Oral chronic graft-versus-host disease: What the general dental practitioner needs to know

Abstract

Background: Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers.

Methods: The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD).

Results: Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management.

Conclusions: General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration.

Practical implications: Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.

Keywords: Oral graft-versus-host-disease; caries; dental treatment; hematopoietic stem cell transplantation; hyposalivation; oral candidiasis; oral care; trismus; xerostomia.