Xerostomia and Burning Mouth Syndrome are Common
Oral Side Effects in Liver Transplant Patients
RO-046
Jaana Helenius-Hietala1, Jukka H Meurman12, Hellevi Ruokonen2, Lisa Grönroos2, Helena Isoniemi3
1 University of Helsinki; Institute of Dentistry, 2 Helsinki University Central Hospital; Oral and Maxillofacial Diseases, 3 Helsinki University Central Hospital; Transplantation and Liver Surgery Clinic
Introduction
Few data exist on oral side effects after liver transplantation (LT) [1-2]. Transplant
patients have immunosuppressive and also many other medications which may
predispose to oral side effects. Hyposalivation may cause discomfort and increase the
risk for oral diseases.
Objectives
The aim of our prospective study was to investigate the prevalence and possible
background factors of subjective oral symptoms in a group of post-LT patients. We also
wanted to study if differences existed between the acute and chronic liver disease
patients with respect to the salivary flow rate.
Results
Median number of medications used was 7 (range 2-11). Xerostomia (feeling of dry
mouth) was recorded in 42.9% of the patients with dryness of mouth mainly at night.
Burning mouth syndrome (BMS) was recorded in 15.6% of the patients most typical site
being the side of the tongue. See the Table below for the risk factors of oral symptoms.
Chronic liver disease patients had lower resting salivary flow rates than acute patients
(0.34 ml/min vs. 0.53 ml/min, p= 0.032).
Risk factors for subjective oral symptoms
Risk factor
95% CI lower
95%CI upper
Significance
Xerostomia
Methods
Patients were recruited for this study (n=77; 26 women, 51 men) to have a
dental examination in connection of an outpatient clinic. The median age of the patients
was 55.9 (range 24.6-70.9) and the median time after LT was 5.0 years (range 2-10).
The main indication for LT was cholestatic liver disease; either primary sclerosing
cholangitis or primary biliary cirrhosis. A structured questionnaire was used to record
oral symptoms and saliva samples were taken. A multivariate logistic regression
analysis was preformed with oral symptoms as dependent variable. Independent
variables included gender, age, post-LT follow-up time, socioeconomic status, smoking,
alcohol use, presence of diabetes, number of medications, systemic corticosteroid use,
type of calcineurin inhibitor (CyA/Tacro), oral health status, and resting and stimulated
salivary flow rates. Diffferences in salivary flow rates were analyzed by the Student’s ttest (PASW version 17.0).
OR
.
Retirement
1.51
1.14
1.99
0.004
No. of medications
1.20
0.91
1.57
n.s.
Alcohol use
2.58
0.73
Burning mouth
syndrome
9.07
n.s.
Xerostomia
5.09
0.97
26.84
0.055
Age
1.07
0.97
1.19
n.s.
Conclusions
Number of medications and alcohol use correlated with xerostomia
which was also a risk factor for BMS. Chronic liver disease patients
had significantly lower salivary flow rates than acute liver disease
patients.
References
An ulcer caused by illfitting prostheses and dry mouth.
1.Olczak-Kowalczyk D, Pawłowska J, Cukrowska B, Kluge P, Witkowska-Vogtt E, Dzierżanowska-Fangrat K et al. Local
presence of cytomegalovirus and Candida species vs oral lesions in liver and kidney transplant recipients. Ann Transplant
2008;13(4):28-33.
2.Oettinger-Barak O, Segal E, Machtei EE, Barak S, Baruch Y, Ish-Shalom S. Alveolar bone loss in liver transplantation patients:
relationship with prolonged steroid treatment and parathyroid hormone levels. J Clin Periodontol 2007;34:1039–1045.
Presented at the 15th Congress of the European Society for Organ Transplantation, 4-7 September 2011, Glasgow, Scotland