Necessity of surgical dental foci treatment prior to organ transplantation and heart valve replacement

Diagnosis and surgical treatment of septic foci (e.g., apical or marginal and profound periodontitis, cysts, unrestorable teeth, or abscesses) in patients awaiting organ transplants and heart valve replacement (HVR) have become a recommended, yet controversial standard procedure. This study aims to evaluate the numerical extent of the required oral surgical procedures removing septic foci in these patients. Data of 204 patients (115 males/89 females) of the Department of Oral- and Maxillofacial Surgery with an average age of 58 years were evaluated in terms of necessary oral surgical procedures before HVR or kidney (K), heart (H), or liver (L) transplant (T) and were compared with data from patients not undergoing transplantation or HVR, who were referred for other reasons such as oral surgery. The number of tooth extractions or apicoectomies per patient averaged two to five for each of the four patient groups (KT, 0–7 affected teeth; HT, 0–5; LT, 1–5; and HVR, 1–10). Treatment of periodontitis was necessary in 64% of patients. A total of 70% of patients required oral surgical procedures before HT, LT, and HVR, while 84% needed before KT. Removal of oral septic foci is necessary to avoid jeopardizing the success of transplantations. With regard to the surprisingly high need for surgical treatment in this patient population, assessment of these patients by the appropriate specialist and continuation with a follow-up program is still highly recommended.