The transplant patient with gingival overgrowths*
A 71-year old patient presents with having previously undergone a kidney transplant and with a history of hypertonia (high blood pressure). Due to his medical history, long-term medication with cyclosporine is required to suppress the immune system, as well as amlodipine to lower blood pressure. The patient also reports sensitive and bleeding gums. From an oral health perspective, the patient has undergone dental restoration and has eight missing teeth, pronounced gingival growth, and grade B, stage II periodontitis with active pockets and initial root caries on tooth 22. The caries risk assessment determines a moderate risk of caries (API 60). The following treatment recommendations can be determined for the prophylaxis session.
Based on the patient’s medical history, it is possible to identify a particular risk of complications. Due to the kidney transplant, the patient is immunosuppressed (cyclosporine), and therefore has a weakened immune system and requires infection prophylaxis (recommendation: 2 g of amoxicillin as an antibiotic, 1 hour before the session). At the same time, the patient’s long-term medication carries an increased risk of disease, as the gingival overgrowths identified are associated with this medication (20).
The patient’s situation must be addressed, especially when it comes to motivation and instruction. Due to the gingival overgrowths, the patient finds it difficult to practise good oral hygiene at home. The increased susceptibility to infection as well as the progression and emergence of the overgrowths (22) should be discussed at the patient’s level. At the same time, the patient should be instructed in hygiene techniques that are tailored to his individual needs.
There are no specific recommendations for cleaning. According to the findings, rotary polishing should be carried out selectively in erosion-sensitive areas. Because the patient’s oral health is fragile, it is important to create the best possible conditions for at-home maintenance in the prophylaxis session, e.g. by creating smooth surfaces, administering fluoridation to prevent tooth decay, and using mouthwash with CHX to address active inflammation.
A shorter recall interval of three to four months is recommended for this patient. This is mainly due to the gingival overgrowths associated with the patient’s medication, the fact these overgrowths make at-home oral care difficult for the patient, and the risk of progression of periodontitis.
* with the kind permission of Dr G. Schmalz and Dr D. Ziebolz MSc.