Oral Alterations in Individuals in Pre and Post Heart Transplantation

Abstract

Heart failure in advanced stages and unsuccessful alternative treatments can lead the patient to heart transplantation. Patients in pre-heart transplantation who present periodontal alterations can progress to an infectious condition and compromise the success of the transplant. Transplanted patients have intraoral changes associated with immunosuppressive therapy, such as gingival hyperplasia and opportunistic infections that deserve attention, as they result in poor quality of life and worse prognosis. This study searched the literature for oral alterations frequently found in patients with heart failure in a transplant program and heart transplant recipients, highlighting the importance of the dentist in the multidisciplinary team and the long-term follow-up of the transplanted patient. In this review, cohort studies, cross-sectional studies, case-control studies and clinical cases included in the PubMed, Biblioteca Eletrônica Científica Online (SciELO) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) databases of the last 11 years (from 2009 to 2020) and in English, Portuguese and Spanish. The search result made available 577 articles, which were screened and selected, so that they included all the information necessary for the statistical analysis. Among the most relevant data regarding the oral condition of pre-heart transplant patients, it was observed that 74.21% of individuals have systemic arterial hypertension as the main comorbidity and 42.69% use immunosuppressants. As for the oral diagnosis, there is a high need for periodontal treatment in 75.57% of the patients. In the profile of transplanted patients, there is a higher prevalence of diabetes mellitus (48.26%), and all patients follow drug therapy, with an association of more than one drug. Of these individuals, 90% need periodontal treatment and 17.34% had gingival hyperplasia. The data obtained allowed us to conclude that both heart transplant and transplant patients need special attention with regard to oral care, as they are susceptible to opportunistic infections and have periodontal care needs, which suggests that oral adequacy prior to transplantation is relevant, as is the control of the secondary effects of immunosuppressive therapy.