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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care - Health Professional Information [NCI] - Oral and Dental Management Before Cancer Therapy

Table 3. Management Guidelines Relative to Invasive Dental Procedures continued...

Assessment of Hematopoietic Stem Cell Transplant Patients

Stages of assessment have been described relative to the hematopoietic stem cell transplant patient (see Table 4).[5] This model provides a useful classification for neutropenic cancer patients in general. Type, timing, and severity of oral complications represent the interaction of local and systemic factors that culminate in clinical expression of disease. Correlating oral status with systemic condition of the patient is thus critically important.

Selected conditioning regimens characterized by reduced intensity for myelosuppression have been used in patients. These regimens have generally been noted to significantly reduce the severity of oral complications early posttransplant, especially for mucositis and infection risk. The guidelines listed in Table 4 can be adjusted to reflect these varying degrees of risk, based on the specific conditioning regimen to be used.

Table 4. Oral Complications of Hematopoietic Stem Cell Transplantation

Transplant PhaseOral Complication
GVHD = graft-versus-host disease.
Phase I: PreconditioningOral infections: dental caries, endodontic infections, periodontal disease (gingivitis, periodontitis), mucosal infections (i.e., viral, fungal, bacterial).
Gingival leukemic infiltrates.
Metastatic cancer.
Oral bleeding.
Oral ulceration: aphthous ulcers, erythema multiforme.
Temporomandibular dysfunction.
Phase II: Conditioning Neutropenic PhaseOropharyngeal mucositis.
Oral infections: mucosal infections (i.e., viral, fungal, bacterial), periodontal infections.
Hemorrhage.
Xerostomia.
Taste dysfunction.
Neurotoxicity: dental pain, muscle tremor (e.g., jaws, tongue).
Temporomandibular dysfunction: jaw pain, headache, joint pain.
Phase III: Engraftment Hematopoietic RecoveryOral infections: mucosal infections (i.e., viral, fungal, bacterial).
Acute GVHD.
Xerostomia.
Hemorrhage.
Neurotoxicity: dental pain, muscle tremor (e.g., jaws, tongue).
Temporomandibular dysfunction: jaw pain, headache, joint pain.
Granulomas/papillomas.
Phase IV: Immune Reconstitution Late PosttransplantOral infections: mucosal infections (i.e., viral, fungal, bacterial).
Chronic GVHD.
Dental/skeletal growth and development alterations (pediatric patients).
Xerostomia.
Relapse-related oral lesions.
Second malignancies.
Phase V: Long-term SurvivalRelapse or second malignancies.
Dental/skeletal growth and development alterations.

Phase I: Before Chemotherapy

Oral complications are related to current systemic and oral health, oral manifestations of underlying disease, and oral complications of recent cancer or other medical therapy. During this period, oral trauma and clinically significant infections, including dental caries, periodontal disease, and pulpal infection, should be eliminated. Additionally, patients should be educated relative to the range and management of oral complications that may occur during subsequent phases. Baseline oral hygiene instructions should be provided. It is especially important to note whether patients have been treated with bisphosphonates (e.g., patients with multiple myeloma) and to plan their care accordingly.

Phase II: Neutropenic Phase

Oral complications arise primarily from direct and indirect stomatotoxicities associated with high-dose chemotherapy or chemoradiotherapy and their sequelae. Mucositis, xerostomia, and those lesions related to myelosuppression, thrombocytopenia, and anemia predominate. This phase is typically the period of high prevalence and severity of oral complications.

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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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