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

Patient Version
Last Modified: 09/16/2011

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:

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.



Glossary Terms

alcohol (AL-kuh-hol)
A chemical substance found in beer, wine, and liquor, and some medicines, mouthwashes, household products, and essential oils (scented liquid taken from plants). Alcohol contains a carbon atom attached to a hydroxyl group (a molecule made of an oxygen atom and a hydrogen atom).
antibacterial (AN-tee-bak-TEER-ee-ul)
A substance that kills bacteria or stops them from growing and causing disease.
antibiotic (AN-tee-by-AH-tik)
A drug used to treat infections caused by bacteria and other microorganisms.
antifungal (AN-tee-FUN-gul)
A drug that treats infections caused by fungi.
biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
bone marrow (bone MAYR-oh)
The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.
complication (kom-plih-KAY-shun)
In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
donor (DOH-ner)
In medicine, a person who gives blood, cells, tissue, or an organ for use in another person, such as in a blood transfusion or an organ transplant.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
fluoride (FLOOR-ide)
A form of the element fluorine that helps prevent tooth decay. Fluoride may be naturally present in drinking water or may be added to it. Fluoride may also be put directly on the teeth, as a gel, toothpaste, or a rinse.
graft-versus-host disease (... dih-ZEEZ)
A disease caused when cells from a donated stem cell graft attack the normal tissue of the transplant patient. Symptoms include jaundice, skin rash or blisters, a dry mouth, or dry eyes. Also called GVHD.
high-dose chemotherapy (hy-dose kee-moh-THAYR-uh-pee)
An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.
immune system (ih-MYOON SIS-tem)
The complex group of organs and cells that defends the body against infections and other diseases.
inflammation (IN-fluh-MAY-shun)
Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
malnutrition (mal-noo-TRIH-shun)
A condition caused by not getting enough calories or the right amount of key nutrients, such as vitamins and minerals, that are needed for health. Malnutrition may occur when there is a lack of nutrients in the diet or when the body cannot absorb nutrients from food. Cancer and cancer treatment may cause malnutrition.
mineral (MIH-neh-rul)
In medicine, a mineral is a nutrient that is needed in small amounts to keep the body healthy. Mineral nutrients include the elements calcium, magnesium, and iron.
mucous membrane (MYOO-kus MEM-brayn)
The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucous membrane make mucus (a thick, slippery fluid). Also called mucosa.
oral (OR-ul)
By or having to do with the mouth.
psoralen (SOR-uh-len)
A substance from plants that is sensitive to light (or can be activated by light). Psoralens are used together with UV light to treat psoriasis, vitiligo, and skin nodules of cutaneous T-cell lymphoma. They are also being studied in the treatment of graft-versus-host disease. Psoralen is a type of furocoumarin. An example of a psoralen is methoxsalen.
recover (ree-KUH-ver)
To become well and healthy again.
saliva (suh-LY-vuh)
The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.
salivary gland (SA-lih-VAYR-ee gland)
A gland in the mouth that produces saliva.
stem cell (stem sel)
A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.
stem cell transplant (stem sel tranz-plant)
A method of replacing immature blood-forming cells in the bone marrow that have been destroyed by drugs, radiation, or disease. Stem cells are injected into the patient and make healthy blood cells. A stem cell transplant may be autologous (using a patient’s own stem cells that were saved before treatment), allogeneic (using stem cells donated by someone who is not an identical twin), or syngeneic (using stem cells donated by an identical twin).
steroid (STAYR-oyd)
Any of a group of lipids (fats) that have a certain chemical structure. Steroids occur naturally in plants and animals or they may be made in the laboratory. Examples of steroids include sex hormones, cholesterol, bile acids, and some drugs.
supportive care (suh-POR-tiv kayr)
Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and symptom management.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
topical (TAH-pih-kul)
On the surface of the body.
transplantation (tranz-plan-TAY-shun)
A surgical procedure in which tissue or an organ is transferred from one area of a person’s body to another area, or from one person (the donor) to another person (the recipient).
ultraviolet radiation (UL-truh-VY-oh-let RAY-dee-AY-shun)
Invisible rays that are part of the energy that comes from the sun. Ultraviolet radiation that reaches the Earth's surface is made up of two types of rays, called UVA and UVB. Ultraviolet radiation also comes from sun lamps and tanning beds. It can cause skin damage, premature aging, melanoma, and other types of skin cancer. It can also cause problems with the eyes and the immune system. Skin specialists recommend that people use sunscreens that protect the skin from both kinds of ultraviolet radiation. In medicine, ultraviolet radiation also comes from special lamps or a laser and is used to treat certain skin conditions such as psoriasis, vitiligo, and skin tumors of cutaneous T-cell lymphoma. Also called UV radiation.