A review of liver transplantation for the dentist and guidelines for dental management

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Boboia Date: 1/15/10
Article title: A review of liver transplantation for the dentist and guidelines for dental management
Author(s): Glassman et all
Journal: Special Care in Dentistry
Volume #; Number; Page #s): 13:2
Year: 1993
Introduction : The major goal of dental intervention before and after liver transplantation is the prevention of bacteremia from an oral source that could lead to systemic infection. In addition there are many pre- and post-transplant issues that should be addressed in order for the dentist to properly and safely render treatment.
Dental Protocol prior to liver transplant:
• Obtain proper medical dental history
• Prioritize dental problems. Those most likely to cause pain, bleeding, infection, or bacteremia in the next 12 months should receive the highest priority.
• PT/PTT, platelet count, and bleeding time should be known prior to performing any procedures which will cause bleeding. A PT time less then 16 seconds requires no transfusions, anything higher will. Platelet count less then 50,000 will require platelet replacement. In additition, minimize bleeding through topical hemostatic agents, pressure packs, etc. Swallowed blood is also an issue because it’s a source of protein that may not be easily metabolized
• Acites – contact physician regarding use of AB prophylaxis or refer to AHA guidelines
• Caution when using drugs such as acetaminophen, local anesthetics, narcotics, etc. since most are metabolized by the liver

Dental protocol after liver transplant:
• Obtain all current medical history
• Thorough dental exam
• Prioritize dental problems. Those most likely to cause pain, bleeding, infection, or bacteremia in the next 12 months should receive the highest priority.
• AB prophylaxis when necessary
• Steroid supplementation when appropriate
• OH procedures; stress use of floss to prevent cyclosporine induced gingival hyperplasia and other dental pathology. Remove local irritants
• Caution when using drugs such as acetaminophen, local anesthetics, narcotics, etc. since most are metabolized by the liver