Need for dental treatment in patients on the waiting list for liver and simultaneous pancreas-kidney transplant at a single center

1 Federal University of São Paulo, Paulista Medical School, Postgraduate Program in Gastroenterology, São Paulo, SP, Brazil. 2 Federal University of São Paulo, São Paulo Hospital, Dentistry Service, São Paulo, SP, Brazil. 3 Federal University of São Paulo, Paulista Medical School, Medical Clinic Department, Discipline of Nephrology, São Paulo, SP, Brazil. Ramaglia Need for dental treatment in patients on the waiting list for liver and simultaneous pancreas-kidney transplant at a single center. 2 Rev Col Bras Cir 46(4):e20192224 In these patients, the most common symptoms include xerostomia, halitosis, bone lesions and greater tartar formation, among others6,7. Likewise, the main oral problems in liver disease patients are poor oral hygiene, high prevalence of periodontal disease, tooth decay and bone loss8. Thus, the early diagnosis of oral cavity disorders in diabetic patients with CKD and chronic liver patients who are candidates for transplantation is important, since an infectious dental focus in the pre-transplant period may lead to postoperative complications. The objective of this study was to evaluate the oral conditions and the main risk factors for dental treatment of patients on the waiting list for simultaneous pancreas-kidney transplantation and for liver transplantation at a single center.

An important question is whether the increase in periodontal damage in diabetic individuals is solely due to a change in host response or there is a change in bacterial pathogenicity that leads to increased inflammation and damage, or whether even both mechanisms are present 5 .

Original Article
Need for dental treatment in patients on the waiting list for liver and simultaneous pancreas-kidney transplant at a single center.
Likewise, the main oral problems in liver disease patients are poor oral hygiene, high prevalence of periodontal disease, tooth decay and bone loss 8 10 . We performed cavity evaluation using the DMFT (decayed, missing or filled teeth) index. We also evaluated endodontic, surgical, dental, prosthesis and soft tissue disease aspects.
The criteria established for the need for dental treatment were decayed teeth, teeth with need for endodontic care, fractured teeth, soft or hard tissue lesions, and gum disease. All patients underwent coagulation tests and assessment of the need for prophylactic antibiotics.
To determine which traditional factors and those associated with transplantation were related to the need for dental treatment, all potential risk factors that were univariably associated with a value of P=0.3 were simultaneously entered into a binary linear regression model. We considered p-values <0.05 as statistically significant.

Extraoral clinical aspects
In the palpation exam of ganglion chains, muscles and joints, we did not observe significant differences and the physical exam was normal in more than 75% of the studied sample.

Dental aspects
Although the number, size and shape of teeth were normal in most LTx and SPKT candidates, fractures and wear were present in 58% and 77% and 33% and 62%, respectively, without statistical significance.

Clinical dental aspects
We noted that 42% of SPKT waiting list patients and 17% of LTx waiting list individuals required endodontic treatment (P=<0.0001).  The DMFT index of 6.6 for cavity prevalence, 83% and 100%, respectively, was rated as very high (P=0.030). During periodontal evaluation, we observed bleeding on probing, presence of supra and/or subgingival calculi and/or excess restorative margins (code 1) in 47% (n=22/50) of patients waiting for SPKT and in 38% (n=19/50) of the ones on the Ltx list, without statistical significance.

Univariate and multivariate analyzes of demographics
In assessing the predisposing factors for dental treatment in patients on the waiting list for SPKT, we found no statistical significance for age, gender, amaurosis color, diabetes mellitus time and dialysis time ( Table 3).
In the analysis of risk factors for dental treatment in LTx candidates, we observed that younger patients, ie those with a median age below 58 years, had significantly more frequent treatment indication than those older than 58 years (84% versus 54%) ( Table 4). As for color, both white and black (n=34, 75%) required dental treatment, this indication being superior to the groups of brown (n=2, 66%) and yellow skin (n=0, 0%). Regarding the etiology of liver cirrhosis, 76% (n=23/30) of patients diagnosed with viral hepatitis required dental treatment and this proportion was 80% (n=4/5) for those with alcoholic cirrhosis and 60% (n=9/15) for patients with cirrhosis of another etiology. Among patients with a history of hepatocellular carcinoma, the need for dental treatment was 65% (n=13/20).