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Table 4. Oral Complications of Hematopoietic Stem Cell Transplantation

Transplant Phase Oral 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.