Posttransplantation Dental Treatment
Caution should be exercised when considering dental treatment for transplant patients until immune reconstitution has occurred; the time frame for this reconstitution can vary from 6 months to 12 months. Although hematologic parameters, including complete blood count and differential, may be documented as within normal limits, functional immune abnormalities may still be present. Patients should not resume routine dental treatment, including dental scaling and polishing, until adequate immunologic reconstitution has occurred; this includes recovery from graft-versus-host disease. The aerosolization of debris and bacteria during the use of ultrasonic or high-speed rotary cutting instruments can put the patient at risk for aspiration pneumonia; additionally, bacteremias often occur as a result of dental treatment, and their impact can be noticeable.
For patients who need urgent or emergency dental treatment, prophylactic antibiotics and strategies to reduce the potential influence of aspirating dental aerosols should be used. Additional administration of antibiotics should be determined by the patient’s risk of infection caused by the presenting condition or as a sequela of treatment.
Appropriate supportive care—including antibiotics, immunoglobulin G administration, adjustment of steroid doses, and/or platelet transfusions—should be comprehensively considered before invasive oral procedures are undertaken.