Oral health in hematopoietic stem cells transplantation survivors

Objectives Complications of hematopoietic stem cell transplantation (HSCT) are common and may negatively impact the quality of life of patients. The aim of this study was to characterize the oral health status of a cohort of HSCT survivors. Study Design A retrospective medical record review was conducted for a select group of HSCT survivors seen at the Oral Medicine Clinic at Dana Farber Cancer Institute from July 2014 until October 2018 as part of the HSCT survivorship clinic. Data included past medical history, information on HSCT, and oral health status pre-HSCT and in survivors. Graft-versus-host disease (GVHD) was graded according to the National Institutes of Health Oral Mucosal Score. The Fox questionnaire was used to assess the severity of dry mouth. Descriptive statistics were used to summarize the data. Results A total of 89 patients were included (53.9% males; median age 58 years). All patients received a dental evaluation and the necessary treatment in the 3 months before HSCT to achieve optimal oral health. Acute myeloid leukemia was the most frequent diagnosis (39.3%; n = 35) followed by myelodysplastic syndrome (19.1%; n = 17). All patients underwent allogeneic stem cell transplantation (SCT), and 12.3% (n = 11) received total body irradiation. On examination (performed 339 days after HSCT; range 262–566 days), 55 patients (61.7%) had oral cGVHD (mild: 55.3%; moderate: 28.6%; severe: 16.1%) with lichenoid features (92.8%) and erythema (64.3%), and 42.8% had extraoral GVHD. Topical steroids were prescribed to 45 patients (50.5%). A median pain score of 5 (range 1–9) was reported by 21.3% of patients; 46.1% (n = 42) needed to avoid certain foods because of oral pain/sensitivity. Sixty-one patients had dry mouth (68.5%; median dryness score: 4 [range 1–10]); 34.1% (n = 31) had difficulty swallowing food and drink because of dryness; and 44% (n = 40) needed to sip liquids to swallow. Jaw tightness and taste changes were reported by 9 patients (9.9%) and 33 patients (36.2%), respectively. Sialagogues were prescribed to 9 patients (10.1%). Caries were identified in 7 patients. Conclusions Oral complications in HSCT survivors are common and may include GVHD, dry mouth, and taste changes. All patients must be screened prior to HSCT and followed up by a dentist periodically to assess the oral health status and modify treatment, if needed.