Organ and Bone Marrow Transplantation

Question 1

What is solid organ transplant ?

Answer 1

The surgical transplantation of internal organs.
(Treatment not cure for end stage organ failure)

Question 2

What is bone marrow transplant ?

Answer 2

• Cellular infusion of stem cells from the bone marrow

Question 3

What are some complication of transplant?

Answer 3

• Risk of infection
• Graft rejection
• Immunosuppression/infection
• Other systemic conditions resulting from immunosuppressive medications

Question 4

What are some of the dental management?

Answer 4

• greatest immunosuppresion following transplant
• Pretransplant dental screening and clearance to reduce the infection risk and complications
• emphasize importantce of oral health maintenace
• Stress basic oral health care
• possible daily chlorhexidine rinse w/ gingi and perio
• Care of removeable prothesis

Question 5

What are some risk assessment?

Answer 5

Thorough medical history
High risk for bleeding

Question 6

Dental management for pretransplant

Answer 6

• Complete all necessary dental treatment at least two weeks before transplantation.

Question 7

Dental management for post transplant

Answer 7

• Defer care during immediate post transplantation period due to profound immunosuppression
• Provide emergency care
• During the stable phase (as indicated
  by physician) provide routine dental
  care, periodontal maintenance
• No elective treatment during chronic
  rejection phase due to significantly
  higher risk for infection

Question 8

What is the most common types of periods?

Answer 8

stable graft period

Question 9

What are some oral complications?

Answer 9

Gingival overgrowth: Management: Periodontal care, improved oral hygiene,
surgical excision by gingivectomy

Oral Mucositis: 7-10 days after immunosuppressant
meds start, can affect the esophagus, diet modification and palliative rinses

Pyogenic granuloma

m-TOR inhibitor Associated Stomatitis: Painful aphthous-ulcer lesions
* Non-keratinized tissue
* Diminishes with time
* Management by intralesional steroid
therapy

Orofacial granulomatosis

Oral hairy leukoplakia

Question 10

What are some oral infections ?

Answer 10

Candidiasis
Herpers Simplex Virus
Invasive Fungal infections

Question 11

What is the graft versus host disease ?

Answer 11

• Complications of bone marrow transplant

Clinical features:
* Oral mucosal lichenoid inflammation
* Typical lichen planus-like changes
* Mouth discomfort and sensitivity
* Salivary gland dysfunction with xerostomia
* Fibrosis of oral and perioral tissues
* Mucoceles; superficial saliva-filled vesicles on the hard palate
* Manage by controlling symptoms, application of topical steroids, topical lip
ointment, Rx topical fluoride if salivary gland dysfunction is present

Question 12

What is the secondary Malignancy?

Answer 12

Organ transplant patients are at an increased risk for developing
cancer.

Typically, within 1-2 years after transplantation if bone marrow
transplant was due to hematologic malignancy

Oral cavity and lip squamous cell carcinoma is increase
significantly in post-transplant patients with graft-versus-host- disease after bone marrow transplant