Haematological diseases and/or haematopoietic stem cell transplantation
Haematology-oncology patients, such as patients with leukemia and lymphoma, multiple myeloma and other diseases and patients undergoing hematopoietic stem cell transplantation may have myelosuppression and immunosuppression due to their disease, the cancer therapy or both. A common profile of oral complications is observed, which include oral mucositis, pain, infections, gingival bleeding, dry mouth, and dysgeusia.
We aim to inform our patients about the possible oral complications, which may develop during chemotherapy for haematological diseases or stem cell transplantation.
Oral mucositis: Mucositis is associated with pain, ulcers, loss of weight, and the need for parenteral nutrition. Patients with low white blood cell counts, who develop oral mucositis, are at increased risk for systemic infection.
Oral fungal infections: Burning sensation in the mouth and throat, taste alterations, increased severity of oral mucositis and dysphagia (difficulties in food intake) are the main symptoms of oral fungal infections.
Invasive fungal infections may present as painful oral ulcers, masses, or dental pain.
Viral infections: Herpes may present with extensive, painful ulcerations.
Bacterial infections: Dental and periodontal abscesses usually develop in patients, with poor oral hygiene.
Gingival bleeding: Gingival bleeding is seen during periods of reduced platelet numbers and particularly in patients with gingivitis.
Graft versus host disease in patients, who receive allogeneic haematopoietic stem cell transplantation
Oral lesions during acute graft versus host disease develop as erythema or painful ulcers. These lesions are difficult to be differentiated from the ulcers, which are related to chemotherapy and/or radiation, administered before the transplantation.
White striae or plaques and painful ulcers, dry mouth and superficial mucous cysts, dental caries, fibrosis, trismus, temporomandibular joint dysfunctions may be seen in chronic graft versus host disease. Regular oral examination is recommended for the early diagnosis of oral cancer, which may be a rare sequalae of the transplantation.
The dental assessment and the preparation of the mouth before myelotoxic chemotherapy, keeping the oral mucosa moist and clean, will reduce the prevalence and the severity of oral complications. Patient will maintain a good quality of life.