Z Gastroenterol 2020; 58(01): e23
DOI: 10.1055/s-0039-3402245
Poster Visit Session II Clinical Hepatology, Surgery, LTX: Friday, February 14, 2020, 2:40 pm – 3:25 pm, Lecture Hall P1
Georg Thieme Verlag KG Stuttgart · New York

Dental health needs assessment and treatment in patients awaiting liver transplant

P Goebel
1   University of Bonn, Internal Medicine I, Bonn, Germany
,
C Forsting
2   University of Bonn, Deparment of Oral Surgery, Bonn, Germany
,
P Knipper
3   University of Bonn, Department of Surgery, Bonn, Germany
,
S Manekeller
3   University of Bonn, Department of Surgery, Bonn, Germany
,
J Nattermann
1   University of Bonn, Internal Medicine I, Bonn, Germany
,
J Kalff
3   University of Bonn, Department of Surgery, Bonn, Germany
,
G Wahl
2   University of Bonn, Deparment of Oral Surgery, Bonn, Germany
,
C Strassburg
1   University of Bonn, Internal Medicine I, Bonn, Germany
,
P Lutz
1   University of Bonn, Internal Medicine I, Bonn, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2020 (online)

 

Background and Aims:

Dental health is assessed in patients with liver cirrhosis awaiting liver transplant to avoid infectious complications due to hematogenous spread from dental foci after successful transplant. However, this recommendation relies on rather old studies. We investigated dental health in liver cirrhosis patients to clarify if dental care is necessary before transplant.

Methods:

Clinical and laboratory data from patients with liver cirrhosis who received a liver transplant between 2010 and 2018 in our department were retrospectively analysed for oral foci of infection in different patient subpopulations and for outcome after transplantation.

Results:

Data on oral health were available from 110/185 patients who received a liver transplant. Median age of patients was 53 years, 67% were male and the most frequent causes for liver transplant were alcoholic liver diseases (34%), viral hepatitis (28%) and autoimmune liver disease (14%). 35 patients showed good oral health without need for dental care, in 39 patients dental care was performed because of pretransplant assessment, 36 patients did not receive dental care despite poor oral health. The most common dental issues encountered were caries, which affected 75% of all patients, and periodontal diseases with a prevalence of 40%. We noted that need for dental care was highest in alcoholic liver disease (95%) compared to viral hepatitis (71%) and autoimmune liver disease (73%). Bleeding complications due to oral care occurred in 5/13 patients, who all presented with platelets below 70 G/L and an INR above 1.5. Mortality in the first 9 months after liver transplant was similar for patients with poor oral health, after dental care and without need for dental care (19%, 11% and 14%, respectively). However, the number of infections after transplant were higher in patients with poor oral health before transplant (2,9) compared to patients who received dental care (1,9) or patients with good oral health (1,8) (p = 0.02). In particular, infections by streptococci affected more frequently patients with poor oral health compared to patients without need for or after dental care (25% vs. 8%; p = 0.02).

Conclusion:

Because dental health was frequently compromised irrespective of aetiology of liver disease and because frequency of infections was lower after transplant in patients with good dental health, our data highlight that all patients awaiting liver transplant should be considered for dental care.