Title Stomatološka skrb prije i nakon transplantacije bubrega
Title (english) Dental management before and after kidney transplantation
Author Lucija Rakocija
Mentor Danica Vidović Juras (mentor)
Committee member Danica Vidović Juras (predsjednik povjerenstva)
Committee member Ivana Škrinjar (član povjerenstva)
Committee member Božana Lončar Brzak (član povjerenstva)
Granter University of Zagreb School of Dental Medicine (Department of Oral Medicine) Zagreb
Defense date and country 2022-09-26, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Dental Medicine Oral Medicine
Abstract Transplantacija bubrega najučinkovitija je metoda nadomještanja bubrežne funkcije. Napredovanjem transplantacijske medicine i imunosupresivne terapije sve je bolja prognoza preživljenja bolesnika s presađenim bubregom. Posljedično se povećava i broj takvih pacijenata koji će tražiti stomatološku pomoć. Stomatolozi imaju aktivnu ulogu u pripremi pacijenata za transplantaciju, kao i u liječenju i praćenju pacijenata dugoročno nakon transplantacije. Zbog visoke imunosupresije nakon transplantacije, znatno je povećana podložnost infekcijama, reducirana obrana od njih i povećana opasnost od sistemskog širenja, stoga oralni fokusi za ove bolesnike mogu biti fatalni. Cilj je transplantaciji pristupiti sa zdravom oralnom šupljinom. Imajući na umu sve komplikacije kronične bubrežne bolesti i hemodijalize koje mogu utjecati na zahvate u oralnoj šupljini, stomatolog se konzultira s nadležnim specijalistom. Dogovaraju se mjere opreza vezane uz krvarenje, potencijalna primjena antibiotske profilakse te koje lijekove i u kojoj dozi primijeniti. Potrebno je dijagnosticirati i liječiti sve oralne bolesti, a naročito one koje bi mogle rezultirati infekcijom
ili potrebom za oralno kirurškim zahvatom neposredno nakon transplantacije kada su pacijenti najugroženiji. Šest mjeseci nakon transplantacije pacijenti primaju najviše doze imunosupresivnih lijekova jer su pod višim rizikom od odbacivanja transplantata, također su češće su ostale komplikacije i skloni su infekcijama. Stoga je uloga stomatologa u ovom razdoblju palijativne i preventivne naravi, ne radi se ništa elektivno, a hitni zahvati obavljaju se u bolničkim uvjetima nakon konzultacije s nadležnim liječnikom. Kada se pacijentovo stanje stabilizira, stomatološki zahvati mogu se sigurno obavljati. U dogovoru s timom koji vodi pacijenta u posttransplantacijskom razdoblju definira se potreba za antibiotskom profilaksom, nadomjesnom kortikosteroidnom terapijom, hematološkim testovima i ostalim modifikacijama liječenja ovisnih o pacijentovu općem stanju. Pacijenti se uključuju u aktivni recall program i naručuju svakih tri do šest mjeseci kako bi se na vrijeme dijagnosticirale i liječile sve promjene. Na svakom pregledu pacijentu se ponavljaju upute u oralnu higijenu, pregledava kompletna oralna šupljina i traže znakovi infekcije ili maligniteta.
Abstract (english) Kidney transplantation is the most effective method of replacing kidney function. With the advancement of transplantation medicine and immunosuppressive therapy, the survival prognosis of kidney transplant patients is getting better. As a result, the number of such patients who will seek dental care is also increasing. Dentists play an active role in the preparation of patients for transplantation as well as in the treatment and monitoring of patients in the long term after transplantation. Due to high immunosuppression after transplantation, the susceptibility to infections is significantly increased, the defense against them is reduced and the risk of systemic spread is enlarged, therefore oral foci can be fatal for these patients. The main aim is to approach the transplantation with a healthy oral cavity. Bearing in mind all the complications of chronic kidney disease and hemodialysis that can affect procedures in the oral cavity, the dentist consults with a competent specialist. Precautions related to bleeding, the potential use of antibiotic prophylaxis and which drugs to use and in what dose are agreed upon. It is necessary to diagnose and treat all oral diseases, especially those which could result in infection or the need for oral surgery immediately after transplantation, when patients are most vulnerable. During the period of 6 months after transplantation, patients receive the highest doses of immunosuppressive drugs because they
are at a higher risk of transplant rejection, other complications are also more common and they are prone to infections. Therefore, the dentist's role in this period is of a palliative and preventive nature, nothing elective is done and emergency procedures are performed in hospital conditions after consultation with the competent doctor. When the patient's condition
is stabilized, dental procedures can be performed safely. In agreement with the team managing the patient in the post-transplant period, the need for antibiotic prophylaxis, additional corticosteroid therapy, hematological tests and other treatment modifications depending on the patient's general condition are defined. Patients are included in the active
recall program with appointments every 3 to 6 months in order to diagnose and treat any changes in time. At each examination, the patient is given repeated oral hygiene instructions, the entire oral cavity is examined and signs of infection or malignancy are looked for.
Keywords
stomatološka skrb za kronične bolesnike
transplantacija burbega
imunosupresivna terapija
Keywords (english)
Dental care for Chronically Ill
Kidney Transplantation
Immunosuppression Therapy
Language croatian
URN:NBN urn:nbn:hr:127:201701
Study programme Title: dental medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2022-10-11 08:42:49