Aspectos bucais de pacientes candidatos a transplante de fígado e pâncreas-rim no Hospital São Paulo e Hospital do Rim
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Data
2018-07-26
Autores
Pereira, Andrea Helena Francisca Ramaglia [UNIFESP]
Orientadores
Gonzalez, Adriano Miziara [UNIFESP]
Tipo
Dissertação de mestrado
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As infecções bacterianas representam um risco elevado para o paciente candidato a transplante de órgão sólido. Este fato nos remete a importância de eliminar focos infecciosos da cavidade oral previamente ao transplante. Lesões periapicais, dentes em péssimas condições, doença periodontal e placa bacteriana são capazes de desencadear risco no pós-operatório. O objetivo deste trabalho foi avaliar as condições bucais dos pacientes candidatos a transplante de fígado e pâncreas – rim. Foi utilizado como método as condições bucais através de exame intra e extras orais, pacientes inscritos na fila do transplante de fígado e pâncreas – rim de agosto/2015 a fevereiro/2018, e correlacionamos estes achados com variáveis demográficas. Como resultados verificou-se que as variáveis demográficas nos candidatos a transplante de fígado (n=50) foram: sexo masculino 70%, idade média 44,5±12,92 anos. A média observada do valor do MELD foi de 22,5±9,2. Na avaliação da cirrose, a hepatite viral ocupou lugar de destaque acometendo 60% dos pacientes. As variáveis demográficas nos pacientes candidatos a transplante de pâncreas – rim (n=50) foram: sexo masculino 66%, idade média 39 ±7,0anos, tempo de diabetes a média foi de 25±7,3 anos, tempo de dialise a média foi 4±1,52 anos. A amaurose unilateral foi identificada em 22% dos pacientes e a amaurose bilateral em10% dos pacientes. O fio dental foi utilizado diariamente por 62% dos pacientes. As principais alterações nos candidatos de fígado e pâncreas foram: índice de CPOD (dentes cariados perdidos e obturados) com escore 5 (candidatos a transplante de fígado 100% versus candidatos a transplante de pâncreas – rim 83%, P<0,0001). No entanto a necessidade de tratamento odontológico foi igual nos 2 grupos: 70% versus 71% respectivamente (P=NS). Com base nestes dados conclui-se que os pacientes em fila de transplantes necessitam de cuidados odontológicos independente das características demográficas devido as condições bucais no momento do exame clínico). Na análise de fatores de risco, observamos que a necessidade de tratamento dentário nos pacientes candidatos a transplante de fígado teve correlação com idade (P=0,046), cor (P=0,046) e diagnóstico de hepatite viral (P=0,033). Não identificamos fatores de risco para os candidatos a transplante de pâncreas-rim.
Bacterial infections represent a high risk for a patient candidate for solid organ transplant. This fact relates to the importance of eliminating infectious sources in oral cavity previous to the transplant. Periapical wounds, teeth in bad conditions, periodontal diseases and plaque can lead to postoperative risks. The aim of this present work was to evaluate oral conditions of liver and pancreas-kidney transplant candidates. The method used was the oral conditions, checked via intra and extra oral exams, of patients registered in the waiting list for liver and pancreas-kidney transplant from August/2015 to February/2018; and the findings were correlated to demographic variables. It was found that demographic variables of liver transplant candidates (n=50) were the following: 70% male, average age of 44.5±12.92 years. The observed MELD value mean was 22.5±9.2. In cirrhosis evaluation, viral hepatitis was emphasized for it affected 60% of patients. Demographic variables of pancreas-kidney transplant candidates (n=50) were: 66% male, average age of 39 ±7.0 years, average diabetes time of 25±7.3 years, average dialysis time of 4±1.52 years. Unilateral amaurosis was found in 22% of patients, and bilateral amaurosis in 10% of patients. Dental floss was used daily by 62% of patients. The main alterations noticed in liver and pancreas transplant candidates were: CPOD index (tooth decay, lost and filled) with a score of 5 (liver transplant patients 100% versus pancreas-kidney transplant patients 83%, P<0.0001). However, the necessity of dental treatment was equal in the two groups: 70% versus 71%, respectively (P=NS). Based on these data, the conclusion is that there is a need for patients in the waiting list for transplants to have dental care, independently of demographic characteristics; it occurs due to the oral conditions at the time of clinical exams. In risk factors analysis, it was observed that the necessity for dental treatment in patients candidates for liver transplant was correlated with age (P=0,046), skin color (P=0,046) and viral hepatitisdiagnosis (P=0,033). No risk factors were identified for pancreas-kidney transplant patients.
Bacterial infections represent a high risk for a patient candidate for solid organ transplant. This fact relates to the importance of eliminating infectious sources in oral cavity previous to the transplant. Periapical wounds, teeth in bad conditions, periodontal diseases and plaque can lead to postoperative risks. The aim of this present work was to evaluate oral conditions of liver and pancreas-kidney transplant candidates. The method used was the oral conditions, checked via intra and extra oral exams, of patients registered in the waiting list for liver and pancreas-kidney transplant from August/2015 to February/2018; and the findings were correlated to demographic variables. It was found that demographic variables of liver transplant candidates (n=50) were the following: 70% male, average age of 44.5±12.92 years. The observed MELD value mean was 22.5±9.2. In cirrhosis evaluation, viral hepatitis was emphasized for it affected 60% of patients. Demographic variables of pancreas-kidney transplant candidates (n=50) were: 66% male, average age of 39 ±7.0 years, average diabetes time of 25±7.3 years, average dialysis time of 4±1.52 years. Unilateral amaurosis was found in 22% of patients, and bilateral amaurosis in 10% of patients. Dental floss was used daily by 62% of patients. The main alterations noticed in liver and pancreas transplant candidates were: CPOD index (tooth decay, lost and filled) with a score of 5 (liver transplant patients 100% versus pancreas-kidney transplant patients 83%, P<0.0001). However, the necessity of dental treatment was equal in the two groups: 70% versus 71%, respectively (P=NS). Based on these data, the conclusion is that there is a need for patients in the waiting list for transplants to have dental care, independently of demographic characteristics; it occurs due to the oral conditions at the time of clinical exams. In risk factors analysis, it was observed that the necessity for dental treatment in patients candidates for liver transplant was correlated with age (P=0,046), skin color (P=0,046) and viral hepatitisdiagnosis (P=0,033). No risk factors were identified for pancreas-kidney transplant patients.
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RAMAGLIA, Andrea Helena Francisca. Aspectos bucais de pacientes candidatos a transplante de fígado e pâncreas-rim no Hospital São Paulo e Hospital do Rim. 2018. 63 f. Dissertação (Mestrado em Ciência Cirúrgica Interdisciplinar) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.