A survey of the oral status of children undergoing liver transplantation

Background: The purposes of this study were to examine the oral tissues and caries prevalence of children undergoing liver transplantation, and to evaluate the relationship between tooth staining and serum bilirubin level. Methods: Thirty-four children (22 boys and 12 girls) under the age of 6 years with end-stage liver disease were referred from the Liver Transplantation Center at Kaohsiung Chang Gung Children's Hospital, Taiwan. Oral tissues were examined, and photographs taken to determine the green staining of the teeth and gingiva. A questionnaire was completed by their parents. Serum bilirubin levels were collected preoperatively in these children. Student's t-test was used to compare the mean decayed, missing, and filled tooth (dmft) difference between night-fed and non-night-fed groups, and to test the relationships between tooth staining and serum bilirubin levels. Results: The caries prevalence of the 34 children undergoing liver transplantation was 61.8%. The mean dmft score of children 2 to 6 years old who were night-fed was significantly higher than that of children who were not (10.1 ± 1.2 vs. 6.3 ± 1.2; p = 0.038). Green staining of the teeth and gingiva was found in 61.3% of cases in children with biliary atresia. Total serum bilirubin levels were significantly higher in the green-stained group than in the non-stained group (17.87±2.50 vs. 2.20±0.65; p < 0.01). Conclusions: Oral findings of children undergoing liver transplant presented significant green staining of the teeth and gingiva related to high serum bilirubin levels. Children who were night-fed showed an increased risk of developing caries suggesting that oral hygiene instructions should begin as early as possible before liver transplantation.