A Review of Oral Chronic Graft-Versus-Host Disease: Considerations for dental hygiene practice.

Purpose: Allogeneic hematopoietic cell transplantation (alloHCT), also known as stem cell or bone marrow transplantation, is a cellular therapy performed to treat a variety of malignant and non-malignant hematologic diseases. Chronic graft-versus-host disease (cGVHD) is a common immune-mediated complication of alloHCT that can affect various organs of the body, with approximately 70% of affected patients presenting with oral features. Oral manifestations of cGVHD include lichenoid lesions (diagnostic feature), erythema, pseudomembranous ulcerations, superficial mucoceles, salivary gland hypofunction, xerostomia, orofacial sclerosis, trismus, and increased sensitivity to spicy, acidic, hard, and crunchy foods. Patients with oral cGVHD are also at increased risk for developing secondary conditions, such as oral candidiasis, dental caries, and oral squamous cell carcinoma. Given these complex oral health challenges, the dental hygienist can play a key role in optimizing patients' oral health care from pre-stem cell transplantation through survivorship. Optimal care includes a comprehensive health history assessment, thorough extraoral and intraoral examinations, detailed hard and soft tissue evaluations, oral hygiene, and dietary assessment, along with the delivery of patient-centered, oral health instruction and preventive therapies. Appropriate monitoring and management of oral cGVHD require a collaborative care approach between dental, oncology, and oral medicine providers. As part of a multidisciplinary care team, dental hygienists play an important role in the management of patients with oral cGVHD. The purpose of this review is to provide an overview of alloHCT and its oral health considerations, with a focus on oral cGVHD etiology, signs and symptoms, and management considerations for the dental team.

Improving Outcomes for Transplant Patients: Contribution of a Dental Hygienist.

UNLABELLED: A dental hygienist member of an interdisciplinary medical team can contribute to improved outcomes when cancer and transplant patients experience oral sequelae. BACKGROUND AND PURPOSE: Cancer and transplant patients benefit from care provided by an interdisciplinary team comprised of general and oral health care providers. Diagnostic and supportive care including assessment and stabilization of oral health as well as management of treatment and disease sequelae are essential treatment planning components. This article provides support for a dental hygienist team member contributing toward optimal care for this patient population at high risk for infection and other serious complications. METHODS: A dental hygienist manager of an oral medicine service that provides clinical care for transplant patients describes how her position within a cancer research center has evolved. Using case scenarios, the impact of an interdisciplinary medical transplant team on patient care is presented. CONCLUSIONS: A dental hygienist, interested in working with oncology or transplant patients, as part of an interdisciplinary medical team, can contribute toward the well-being of patients and experience a challenging and rewarding career that combines aspects of medicine and dentistry.

A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation.

INTRODUCTION: Oral mucositis (OM) is a significant early complication of hematopoietic cell transplantation (HCT). This phase III randomized double-blind placebo-controlled study was designed to compare the ability of 2 different low level GaAlAs diode lasers (650 nm and 780 nm) to prevent oral mucositis in HCT patients conditioned with chemotherapy or chemoradiotherapy. MATERIALS AND METHODS: Seventy patients were enrolled and randomized into 1 of 3 treatment groups: 650 nm laser, 780 nm laser or placebo. All active laser treatment patients received daily direct laser treatment to the lower labial mucosa, right and left buccal mucosa, lateral and ventral surfaces of the tongue, and floor of mouth with energy densities of 2 J/cm2. Study treatment began on the first day of conditioning and continued through day +2 post HCT. Mucositis and oral pain was measured on days 0, 4, 7, 11, 14, 18, and 21 post HCT. RESULTS: The 650 nm wavelength reduced the severity of oral mucositis and pain scores. Low level laser therapy was well-tolerated and no adverse events were noted. DISCUSSION: While these results are encouraging, further study is needed to truly establish the efficacy of this mucositis prevention strategy. Future research needs to determine the effects of modification of laser parameters (e.g., wavelength, fluence, repetition rate of energy delivery, etc.) on the effectiveness of LLE laser to prevent OM.