Long-Term Follow-Up

Dental Issues Following a Transplant

Q: Can having a bone marrow or stem cell transplant affect my teeth and oral health?

Yes. Total body radiation and high dose chemotherapy given before a transplant, or previous radiation to the head and neck for cancer treatment, can affect the mouth by decreasing the production of saliva. Chronic graft-vs.-host disease of the mouth can also damage salivary glands and cause mouth dryness. Because saliva helps protect the teeth from decay, transplant patients are at greater risk for tooth decay. Decreased saliva secretion can combine with reduced immunity from the transplant, GVHD of the mouth and immunosuppressive medications to increase the risks of oral infections and oral cancer. Infection in the mouth is most often caused by yeast. See:

Cancer Treatment and Oral Health

Q: What long-term dental guidelines do I need to follow after transplant?

All transplant patients should be diligent about daily brushing and flossing. Patients who suffer from dry mouth should follow a program of daily brush-on prescription-strength fluoride gel or other specific treatments to reduce the risk of tooth decay. Routine dental examinations, including X-rays as needed, are important to identify and assess any problems. Decay associated with mouth dryness can be very aggressive and can cause severe damage. This problem can be reduced or prevented by proper brushing and flossing and daily treatment with prescription-strength fluoride (1.1 percent neutral sodium fluoride).

Patients who are taking immunosuppressive medications and patients with chronic GVHD need effective oral care to prevent inflammation of the gums (gingivitis), periodontal disease and other dental infections. These infections can potentially spread to cause systemic problems and can make GVHD worse. See:

Management of Oral Complications During and After Chemotherapy and/or Radiation Therapy

Q: Should I go to the dentist when I'm immunosuppressed?

Dental exams and appropriate supportive treatment can be very important after transplant to maintain oral health. Examinations should be carried out during this time in order to prevent and identify potential problems. Elective or routine dental procedures, even such treatments as dental cleanings, should not be performed for at least the first year after transplant or during treatment with immunosuppressive medications. Dental treatment can potentially increase the risk of infection due to the spread of bacteria into the bloodstream. In addition, bacteria and debris can be inhaled into the lungs during dental drilling or use of ultrasonic tooth cleaning equipment.

If urgent or emergency dental procedures are required during this time, special precautions are needed to prevent infection. These steps include blood tests to assess the risk of infection and bleeding, antibiotics before and after the procedure, and special precautions by your dental team. Also, patients with indwelling central venous catheters (Hickman, etc.) should take antibiotics before dental procedures. If you have dental insurance, some policies may provide for additional exams or treatment for immunosuppressed patients. For an example of treatment that may be covered by insurance, see:

Immunosuppression and oral health

Q: My dentist says the American Heart Association guidelines about who needs to take antibiotics before dental procedures have changed. What should I do?

The AHA reviews their guidelines for using antibiotics before dental procedures quite often. The AHA has determined that for most patients with certain types of heart problems, the risk of allergic complications from antibiotics before dental procedures is greater than the benefit.  The new guidelines state that only patients with serious specific cardiac conditions at high risk for heart infection (endocarditis) should take antibiotics before dental procedures. However, the AHA guidelines do not address the risk of infection in patients who are immunosuppressed due to bone marrow or stem cell transplant or systemic immunosuppressive therapy, or in patients who have oral GVHD disease.  For these patients, the risk of oral infection, blood infection (bacteremia), certain types of pneumonias, or endocarditis is greater than the risk from allergic reactions against the recommended antibiotics. We continue to advise these patients to take antibiotics before any dental work. If you or your dentist would like further guidance on whether or not you should take antibiotics before dental procedures, we ask that you contact LTFU at 206-667-4415.

Q: Is it normal to develop new mouth dryness or pain when I return home after my transplant?

If you develop mouth pain, sores or dryness after you return home, you should contact your doctor. You could have an easily treatable infection, such as yeast infection in the mouth (thrush) or herpes simplex. If you had an allogeneic transplant from a relative or unrelated donor, you could have developed GVHD of the mouth. Oral GVHD can potentially cause mouth sores and can damage salivary glands. Also, certain medications can cause dry mouth. LTFU can assist you and your doctor or dentist in determining what to do for you. The sooner the problem is diagnosed and treated, the fewer problems you will have.