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Dental care before lung transplantation: are we being too rigorous?

Authors


  • Authorship and contributorship

    SW participated in performance of the research, writing of the paper, data analysis and research design.

    CF participated in performance of the research, writing of the paper and data analysis.

    MG participated in performance of the research, research design and data analysis.

    PRK participated in research design, writing of the paper and data analysis.

    WW participated in performance of the research, writing of the paper, data analysis and research design.

  • Ethics

    The study was approved by the Ethics Committee of the University Hospital of Freiburg and complies with the standards laid down in the Declaration of Helsinki.

  • Conflict of interest

    The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Correspondence

Stephan Walterspacher, MD, Department of Respiratory Medicine, University Hospital Freiburg, Killianstr. 5, 79106

Freiburg, Germany.

Tel: +49 761 270 37060

Fax: +49 761 270 37040

email: stephan.walterspacher@uniklinik-freiburg.de

Abstract

Objective

Poor dental status is known to cause infections in severely sick and in elderly patients. In patients awaiting lung transplantation, rigorous dental treatment is a common prerequisite, although evidence-based data are lacking with regard to extent, necessity and effect on post-transplantation infectious status.

Materials and Methods

In the present retrospective study, dental status [dental history (missing teeth, caries, tooth restorations and extractions, prevalence of periodontitis) and dental treatment prior transplantation] was assessed in 85 lung transplant candidates at the University Hospital of Freiburg, Germany and evaluated for infectious foci in the first 3 years following transplantation.

Results

Forty-nine patients got transplanted in the observed timespan. Total tooth count differed significantly between chronic obstructive pulmonary disease (16 ± 9), pulmonary fibrosis (22 ± 7) or cystic fibrosis (30 ± 3) patients prior transplantation (P > 0.001). Periodontitis prevalence yielded no difference and was mainly not treated prior transplantation. No dental-related infectious focus could be diagnosed post-transplantation. However, 15% of post-transplantation infections were of unknown focus, and infection rate was increased in year 2 post-transplantation in patients without periodontitis.

Conclusion

No clearly defined dental foci were registered following transplantation. This raises the question of whether current dental treatment in these highly compromised patients is too rigorous with regard to tooth extractions. However, no focus could be detected in 15% of the registered infections. Therefore, controversially, post-transplantation dental care could also be insufficient with regard to undertreated periodontitis.

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