Oral complications in patients induced after stem cell transplantation

Abstract

Background and aim: Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for several hematological malignancies. Despite advances in patient selection and treatment of transplant-related comorbidities, the prevalence of complications after HSCT remains high. In particular, the occurrence of oral complications is poorly understood. The aim of this study was, thus, to explore the occurrence of oral complications before and after HSCT and compare it with healthy controls. Methodes:A total of 50 adult HSCT patients and 50 healthy controls will be included in this study. In this preliminary study 42 patients and 30 controls are included until now. The study is ongoing. Participants’ health status was obtained through a questionnaire especially designed for this study. The detailed medical history of patients was ascertained through a thoroughly updated medical journal from OUS. Salivary functionwas assessed with the Summated Xerostomia Inventory-Dutch questionnaire (XI). A clinical oral examination was performed to obtain a Clinical Oral Dryness Score (CODS). Unstimulated saliva was collected to measure hyposalivation. Radiological and clinical examinations were performed to evaluate gingival and dental status. Oral mucosal status was assessed by a plaque and mucosal index (BSI index). Oral mucositis was assessed using the World Health Organization (WHO) toxicity scale. Trismus was measured by a method Maximum Mouth Opening (MMO). Nutritional status was evaluated by the Malnutrition Screening Tool (MST). Oral health impact profile (OHIP) was evaluated byusing the OHIP questionnaire. Statistical analysis were performed using the SPSS. Results:The major findings in this study were that (1) saliva secretory flow was impairedamong patients before HSCT,(2) clinical and subjective experience of oral dryness was higher in patients after HSCT, (3) huge impaired oral health was reported by patients after HSCT,(4) dental caries burden was higher in patients before HSCT,(5) oral candida, mucositis and trismus were more prominent in patients after HSCT, (6)oral health related quality of life was significantly reduced in patients before HSCT and even more worsened inpatients after HSCT, (7) and a higher ratio of patients were at nutritional risk after HSCT. Conclusion:To summarize, salivary dysfunction and caries seem to be associated with pre-conditioning treatment with chemotherapy, while mucositis, candida, trismus and reduced nutritional intake wereimpaired even more after the HSCT. These findings call for increased awareness of oral complications in hospitalized patients undergoing HSCT treatment.