What Every Transplant Patient Needs to Know About Dental Care International Transplant Nurses Society Should patients have that still need to be done. Taking gums each day because they don’t feel a dental exam before care of your teeth and gums (oral well. So some patients already have hygiene) is important for everyone. dental problems before they receive having a transplant? For people who are waiting for an a transplant. After transplant, you Transplant candidates should have a organ transplant and for those who may have been more concerned about dental check-up as part of the pre- have received organ transplants, problems like rejection, infection, transplant evaluation. It is helpful to maintaining healthy teeth and gums is or side effects of your medications. have an examination by your dentist an essential area of care. This booklet Because you are now taking medicines when you are being evaluated for will discuss many issues about dental to suppress your immune system, you transplant to check the health of your care and the best ways to take care of could have an increased risk of dental teeth and gums. This is important your teeth and gums. health problems. All of these factors because some medications that you can add to dental problems following take after transplant may cause you Why could I have transplant. to develop infections more easily. problems with my teeth Maintaining your dental health as best What are the most as you can while waiting for an organ and gums? will help you do better after your There are several reasons why you common dental transplant. might have problems with your teeth problems that transplant or gums before and after transplant. recipients have? Dental Care after When you were waiting for transplant, The types of dental problems seen Transplant you may not have thought a lot about in transplant patients are similar to caring for your teeth. This may have As you recover from transplant those in the general population. Gum been because you were ill or unable to surgery, you will learn a lot about disease, tooth decay, mouth ulcers, take care of yourself as well as when how to take care of yourself and dry mouth, and dental infections can you were healthier. Patients who your healthy organ. You will learn occur. Some dental problems are side are very ill before transplant often many new things about medications, effects of medications you take after cannot visit their dentist for regular rejection, and infection. But there transplant. Also, you can develop check-ups and dental care. It is hard are also many routine care needs infections more easily because your for them to care for their teeth and immune system is suppressed. Gum Disease (Gingivitis) What is gum disease and Symptoms of gum disease (gingivitis) how is this treated? include: Gum disease, or gingivitis, is an • Red, swollen, and/or tender gums infection of the tissue that surrounds • Gums that bleed easily your teeth. Infection can develop in the gap between the tooth and Symptoms of gum disease and/or the gum, just below the gum line. periodontal disease include: The infection can cause the tissue to • Gums that have pulled away from break down. As this tissue breaks the teeth down, a pocket develops within the • Bad breath (halitosis) or a bad gap between the tooth and gum. taste in the mouth that does not The pocket will develop into a more go away serious type of gum infection called • Loosening of the teeth periodontal disease. Some transplant • Wider separations between your medications can increase your risk of teeth gum disease. Diabetes and smoking • Changes in the way your teeth fit or chewing tobacco can speed up the together when you bite progress of gum disease. 2 some cases, it may be possible to To prevent plaque build up and change to another type of anti- further complications: rejection medication that does not • Brush at least twice a day with have this side effect. If the medication fluoride toothpaste, especially after cannot be changed, sometimes the meals or snacks. level or dose of the medication can • Always brush your teeth before be lowered. going to sleep at night. • Gum surgery can reduce gum • Clean between your teeth by tissue if your gums have become flossing once a day. Gum overgrowth severely overgrown. This will • Discuss the best method for help maintain good gum health brushing and flossing your teeth Gum Overgrowth and decrease the risk of infection. with your hygienist or dentist. (Gingival Hypertrophy) • Visit your dentist and dental Another condition of the gums that hygienist at least every 6 months can occur in patients after transplant or more often if necessary for is gum enlargement or overgrowth. a professional examination and This is caused by several medications, cleaning. The hygienist will be able including some anti-rejection to remove any hard plaque on your medications. These medications can gum line or between your teeth. cause the gums to grow over their • Eat a well-balanced diet. Limit usual borders. As the gums enlarge, between meal snacks and sweets. they cover part of the teeth. This Plaque deposits on teeth Limit high sugar foods and sugar- gum overgrowth is called gingival containing drinks, particularly if hypertrophy. When the gums are Dental Decay they are in prolonged contact with enlarged, the overgrown gums (Dental Caries) your teeth. interfere with brushing and flossing. • Call your dentist if you notice any Bleeding and infection can occur. What is plaque and how chips or rough areas on your teeth, does it lead to tooth if your teeth become sensitive to If you are concerned about gum decay? cold or hot foods and drinks, or if overgrowth or have enlarged gums: you develop any tooth pain. Plaque is a sticky layer of bits of food • Call your transplant coordinator to • Have cavities treated as soon as and bacteria that is always forming discuss this medication side effect. possible to avoid the progression of on teeth. After you eat or drink Ask if you are taking any of the decay and infection. medications that can cause gum foods that contain sugar or starch, the overgrowth. bacteria in plaque make acids that • Observe your gums for any fullness attack the hard enamel covering of the and growth over the usual gum- tooth. The enamel can break down tooth border when you brush. over time from repeated attacks of this • Visit your dentist regularly for a acid. When the enamel breaks down, dental exam and cleaning. that area of the tooth decays, forming • Provide your dentist with a list of a cavity. your current medications. • Brush according to your dentist’s Plaque can also build up around the or hygienist’s guidelines if you have base of the teeth. Plaque hardens and gum overgrowth. A very soft is more difficult to remove if you do toothbrush is recommended to not brush and floss daily or get routine avoid bleeding gums. cleanings. Plaque irritates the gums, • Discuss any problems you are causing them to become swollen and having because of gum overgrowth bleed. This can progress to periodontal with your transplant physician. In disease. The tissue can also become infected. 3 What other oral problems effect of some medications. Many can occur? over-the-counter medications, such as antihistamines and decongestants, Thrush (candidiasis) is an infection cause dry mouth. Some of the caused by a fungus that normally lives medications that you are prescribed in your mouth and does not cause any after transplant cause dry mouth. Dry problems. But because you are taking mouth is often seen in older adults. medicines to suppress your immune system, this fungus can cause an Common symptoms of dry mouth infection. You are at a greater risk of Mouth ulcer include: thick, stringy saliva, a developing thrush during times when constant sore throat, mouth/tongue you are receiving higher levels of burning, bad breath, and difficulty Mouth ulcers or sores can develop immunosuppression to treat rejection. chewing, tasting, and swallowing. It in the soft tissue lining the mouth is also difficult to talk when you have (oral mucosa). These sores appear Thrush appears as white patchy dry mouth. Tooth decay and gum for many reasons, as in the general areas in your mouth. The areas can disease progress faster when there population. Transplant recipients be reddened and may be sore. It is not enough saliva to wash away can also get mouth ulcers as a result commonly forms on the lining of the acids produced by the bacteria of some anti-rejection medications. the mouth (oral mucosa), tongue, and in plaque. Dry mouth is harmful to Ulcers also occur by accidentally throat. If you have thrush, it might the transplant recipient because the biting the inside of your lip or when be uncomfortable to eat and your dryness can irritate the soft tissue in your mouth is irritated from dental mouth might be dry. Thrush is treated the mouth. Mouth sores or ulcers can braces or dentures. The ulcers wear with a medicine that can be taken as a develop. Having these open sores in away the mucosa resulting in a lozenge, pill or oral rinse. Your doctor your mouth can increase the risk of shallow sore with a red border and will prescribe this medication for you infection. a yellow or white center. The area is after transplant to prevent thrush, usually swollen and painful. Having particularly if you are on high levels of If you have dry mouth, discuss this mouth ulcers can cause problems anti-rejection medications, including side effect with your transplant with chewing, swallowing, and even prednisone (corticosteroids).