Oral changes associated with end-stage liver disease and liver transplantation: implications and dental management

Kris Hendricks January 15, 2010

Article Title: Oral changes associated with end-stage liver disease and liver transplantation: implications for dental management.

Authors: W. Kim Seow, R.W> Shepherd, T.H. Ong

Journal: Journal of Dentistry for Children

Volume: Nov-Dec 1991

Major Topic: Liver Disease and its dental complications

Minor Topic: Oral Pathology

Type of Article: Informative with Case studies

Main Purpose: The study investigates a group of children with end-stage liver disease with particular reference to the oral manifestations of the disease, as well as the complications associated with liver transplantation.

Overview of Method of Research: Review of current (1991) literature for medical and dental live disease management in children. Case study also.

Findings:

• All patients presented with enamel defects and some degree of gingival and enamel staining.
• Good oral hygiene lessens gingival hypertrophy in post-transplant patients
• High concentration topical fluoride applications are not recommended due to compromised metabolism
• Postoperative antibiotic coverage with Pen VK is recommended due to weakened immune system.
• Bleeding tests must be performed prior to any surgical treatment and all deficiencies should be treated prior to or during procedures, including IV infusion of fresh frozen plasma and Vit. K.
• Special anesthetic consideration due to decreased liver function. Usually isoflurane is the general anesthetic of choice.

Key Point/Summary

• End-stage liver disease causes nutrition deficiences due to poor absorption of fats and fat soluble vitamins such as A,D,E,K
• Vit. K deficiencies lead to bleeding tendencies
• Osteopenia, and rachitic skeletal changes as a result of poor vit D metabolism
• Transplant is the preferred treatment
• Post-transplant patients are usually immuno-suppressed with cyclosporin ( at least they were 20 years ago)
• Oral manifestations are green staining on teeth, enamel hypoplasia, gingival staining and cyclosporin induced gingival hypertrophy.
• Histologic and anatomical studies reveal that post-transplant enamel formation is normal. For example a tooth root may be stained and malformed until transplanation and then continue in a normal fashion thereafter.
• In this sample, gingival staining often continued post-transplant, even when billirubin levels were well controlled.
• Gingival hypertrophy increased with time after cyclosporin treatment.

Assessment of article: Good article. May be outdated, but it was interesting and informative without taking it beyond the scope of what a dentist needs to know.