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| Special considerations | Pre-HSCT
(preconditioning) | Immediate post-HSCT
(neutropenic conditioning phase and engraftment to hematopoietic recovery) | Late post-HCST
(immune reconstitution/recovery from systemic toxicity and long-term survival) |
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| Oral manifestations | (i) Oral infections
(ii) Soreness
(iii) Bleeding
(iv) Temporomandibular dysfunction. | (i) Mucositis
(ii) Dysgeusia
(iii) Xerostomia
(iv) Hemorrhage
(v) Oral pain
(vi) Opportunistic infections
(vii) Neurotoxicity
(viii) Temporomandibular dysfunction
(ix) Acute GVHD. | (i) Chronic GVHD
(ii) Late viral infections
(iii) Salivary dysfunction
(iv) Squamous cell carcinoma
(v) Craniofacial growth abnormalities (children)
(vi) Impairment of bones and teeth (children). |
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| Oral health | (i) Identify and eliminate sources of existing or potential infection.
(ii) Orientate the patient about the importance of maintaining oral health.
(iii) Warn about the possible effects of antineoplastic therapy in the oral cavity. | (i) Maintain and reinforce the importance of optimal oral health.
(ii) Treat side effects of HSCT therapy.
(iii) Pay attention to periodontitis and gingivitis as potential sources of bacteremia. | (i) Diagnosis and treatment of mucosal lesions and lichen-type features with symptoms
(ii) Caries prevention and reestablishment of oral health in case of rampant caries
(iii) Treatment of hyposalivation and xerostomia
(iv) Early detection of oral cancer and precursor lesions. |
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| Dental treatment | (i) Complete necessary dental treatment
(ii) Elective treatment should be delayed until the re-establishment of immunity (at least 100 days after transplant, or more in the case of oral complications or other cGVHD). | Neutropenic conditioning phase
(i) Dental procedures should not be performed at this stage
(ii) If emergencies, perform the necessary dental approach, with the participation of medical staff.
Engraftment to hematopoietic recovery
(i) Monitoring and management of oral complications of HSCT
(ii) Invasive procedures only with the approval of the medical team
(iii) Strengthening the maintenance guidelines of good oral hygiene and noncariogenic diet
(iv) Special attention to xerostomia and GVHD. | Immune reconstitution/recovery from systemic toxicity
(i) Periodic dental evaluation
(ii) Avoid invasive procedures
(iii) Clarify risks and benefits of orthodontic appliances.
Long-term survival
(i) Periodic dental evaluation
(ii) In the first 12 months after HSCT:
(a) avoid routine dental care, including scaling and periodontal planning;
(b) if emergencies, strategies to reduce inhalation of aerosols and antibiotic prophylaxis;
(c) before invasive procedures, consider the use of IgG, antibiotics, corticosteroids, and/or platelet transfusion. |
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