Walterspacher Stephan, Fuhrmann Carsten, Germann Martin, Ratka-Krüger Petra, Windisch Wolfram
Department of Respiratory Medicine, University Hospital Freiburg, Freiburg, Germany.
Clin Respir J. 2013 Apr;7(2):220-5. doi: 10.1111/j.1752-699X.2012.00308.x.
Poor dental status is known to cause infections in severely sick and in elderly patients. In patients awaiting lung transplantation, rigorous dental treatment is a common prerequisite, although evidence-based data are lacking with regard to extent, necessity and effect on post-transplantation infectious status.
In the present retrospective study, dental status [dental history (missing teeth, caries, tooth restorations and extractions, prevalence of periodontitis) and dental treatment prior transplantation] was assessed in 85 lung transplant candidates at the University Hospital of Freiburg, Germany and evaluated for infectious foci in the first 3 years following transplantation.
Forty-nine patients got transplanted in the observed timespan. Total tooth count differed significantly between chronic obstructive pulmonary disease (16 ± 9), pulmonary fibrosis (22 ± 7) or cystic fibrosis (30 ± 3) patients prior transplantation (P > 0.001). Periodontitis prevalence yielded no difference and was mainly not treated prior transplantation. No dental-related infectious focus could be diagnosed post-transplantation. However, 15% of post-transplantation infections were of unknown focus, and infection rate was increased in year 2 post-transplantation in patients without periodontitis.
No clearly defined dental foci were registered following transplantation. This raises the question of whether current dental treatment in these highly compromised patients is too rigorous with regard to tooth extractions. However, no focus could be detected in 15% of the registered infections. Therefore, controversially, post-transplantation dental care could also be insufficient with regard to undertreated periodontitis.
众所周知，口腔状况不佳会导致重症患者和老年患者发生感染。在等待肺移植的患者中，严格的牙科治疗是常见的前提条件，尽管在治疗范围、必要性以及对移植后感染状况的影响方面缺乏循证数据。
在本回顾性研究中，对德国弗莱堡大学医院的85例肺移植候选者的口腔状况[牙科病史（缺牙、龋齿、牙齿修复和拔牙、牙周炎患病率）以及移植前的牙科治疗]进行了评估，并对移植后前3年的感染源进行了评估。
在观察期内，49例患者接受了移植。慢性阻塞性肺疾病患者（16±9颗）、肺纤维化患者（22±7颗）或囊性纤维化患者（30±3颗）移植前的牙齿总数存在显著差异（P>0.001）。牙周炎患病率无差异，且移植前大多未治疗。移植后未诊断出与牙科相关的感染源。然而，15%的移植后感染感染源不明，在移植后第2年，无牙周炎患者的感染率有所增加。
移植后未发现明确的牙科感染源。这就引发了一个问题，即对于这些身体状况严重受损的患者，目前的牙科治疗在拔牙方面是否过于严格。然而，在15%的已登记感染中未检测到感染源。因此，有争议的是，对于未充分治疗的牙周炎，移植后的牙科护理也可能不足。
