiratory Medicine, University Hospital Freiburg, Freiburg, Germany. stephan.walterspacher@uniklinik-freiburg.de
Stephan
S
Walterspacher
Carsten
C
Fuhrmann
Martin
M
Germann
Petra
P
Ratka-Krüger
Wolfram
W
Windisch
D003729:Dental Care / Q000379:methods*; D003731:Dental Caries; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000517:prevention & control; D009910:Oral Hygiene / Q000379:methods; D010518:Periodontitis / Q000628:therapy; D012189:Retrospective Studies; D014076:Tooth Diseases / Q000628:therapy*