Oral Complications of High-Dose Chemotherapy or Stem Cell Transplant

by National Cancer Institute

(Page 5 of 5)

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. 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).

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 rinses, gels, creams, or powders.
• Antifungal drugs taken by mouth or injection.
• 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 guidelines 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 to 4 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.

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. Caution is advised for at least a year after the transplant.

Relapse and Second Cancers

Cancer survivors who received chemotherapy or a transplant or who underwent radiation therapy are at risk of developing a second cancer later in life. Oral squamous cell cancer is the most common second cancer occurring in transplant patients. The lips and tongue are the sites most often affected.

Mental and Social Considerations

The social aspects of oral complications can make them the most difficult problems for cancer patients to cope with. Oral complications affect eating and speaking and may make the patient unable or unwilling to take part in mealtimes or to dine out. Patients may become frustrated, withdrawn, or depressed, and they may avoid other people. Some drugs that are used to treat depression may not be an option because they cause side effects that make oral complications worse.

Education, supportive care, and the treatment of symptoms are important for patients who have mouth problems that are related to cancer therapy. Patients will be closely monitored for pain, ability to cope, and response to treatment. Supportive care from health care providers and family can help the patient cope with cancer and its complications.

Special Considerations for Children

A change in dental growth and development is a special complication for cancer survivors who received high-dose chemotherapy and/or radiation therapy to the head and neck for childhood cancers. Changes may occur in the size and shape of the teeth; eruption of teeth may be delayed; and development of the head and face may not reach full maturity. The role and timing of orthodontic treatment for patients with altered dental growth and development is under study. Some treatments have been successful, but standard guidelines have not yet been established.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.