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

Patients who have received transplants are at risk of graft-versus-host disease.

Graft-versus-host disease (GVHD) is a reaction of donated bone marrow or stem cells against the patient's tissue. Graft-versus-host disease can cause inflammation and breakdown of the mucous membranes. Symptoms of oral GVHD include the following:

• Sores that 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 lining of the mouth.
• Taste changes.

It's important to have these symptoms treated as they can lead to weight loss or malnutrition.

Biopsies taken from the lining of the mouth and salivary glands may be needed to diagnose oral GVHD. Treatment of oral GVHD may include the following:

• Topical steroid rinses, gels, creams, or powders.
• Antifungal drugs taken by mouth or applied as a lotion to skin.
• Psoralen (a drug used with ultraviolet light to treat skin disease).
• Drugs that promote the production of saliva.
• Fluoride treatments.
• Treatments to replace minerals lost from teeth by acids in the mouth.

Dentures, braces, and oral appliances require special care during high-dose chemotherapy and/or stem cell transplant.

The following are instructions for the care and use of dentures, braces, and other oral appliances during high-dose chemotherapy and/or stem cell transplant:

• Remove brackets, wires, and retainers before high-dose chemotherapy begins.

• Wear dentures only when eating during the first 3 weeks after the transplant.

• Brush dentures twice a day and rinse them well.

• Soak dentures in an antibacterial solution when they are not being worn.

• Clean denture soaking cups and change denture soaking solution every day.

• Remove appliances or dentures when cleaning the mouth.

• If mouth sores are present, avoid wearing removable appliances until the mouth is healed.

Care of the teeth and gums may continue under professional guidance.

Careful brushing and flossing may help prevent infection of oral tissues. The following are guidelines for general oral care during high-dose chemotherapy and stem cell transplant, but it's important that patients check with their medical professional for individual guidelines:

• 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 make the bristles softer.

• Rinse the mouth 3 or 4 times while brushing.

• Avoid rinses containing alcohol.

• Use a mild-tasting toothpaste.

• Let the toothbrush air-dry between uses.

• Flossing may be done according to the professional's directions.

• Clean the mouth after meals.

• Foam swabs may be used to clean the tongue and roof of the mouth.

Dental treatments may be resumed when the transplant patient's immune system returns to normal.

Routine dental treatments, including scaling and polishing, should be delayed 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 remains high. If dental treatments are needed, antibiotics and supportive care are given. Care must be taken to prevent accidentally breathing fluids into the lungs during dental treatments.