Oral manifestations in liver transplant recipients

Editor, The article “oral manifestation in transplant patients” was read with enthusiasm.[1] However, the following points may be noted worthy. Fissured tongue, atrophy of tongue papillae, and angular cheilitis can be observed in liver transplant patients and these may be due to concurrent hyposalivation, due to intake of diuretic drugs such as thiazides and loop diuretics.[2,3] Excessive bleeding with serious complications are encountered in the liver transplant patients when they undergo simple procedures such as scaling, tooth extraction, minor periodontal surgery, and administration of local anesthetics.[4] These patients exhibit hemostatic abnormalities such as prolonged prothrombin time, activated partial thromboplastin time; increased international normalized ratio and low platelet count. Primary wound closure, Vitamin K 10 mg intramuscularly, and use of topical thrombin and fi brin glue along with antifi brinolytic agents such as oxidized cellulose tranexamic acid and amino-caproic acid may be helpful to control oral bleeding due to dental procedures.[4]