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1.
Dentistry consensus on HSCT - Part III: Special topics - Dentistry on HSCT
Santos, Psds, Granzotto, F. C. N., Antunes, H. S., de Lima, E. M., Varanda, R. F., Maccari, K., Bezinelli, L. M., Melo, W. R., Junior, Lavs, De Macedo, L. D., et al
Hematology, transfusion and cell therapy. 2023
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team.
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2.
Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study
Sabancı, A., Kuku, İ
Oral surgery, oral medicine, oral pathology and oral radiology. 2022
Abstract
OBJECTIVE Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT. STUDY DESIGN Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT. RESULTS Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05). CONCLUSIONS The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.
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3.
Taste and smell disturbances in patients with chronic oral graft vs. host disease: An observational study
Boor, M., Raber-Durlacher, J. E., Hazenberg, M. D., Rozema, F. R., Laheij, Amga
Frontiers in oral health. 2022;3:934607
Abstract
BACKGROUND A common complication of allogeneic hematopoietic stem cell transplantation (alloHSCT) is chronic oral graft vs. host disease (cGvHD). Oral cGvHD may present as mucosal lesions, salivary gland dysfunction, and trismus. Moreover, taste and smell ability may be affected, but the prevalence, nature and severity of altered taste and smell function, and their impact on quality of life (QoL) are understudied. AIM: To identify the prevalence, nature, and severity of taste and smell disturbances, their impact on QoL and to assess whether altered taste/smell ability is associated with oral mucosal cGvHD or hyposalivation. MATERIALS AND METHODS AlloHSCT recipients at least 100 days post-HSCT and referred for oral cGvHD-related oral complaints were eligible for participation in this cross-sectional study. Manifestations of oral mucosal cGvHD were scored, the (un)stimulated salivary flow was measured, and objective taste and smell ability was evaluated. Subjective taste and smell alterations, and overall and oral health (OH)-related QoL were assessed. RESULTS In total, 45 patients were included, of which objective reduced taste ability (hypogeusia) was identified in 68.9%; 28.9% had reduced smell ability and 11.1% had complete loss of smell. Nevertheless, only 31.1% of patients reported severe taste alterations and 22% reported moderate taste alterations indicating that not all the patients were aware of their altered taste sense. Taste/smell disturbances were not related to oral mucosal cGvHD or hyposalivation. Most alloHSCT recipients reported a decreased OH-related QoL. However, a relation between taste/smell ability and global or OH-related QoL could not be identified. CONCLUSION Taste and smell disturbances are prevalent among alloHSCT recipients. Most patients reported a decreased OH-related QoL, but the specific impact of taste and smell disturbances remains to be elucidated.
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4.
Dental developmental complications in pediatric hematopoietic stem cell transplantation patients: A study using CMC clinical data warehouse
Kim, J., Lim, H. J., Ku, J. H., Kook, Y. A., Chung, N. G., Kim, Y.
PloS one. 2022;17(12):e0279579
Abstract
OBJECTIVE This study aimed to investigate the prevalence and extent of dental developmental complications in patients who have undergone pediatric hematopoietic stem cell transplantation (SCT) and identify the risk factors. MATERIALS AND METHODS We retrospectively investigated the clinical data warehouse of the Catholic Medical Center information system for identifying patients who: 1) visited the Department of Pediatrics between 2009 and 2019, 2) underwent SCT under the age of 10, and 3) had panoramic radiographs. Thus 153 patients were included in this study. The prevalence and extent of tooth agenesis, microdontia, and root malformation were assessed using panoramic radiographs obtained after SCT, and the risk factors were analyzed using regression analysis. RESULTS All 153 patients had at least one dental anomaly. When grouped according to the age at initial chemotherapy (≤ 2.5; 2.6-5.0; 5.1-7.5; > 7.5 years), the prevalence of agenesis showed statistically significant differences among the different age groups (P < 0.001). The prevalence of agenesis was highest in the youngest age group. As the initial age at chemotherapy increased, the number of affected teeth per patient decreased for all three anomalies. The location of the affected tooth was also influenced by the age at initial chemotherapy. Regression analysis demonstrated that young age at initial chemotherapy was a risk-increasing factor for tooth agenesis and microdontia. CONCLUSIONS The age at initial chemotherapy may be a critical factor in determining the type, extent, and location of dental complications after SCT. These results suggest that careful dental follow-up and timely treatment are recommended for pediatric patients undergoing SCT.
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5.
Caries, periodontitis and tooth loss after haematopoietic stem cell transplantation: a systematic review
van Gennip, L. L. A., Bulthuis, M. S., Blijlevens, N. M. A., Huysmans, Mdnjm, van Leeuwen, S. J. M., Thomas, R. Z.
Oral diseases. 2022
Abstract
OBJECTIVE A systematic review was conducted to assess scientific knowledge concerning the effect of haematopoietic stem cell transplantation (HSCT) on the occurrence of caries, periodontal conditions and tooth loss, and to evaluate the prevalence of these diseases in adult HSCT survivors (PROSPERO 152906). METHODS PubMed and Embase were searched for papers, published from January 2000 until November 2020 without language restriction, assessing prevalence, incidence or parameters of caries, periodontal conditions and tooth loss in HSCT recipients (≥80% transplanted in adulthood). Bias risk was assessed with checklists from Joanna Briggs Institute, and data synthesis was performed by narrative summary. RESULTS Eighteen papers were included (1,618 subjects). Half were considered at high risk of bias. Longitudinal studies did not show caries progression, decline in periodontal health or tooth loss after HSCT. The prevalence in HSCT survivors ranged from 19% to 43% for caries, 11% to 67% for periodontitis, and 2% to 5% for edentulism. Certainty in the body of evidence was very low. CONCLUSIONS HSCT, on the short term, may have little to no effect on caries, periodontal conditions and tooth loss. Caries and periodontitis may be more common in HSCT survivors compared to the general population, whereas edentulism may be comparable. However, the evidence for all conclusions is very uncertain.
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6.
Oral health status after hematopoietic stem cell transplantations: Outcomes from an adult Italian population
Arduino, P. G., Gambino, A., Giaccone, L., Suria, M., Carbone, M., Carrozzo, M., Broccoletti, R., Conrotto, D.
Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2022
Abstract
AIM: To describe oral cavity changes in patients who underwent a hematopoietic stem cell transplantation (HSCT). METHODS AND RESULTS A group of 32 patients was studied after a mean period of 48.8 months (±11.22) from HSCT; oral, dental, and periodontal status were collected and compared with those of healthy matched controls. Unstimulated whole salivary flow (UWS) and salivary pH were also measured. A validated questionnaire (EORTC QLQH&N-35) was used for reported quality of life. Fifty-nine percent of patients were affected by chronic graft-versus-host disease (cGVHD). Dental health and periodontal status were statistically worse than in controls (P = .003 and P = .008, respectively). Regarding the HSCT group, UWS was statistically lower, and EORTC QLQH&N-35 significantly higher than those reported in controls (P = .000 for both). There was no statistical correlation between hypo-salivation and conditioning, presence of cGVHD, type of medication used before and after transplantation, and time of follow-up. A reduction in salivary pH has been noted only for patients with erosive oral lesions. CONCLUSION The oral cavity of HSCT patients appeared to undergo substantial modifications and the quality of life was deeply compromised.
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7.
Oral active matrix metalloproteinase-8 immunotest may be less accurate in haemato-oncologic patients
Mauramo, M., Uutela, P., Sorsa, T., Tervahartiala, T., Bornstein, M. M., Waltimo, T.
Oral diseases. 2022
Abstract
OBJECTIVES This study examines associations of active matrix metalloproteinase-8 (aMMP-8) point-of-care immunotest (Periosafe) outcomes with oral health of patients with haemato-oncologic diseases. METHODS Adult patients diagnosed with haematological diseases aimed to be treated with haematopoietic stem cell transplantation (HSCT) between 2018 and 2019 were included in the study. Clinical and radiological dental examination were taken immediately prior to transplantation. Presence of oral foci of infections, caries or periodontitis were examined and compared with the outcomes of aMMP-8 immunotest. RESULTS Acute oral infection foci were present in 11.9%, chronic in 44.1% and periodontitis in 42.0% of the 143 subjects. aMMP-8 immunotest was positive in 13.3% of all the 143 subjects. Among subjects with periodontitis (n=60) the aMMP-8 immunotest was also positive in 13.3% of these subjects. However, the subjects with positive aMMP-8 immunotest (n=19) had more often acute or chronic infection foci and more than one of the examined dental treatment needs compared to subjects with negative immunotest (all P<0.05). There were no differences in age, sex, hyposalivation, DMFT-index values nor with plasma levels of leukocytes, neutrophils or C-reactive protein between subjects with positive or negative aMMP-8 immunotest. CONCLUSIONS aMMP-8 immunotest accuracy might be reduced, in relation to periodontitis, in haemato-oncologic patients.
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8.
Common oral diseases, hyposalivation and survival post-HSCT, a longitudinal study
Uutela, P., Passweg, J., Halter, J., Gerull, S., Weiger, R., Mauramo, E., Waltimo, T., Mauramo, M.
European journal of haematology. 2019
Abstract
OBJECTIVES Haematopoietic stem cell transplantation (HSCT) recipients are at risk of side effects within the oral cavity. The purpose of this study was to examine progression of common oral diseases and hyposalivation and their associations with survival in allogeneic HSCT recipients. METHODS 269 adult HSCT recipients treated with HSCT between 2008 and 2016 were included in this study. The associations of caries, decayed, missing, filled teeth (DMFT) index, radiological attachment loss and stimulated salivary flow rate with six-month survival and the progression of the oral disorders within two years were examined. RESULTS Forty HSCT recipients (14.8%) deceased within six months post-HSCT. Among the deceased recipients, hyposalivation and caries were more common pre-HSCT than in recipients who survived over six months (P<0.05). HSCT recipients with hyposalivation pre-HSCT had higher risk of death (HR:1.90, 95% CI:1.00-3.60; P=0.044) within six months post-HSCT compared to recipients without hyposalivation. Hyposalivation pre-HSCT was associated with a higher DMFT index score (P<0.05) and a smaller number of teeth (P<0.005) 24 months post-HSCT in comparison to those without hyposalivation. CONCLUSIONS Hyposalivation and caries were associated with a lower rate of survival in HSCT recipients. Additionally, hyposalivation predisposed to deterioration of oral health post-HSCT. This article is protected by copyright. All rights reserved.
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9.
The impact of a hematopoietic stem cell transplantation on dental development
Ruyssinck, L., Toulouse, K., de Braem, V. B. C., Cauwels, R., Dhooge, C.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
To investigate dental development in patients treated with a hematopoietic stem cell transplantation (HSCT), 42 children/young adults who were under 12 years old at time of HSCT were examined for dental agenesis, microdontia and root-crown ratio. Conditioning regimens were total body irradiation (TBI) based in 12 patients, 21 patients received a busulfan based regimen and 9 patients had other chemotherapeutic agents. Sixteen patients were < 3 years old, 9 patients were 3 - 6 years old and 17 patients were 6-12 years old at HSCT. Prevalence of agenesis and microdontia of at least one permanent tooth were respectively 51.3% and 46.2% in the study population and 76.3% had an aberrant root-crown ratio. All these results were highly different from the prevalence in the healthy population. Patients treated before 3 years of age had more microdontia (76.9%) and agenesis (92.3%) compared to patients treated at an older age. In the subgroup of patients treated after 6 years, there was more microdontia when treated with busulfan (50%) compared to treatment with TBI (0%) (P=0.044). CONCLUSION patients treated with HSCT had many disturbances in dental development. Age at HSCT and possibly also the conditioning regimen used had an effect on their type and prevalence. Dental follow-up should be incorporated in the multidisciplinary follow-up program of these patients.
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10.
Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia
Dyer, G., Brice, L., Schifter, M., Gilroy, N., Kabir, M., Hertzberg, M., Greenwood, M., Larsen, S. R., Moore, J., Gottlieb, D., et al
Australian dental journal. 2018
Abstract
BACKGROUND Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients, and to identify gaps in service provision provided to this high-risk group. METHODS Participants were Allo-BMT recipients, aged >18years, and received transplants between 2000-2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments. RESULTS Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team. CONCLUSION Despite oral complications commonly occurring after Allo-BMT many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks, and improvement in the delivery of dental health services for BMT survivors. This article is protected by copyright. All rights reserved.