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Odontogen fokussanering forud for organtransplantation

ABSTRACT

Oversigtsartikel Dato: 08.05.2008

Organtransplantation har udviklet sig fra en eksperimentel behandling til i dag at være en veldokumenteret behandlingsmulighed, der foretages i mange centre internationalt. Danske specialister var tidligt aktive, og i øjeblikket udføres ca. 300 organtransplantationer årligt i Danmark. Systemisk infektion er som oftest en kontraindikation for behandlingen, og infektioner udgående fra tænder og kæber er beskrevet for transplantationspatienter. En odontologisk undersøgelse er derfor en del af det prætransplantatoriske udredningsprogram. Formålet med artiklen er at belyse indikationen for prætransplantatorisk odontogen fokussanering med udgangspunkt i den tilgængelige litteratur. Endvidere opstilles anbefalinger til saneringsniveau.

Removal of odontogenic infectious foci prior to organ transplantation: Organ transplantation is now considered a safe and predictable procedure for treatment of irreversible end-stage organ failure.Systemic infections and malignancies are a contraindication for organ transplantation. Odontogenic infections are described for these patients. Bacteria, fungi, and viruses are commonly found in the oral cavity and are therefore potential candidates for developing local infections and sepsis. Oral screening of the transplant candidate is therefore a part of the pretransplant evaluation. A PubMed search was carried out. Only a low level of evidence and no prospective randomised studies were identified to support guidelines for dental management before organ transplantation. Based on the available literature and pathophysiologic considerations we recommend a conservative treatment strategy aimed on identification of infectious foci and including a screening of the oral mucosa. Early referral for dental evaluation of these patients is a key factor. Prophylaxis is important to minimize the risk for bacteraemia. Biopsies should be taken for histologic evaluation in case of mucosal lesions. If adequate time is available apical pathosis should be endodontically treated and marginal infection controlled by scaling. Indications for treatment should not differ markedly from systemic healthy patients and tooth extractions should only be carried out when a tooth is compromised. Impacted teeth should be removed in the case of infection.