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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®)

Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant

Patients who receive transplants have an increased risk of graft-versus-host disease.

Graft-versus-host disease (GVHD) occurs when your tissue reacts to bone marrow or stem cells that come from a donor. Symptoms of oral GVHD include the following:

  • Sores that are red and have ulcers, which appear in the mouth 2 to 3 weeks after the transplant.
  • Dry mouth.
  • Pain from spices, alcohol, or flavoring (such as mint in toothpaste).
  • Swallowing problems.
  • A feeling of tightness in the skin or in the lining of the mouth.
  • Taste changes.

It's important to have these symptoms treated because they can lead to weight loss or malnutrition. Treatment of oral GVHD may include the following:

Oral devices need special care during high-dose chemotherapy and/or stem cell transplant.

The following can help in the care and use of dentures, braces, and other oral devices during high-dose chemotherapy or stem cell transplant:

  • Have brackets, wires, and retainers removed before high-dose chemotherapy begins.
  • Wear dentures only when eating during the first 3 to 4 weeks after the transplant.
  • Brush dentures twice a day and rinsing them well.
  • Soak dentures in an antibacterial solution when they are not being worn.
  • Clean denture soaking cups and changing denture soaking solution every day.
  • Remove dentures or other oral devices when cleaning your mouth.
  • Continue your regular oral care 3 or 4 times a day with dentures or other devices out of the mouth.
  • If you have mouth sores, avoid using removable oral devices until the sores have healed.

Care of the teeth and gums is important during chemotherapy or stem cell transplant.

Talk to your medical doctor or dentist about the best way to take care of your mouth during high-dose chemotherapy and stem cell transplant. Careful brushing and flossing may help prevent infection of oral tissues. The following may help prevent infection and relieve discomfort of oral in tissues:

  • Brush teeth with a soft-bristle brush 2 to 3 times a day. Be sure to brush the area where the teeth meet the gums.
  • Rinse the toothbrush in hot water every 15 to 30 seconds to keep the bristles soft.
  • Rinse your mouth 3 or 4 times while brushing.
  • Avoid rinses that have alcohol in them.
  • Use a mild-tasting toothpaste.
  • Let the toothbrush air-dry between uses.
  • Floss according to your medical doctor's or dentist's directions.
  • Clean the mouth after meals.
  • Use foam swabs to clean the tongue and roof of the mouth.
  • Avoid the following:
    • Foods that are spicy or acidic.
    • "Hard" foods that could irritate or break the skin in your mouth, such as chips.
    • Hot foods and drinks.

Medicines and ice may be used to prevent and treat mucositis from stem cell transplant.

Medicines may be given to help prevent mouth sores or help the mouth heal faster if it is damaged by chemotherapy or radiation therapy. Also, holding ice chips in the mouth during high-dose chemotherapy, may help prevent mouth sores.

Dental treatments may be put off until the patient's immune system returns to normal.

Regular dental treatments, including cleaning and polishing, should wait until the transplant patient's immune system returns to normal. The immune system can take 6 to 12 months to recover after high-dose chemotherapy and stem cell transplant. During this time, the risk of oral complications is high. If dental treatments are needed, antibiotics and supportive care are given.

Supportive care before oral procedures may include giving antibiotics or immunoglobulin G, adjusting steroid doses, and/or platelet transfusion.

  • Updated: April 24, 2014