A survey of dental care protocols among US organ transplant centers


James Guggenheimer, G-137 Salk, University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, Pittsburgh, PA 15261, USA.
Tel.: 412 648 8627; fax: 412 383 9142;
e-mail: guggen@pitt.edu


Abstract:  Untreated dental disease represents a potential risk for infection in transplant patients, but the vast transplantation literature has few references to this complication. There is also little information with regard to dental care protocols for patients before and after organ transplantation. To obtain more definitive documentation about the policies that deal with dental care and experience with dental infections, we conducted a survey of US transplant centers.The instrument consisted of eight questions that addressed pre-transplant dental evaluation procedures, incidence of pre- and post-transplant dental infections, and recommendations for antibiotic prophylaxis with dental treatment after transplantation. Questionnaires were sent to 768 medical and/or surgical directors at all US transplant centers. Responses were received from 294 recipients (38%). Among the respondents, 80% routinely requested a pre-transplant dental evaluation, but 49% of these were only for specific organs. The occurrence of a dental infection prior to transplantation that resulted in a postponement or cancellation was reported by 38% of the respondents. Post-transplantation sepsis from a suspected dental source was acknowledged in 27% of the surveys. Prophylaxis with antibiotics prior to dental care was recommended by 83%; 77% indicated that it be used for all dental procedures, whether invasive or not. Most respondents (96%) recommended the 1997 American Heart Association endocarditis prevention regimen. A survey of organ transplant centers has provided some information with regard to pre-transplantation dental screening, dental infections, and the use of prophylactic antibiotics. Additional studies are needed in order to accrue more definitive data that will assist with the development of standardized and appropriate pre- and post-transplant dental care protocols.