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What Every Transplant Patient Needs to Know About Dental Care

International Transplant Nurses Society Should patients have that still need to be done. Taking each day because they don’t feel a dental exam before care of your teeth and gums (oral . 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, , transplant evaluation. It is helpful to maintaining healthy teeth and gums is or side effects of your . 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 , 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 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 , decay, 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 ()

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. 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 • (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. and • Changes in the way your teeth fit or 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 that does not • Brush at least twice a day with have this side effect. If the medication fluoride , 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 Gum Overgrowth help maintain good gum health brushing and flossing your teeth 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 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 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 • Call your transplant coordinator to • Have cavities treated as soon as and 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 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 . 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 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 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 . You are at a greater risk of include: thick, stringy , a developing thrush during times when constant sore , mouth/ 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 lining the mouth is also difficult to talk when you have (). These sores appear Thrush appears as white patchy dry mouth. 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 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 . 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). physician and/or dentist. Ask if talking. Eating soft, mild foods that this is a side effect of any of the are easy to swallow such as creamed Smoking, dry mouth, diabetes, and medications you are taking. Your soups, cottage cheese, and yogurt can having dentures increase the risk of dentist can recommend some ways to help relieve the pain. Drinking cold getting a thrush infection in your increase the moisture in your mouth. fluids will also help. There are some mouth. You can improve the symptoms of dry over-the-counter medicines that can be mouth by: applied to the ulcer and surrounding • sucking on sugar-free to area to decrease pain. Patients who stimulate saliva have ulcers that are very painful • chewing sugar-free gum may find relief with a medicine that • using artificial saliva or an over-the- numbs the area (anesthetic). This counter oral moisturizer medication is sprayed or applied to • rinsing frequently with alcohol- the irritated area. Ask your dentist free oral rinses such as normal about the product that is best for you. , 3% , club Mouth ulcers usually heal within 1 to Thrush (candidiasis) soda, or Biotene® 3 weeks. Call your doctor or dentist • avoiding alcohol, salty foods, and if you have mouth ulcers that are not Dry mouth () occurs when caffeine healing or if the area around the ulcers you do not have enough saliva to • drinking water frequently has increasing redness, swelling, or keep your mouth moist. This happens • sucking on ice chips pain. when the salivary glands are not working well and can occur as a side

4 How can I avoid these ✓ Use a toothbrush that has a small As a transplant patient, you should dental problems? head with soft or ultra soft bristles. also: Soft will provide a safe ✓ Remind your dentist and hygienist You can have healthy teeth, gums and and gentle action to remove trapped that you have had a transplant. mouth tissue after transplant with plaque and food. Automatic (rotary) ✓ Always take all your medications as good . It’s easy to forget toothbrushes are also recommended. prescribed by your transplant team. about this part of your health with all ✓ Brush for about 3 minutes. Power ✓ Get your labs drawn regularly as the other responsibilities you have as toothbrushes will automatically do instructed. a new transplant recipient. Here are this. ✓ Make sure your dentist knows what some important guidelines for good ✓ Replace your toothbrush at least medicines you are taking. dental health: every 3 months. ✓ Examine your mouth regularly ✓ Brush at least twice a day, ✓ Rinse with a to help and call your physician and/or particularly after meals and before decrease bacteria, freshen your dentist if you have any chipped or going to sleep. breath, and reduce plaque. cracked teeth, tooth pain, swelling, ✓ Floss between teeth daily to remove ✓ Visit your dentist and hygienist for red or swollen gums, bleeding, food particles and plaque. regular check-ups and cleanings sores in your mouth, or white every 6 months. If you develop patches on your tongue or the lining problems, you should have a check- of your mouth. up every 3 or 4 months. ✓ Remember that your dentist and ✓ Eat a balanced diet and avoid sweets. hygienist are a part of your transplant team.

motion or a small circular motion. • Brush behind the upper and lower front teeth. Hold your brush How should I brush my vertically (straight up instead of teeth? sideways) and use the bristles at the Discuss the best way to brush and top of the brush. floss your teeth with your dentist • Brush the surfaces of the back teeth. and hygienist. If you are having any • Rinse thoroughly. dental problems, they can advise you about the best method. Generally, the How should I floss? following steps will lead to a thorough • Wrap the floss comfortably around cleaning: your fingers so that you can control • Choose toothpaste that is approved it as you floss. by your dental association (ADA • Gently ease and glide the floss back approved, CDA approved). and forth between your teeth • Choose a toothbrush as making a “C” shape around the recommended by your dentist. A tooth with the floss. soft bristle brush is usually the best. • Be careful to move the floss up and Your dentist may also recommend down the side of the tooth so that an automatic (rotary) toothbrush. you are thoroughly cleaning between • Hold the brush at a 45 degree angle the teeth and between each tooth against your teeth so that the and the gum. bristles of the brush into the • If it is difficult to get the floss space between your teeth and gums. between your teeth, try using dental • Gently brush the outside and tape. It is slightly thicker than floss insides of your teeth on the top and and may be helpful. bottom using a short back-and-forth 5 Do I have to do anything injure the gum, like having a tooth Do not ignore any dental pain or delay special before having a pulled, taking an before the treatment. It is important to have procedure to prevent any problems injured teeth repaired quickly to avoid dental procedure since with infection may be recommended further complications. my immune system is by some transplant centers. This is suppressed? called infection prophylaxis. Your Transplant recipients may have a dentist will prescribe the appropriate greater risk for developing an oral antibiotic and will tell you how to infection when the gums or the lining take it. Please contact your transplant of the mouth are injured through coordinator about your center’s a procedure because their immune protocol for infection prevention system is suppressed. Bacteria that before dental procedures. are commonly in the mouth can cause infection. This can become more What should I do if I have serious if the infection spreads into the a ? bloodstream. Infection may be more If you have an emergency situation, of a risk if the levels of anti-rejection such as a cracked or broken tooth, medications are high, as during pain, or swelling, contact your dentist treatment for rejection. immediately. Tell your dentist what medications you are taking or show If you are seeing your dentist for him your current medication list. Your a routine examination, no special dentist may prescribe an antibiotic if treatment is needed before your there is concern about infection before appointment. If you are having a any procedure is begun. cleaning or any procedure that may

healthy teeth and gums: decrease the growth of plaque and • Vitamin C and folic acid help can also help rinse food particles maintain healthy gums. Many fruits from your teeth. and vegetables provide good sources of these nutrients. Eat a diet that includes the appropriate • Iron and B Vitamins, which are amounts of these foods based on your important for your blood, are found health needs. Do not take additional in whole grains. Breads high in vitamins or supplements unless fiber, whole grain cereals, and rice prescribed by your physician. are good sources. • Protein is important for wound can add to tooth decay healing and tissue growth and by feeding the bacteria in plaque. repair. Good sources of protein Foods such as pasta, white bread, include lean meat, fish, poultry, and whole milk, cakes, and cookies can beans. cause the bacteria to release acids How does my diet affect • Fruits and vegetables high in fiber leading to decay. Some of this acid can my dental health? can contribute to good dental health be rinsed away by drinking or rinsing The types of food that you eat and by increasing the flow of saliva your mouth with water, the rinsing your eating habits affect the health which lowers acid levels and helps action of your saliva, and of course, by of your teeth and gums. Some foods clean the teeth. Chewing these brushing your teeth. Foods that stick promote and maintain healthy teeth foods can also help clean your teeth. to your teeth can be more harmful and gums. Other foods cause plaque • It is also helpful to drink water because the plaque acids will continue and tooth decay to develop. Good throughout the day. Water will help to attack the enamel even after you nutrition is important to maintain 6 have stopped eating. Other “sticky” are more resistant to acid attacks that Foundation recommend the foods include raisins and other dried increase tooth decay. If you drink appropriate use of fluorides through fruits, candy, and . fluoridated water the fluoride will also fluoride toothpaste in adults and be in your saliva, which continually children over the age of 2 years, in Remember that drinks such as fruit washes your teeth. This applies to mouth rinses with fluoride for adults , iced , sports drinks and the general population as well as and children over the age of 6 years, carbonated drinks contain sugar, transplant recipients. Thanks to water and through applications of fluoride unless they are diet drinks. All these fluoridation, the incidence of tooth by a dentist or during products have a high acid content that decay has decreased significantly. routine dental visits. can promote tooth decay. can also be applied to the What is fluoride and why tooth surfaces. This is the fluoride is it important for my treatment applied to your teeth by your dentist or hygienist. Most teeth? contain fluoride. Fluoride Fluoride is a mineral that is usually mouth rinses are also available either added to the drinking water in over-the-counter or by prescription. many cities. It has been proven to be Adding topical fluoride treatments to safe and effective in reducing tooth your dental care routine helps teeth decay. Fluoride helps strengthen resist the development of tooth decay. teeth by repairing the areas in the enamel where acid from foods and the The American Dental Association bacteria in plaque has begun to break (ADA), Canadian Dental Association, it down. Teeth exposed to fluoride and the British Dental Health

I know I should visit my patients. Try bringing a portable CD dentist regularly, but I’m player or radio with a headset so you can listen to your favorite music or really frightened about talk radio. Listening may help distract having any dental work. you during the procedure. What should I do? Being worried and even scared about Dental treatments have become more visiting the dentist is a common fear. comfortable over the years, so you There’s even a name for it! It’s called may be worrying unnecessarily. Talk “dental anxiety.” The best way to to your dentist about your fears. If you overcome your fear of going to the continue to have severe dental anxiety, dentist is to make an appointment medications can be used to help you to discuss your concerns. As your relax. There are some medications dentist and the dental staff get to that can put you into a light sleep or know you better, they will be able a deep sleep, if necessary. If this type to work with you on ways to reduce of medication is needed, your dentist your fear. Choose a time for your and transplant physician will consider visit when you are not rushed. An your overall health status, any early appointment might be helpful ongoing problems, the type of dental so you don’t worry all day. Many procedure, your level of anxiety, and dentists can use a variety of relaxation your current medications. therapies, music, and other distraction techniques to help their anxious

7 My insurance does not their natural teeth. They may or may cover any dental care. not choose to use dentures. Having healthy gums is just as important for What options do I have these patients. You are also at risk for for care? some of the conditions that have been Dental health plans and coverage described in this booklet, including Can transplant patients for dental care varies widely. Some infection with a mouth fungus develop cancer of the patients pay only a small co-payment (thrush), dry mouth, and mouth ulcers. mouth? while others have very little coverage The methods for the prevention and Cancers of the mouth (oral cancer) tend or must pay out-of-pocket for all treatment of these problems will be to develop in older people, especially dental care. If you do not have the same as for patients who have if they have smoked. This also insurance coverage for dental care, teeth. You should keep your mouth applies to patients who have received discuss this with your transplant and dentures clean and rinse both transplants. Mouth cancers tend to social worker or insurance case after eating. Dentures should not be grow slowly and patients are usually worker. Your social worker may be worn at night. not aware that cancer has developed able to help you get an appointment in their mouth until the tumors have at a free dental clinic through a dental Weight gain or loss before or after become advanced. This is another school or at a community health clinic. transplant surgery can cause changes reason why you should have a Some dental clinics may offer a sliding in how your dentures fit. This should regular check-up with your dentist. scale for payment based on your be corrected as soon as possible so that Dentists should include an oral cancer income. You may also be able to set poor-fitting dentures do not interfere at routine check-ups every up a payment schedule with your with eating and maintaining a healthy six months, or every year for denture dentist. diet. wearers. Your dentist will carefully inspect all areas in your mouth I wear dentures. Do I still If you develop a sore spot, a lump, including your gums, the inside of have to be concerned or an ulcer in your mouth that does your , the tissue under your about mouth care? not heal within 2 weeks, schedule an tongue, and your tongue surfaces. appointment to see your dentist as If you have lost some of your teeth soon as possible. and have partial dentures, you should Some mouth cancers develop from follow the same guidelines that have pre-cancerous lesions, or patches in Denture wearers should have their been described for patients who the mouth. These are painless white examined by a dentist at least have their natural teeth. Some organ patches () or red patches once a year. This examination should transplant recipients will have lost all (). These lesions should include a screening for mouth cancer. be examined by a dentist immediately, particularly if they develop on the sides or under your tongue. A biopsy of these abnormal areas will be taken to see if the cells of the lesion are benign (not cancerous), pre-cancerous, or malignant (have cancer cells). Your dentist may perform the biopsy or refer you to an oral surgeon or an , nose, and throat (ENT) specialist for this procedure.

If you develop a lump, sore, or ulcer anywhere in your mouth, or a lump in your neck that lasts for more than two weeks, you should see your doctor or dentist for an examination.

8 Dental Care for Children milk has settled. This pattern of decay with an Organ Transplant is called “ mouth.” Saliva, which helps rinse and protect the teeth, decreases when sleeping which My child has received a adds to the development of tooth transplant. How should I decay. start caring for his teeth? As your child gets older, it is If your child is a transplant recipient, important to have him brush twice What are my child’s risks caring for your child’s teeth and gums daily, especially before going to for dental problems after includes the same care routines as for bed. Place a pea-sized amount of transplant? any child. The first step in taking toothpaste on his toothbrush. Teach Children, like adults, are at risk for care of an infant’s teeth is to get him your child to brush each section of gum problems, tooth decay, mouth used to the feeling of cleaning his his mouth: the upper and lower teeth ulcers, and infection. Gum overgrowth teeth and gums. Dentists call this on each side, and the top and bottom can also occur as a side effect of some “desensitizing” the mouth. You can front teeth. After brushing, he should medications. begin to desensitize your child’s swish and spit, then rinse. Learning to mouth by touching or rubbing his “swish and spit” is difficult for a small What can I do to help my mouth and gums with your clean child, but he will improve in time. fingers. You can use a washcloth, a Rotary (automatic) toothbrushes can child have healthy teeth rubber stimulator (in the baby section be helpful for young children learning and gums? of your or supermarket), or to hold and position the toothbrush in There are several things you can do to a toothette sponge (like a toothbrush, their mouths. help your child maintain good dental but with a small sponge on the end) health. to massage and clean the gums and Flossing between your child’s teeth ✓ Remind, supervise, and help your any new teeth. Use water to clean an is important to remove plaque and child brush his teeth and floss. infant’s teeth and gums. food debris. Your child will need ✓ Examine your child’s mouth help with this for a while, particularly regularly for gum swelling, redness You should rinse your baby’s mouth if they have tightly arranged teeth. or overgrowth. Check for mouth with water or clean it with a moist Individual dental “flossers” are easy ulcers and signs of infection toothette or clean cloth after breast or to use when flossing your child’s including red, swollen gums and/or bottle-feeding. Avoid soothing your teeth. These are available in the white patches (thrush). As your child to sleep with breast or bottle dental section of your pharmacy or child gets older, teach him how to feedings or a sippy cup. Tooth decay supermarket. check for these oral health problems. develops around the teeth where the ✓ Provide healthy snacks for your child and avoid high sugar snacks, soft drinks, and treats that can contribute to tooth decay. ✓ Schedule visits to your child’s dentist and dental hygienist at least every 6 months for an examination and cleaning. ✓ Call your dentist with any problems or complaints and have dental problems treated promptly. ✓ Ask your dentist about sealants. A sealant is a protective coating that can be applied to the surface of the back teeth where cavities often develop.

9 ✓ Be sure your child is getting the How can I talk to my right amount of , vitamin D, teenager about the risks and . These nutrients help build strong teeth as well as of oral piercing? bones and are found in dairy Piercing the tongue and has products such as milk, cheese, and become popular in some groups of yogurt. Talk to your pediatrician or adolescents and young adults as a transplant dietician about food form of self-expression. Many serious choices for your child. Do not complications have been associated the mouth. Oral jewelry can affect give additional vitamins or food with this practice. Teens should speech, cause problems with chewing supplements unless instructed to do be given advice about the serious and swallowing food, and stimulate so by your physician. complications that can arise from oral excessive saliva. Oral jewelry will ✓ Fluoride is important for children piercing. interfere with good because it strengthens the teeth and flossing. as they develop - even before the There are many risks associated teeth appear. Your child can absorb with oral piercing. Injuries, tongue Infection is a common side effect of fluoride through drinking water that bleeding or swelling, nerve damage, oral piercing. With all the bacteria is fluoridated or by taking vitamins and transmission of infections can in the mouth, infections can easily that have fluoride. Fluoride can also occur. These pieces of metal can develop in injured tissues. Transplant be given as drops, tablets, or lozenges crack or chip teeth and can lead patients are at an even higher risk of if you do not have fluoridated water. to gum injury and recession of the infection since their immune system gums. The jewelry can also be a is suppressed. Transplant patients choking hazard if it becomes loose in should never consider oral piercing.

How can I find a dentist? Before you arrange an appointment • How often would you like to see me The best plan for most patients is to with a dentist for your first check-up, for routine check-ups and cleanings? have your regular dentist continue ask for some time to discuss your • Are procedures for sterilizing your to treat you after transplant. That dental care as a transplant recipient. dental instruments appropriate for person will be familiar with your Asking questions before your check- patients who are immunosuppressed? mouth and will be able to determine up can help you feel comfortable with • What types of procedures are done if you are developing problems that your dentist’s care. It is important that in your office? were not present before you had your your dentist spends enough time with • What types of procedures will be transplant. Providing dental care you to answer your questions and referred to another specialist? for transplant recipients is not much discuss your concerns. • What should be done in case of a different than treating other patients. dental emergency? Is there an office Some questions to ask when choosing emergency line, emergency contact, However, dentists may relocate or a dentist: or answering service? retire. Your regular dentist may not • Do you have any experience in be comfortable treating you after providing dental care for transplant Dental health is an important aspect transplant. If this is the case, you can recipients? of care for everyone. As a transplant start by asking your local physician for • If not, are you comfortable treating patient, it is essential that you take a referral to a dentist in your area who patients who are immunosuppressed? care of your teeth and gums by is comfortable with caring for patients • Do you think it is important to take routinely brushing and flossing. Be with transplants or has experience before any invasive sure to see your dentist and dental with these patients. Friends, family, dental procedure since I’m hygienist every 6 months. Remember, or co-workers can be a referral source. immunosuppressed? If so, will you your dental care practitioners are part You can also get a listing of dentists give me a prescription for the of your transplant team! through professional organizations in medication or should I ask my your country by contacting your local transplant physician for the dental society. prescription?

10 Related Links for More Information

ITNS is not responsible or liable for any information received from these websites. These sites are provided as a network resource. Information from the Internet in regard to your transplant should always be discussed with your transplant team. For additional information on dental care: www.hdassoc.org The Hispanic Dental Association is the only national association of dental health professionals www.ada.org The American Dental Association is dedicated to promoting and improving the oral health of the professional association of dentists committed to the Hispanic community. the public’s oral health, ethics, science and professional advancement http://www.nidcr.nih.gov The National Institute of Dental and Craniofacial Research (NIDCR). The www.ada.org.au The Australian Dental Association is an mission of this organization is to improve oral, dental and organization of dentists whose aim is the encouragement craniofacial health through research, research training, and of the health of the public and the promotion of the art and the dissemination of health information. science of . http://www.oralcareindia.com/ Oral Care India. http://www.adha.org/oralhealth/index.html The Information on dental care, emergencies, and dental American Dental Hygienists’ Association. Contains practitioners in India. consumer information about dental care. http://www.simplestepsdental.com Information about http://www.aakp.org/newsletters/Kidney-Transplant/ dental care from the Columbia University College of Dental August-2005/The-Importance-of-Dental-Care-for- Medicine, New York. Transplant-Recipients/index.cfm An article on the American Association of Kidney Patients website about http://www.splut.com/015/007.htm. UK Dental Care dental care pre- and post-transplant. Websites. A complete listing of a variety of dental care websites within the UK http://www.cdc.gov/OralHealth/ Oral Health Resources through the Centers for Disease Control and Prevention (CDC). Contains information about state- and community-based programs in the US to prevent oral disease, promote oral health, and foster research to enhance oral disease prevention. http://www.dentalhealth.org.uk The British Dental Health Foundation is the leading UK-based independent charity working to bring about improved standards of oral health care. Its goal is to serve the public interest by improving awareness of and access to better oral health. www.cdha.ca The Canadian Dental Hygienists Association. The CDHA contributes to the health of the public by leading the development of national positions and encouraging standards related to dental hygiene practice, education, research, and regulation. Information is available on oral health care for the public.

11 This project is supported by an educational grant from Novartis Pharmaceuticals Corporation. ITNS gratefully acknowledges their support of this educational endeavor for improving patient care and outcomes.

Authors: Leslie Gibson RN, BScN, CDA II Beverly Kosmach-Park MSN, CRNP James Guggenheimer DDS

Reviewers: Caroline Tassey MS ARNP CCRN Pat Folk RN, BSN, CCTC Kathy Lawrence MN, RN Darlene Long MS, APRN, BC, ANP, CCTC Cindy Hoekstra RN, BScN, CCTN Lisa L. Bakken RN BSN CCTC

The International Transplant Nurses Society was founded in 1992 as the first professional nursing organization to focus on the professional growth and development of the transplant clinician. ITNS is committed to the promotion of excellence in transplant clinical nursing through the provision of educational and professional growth opportunities, interdisciplinary networking and collaborative activities, and transplant nursing research. This educational brochure is designed to enhance patient education as provided by individual transplant centers. Patients should follow their transplant team’s specific guidelines for dental care after transplant.

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