TY - JOUR
T1 - Oral chronic graft-versus-host disease: What the general dental practitioner needs to know
AU - Haverman, Thijs M.
AU - Raber-Durlacher, Judith E.
AU - Raghoebar, Iva I.
AU - Rademacher, Willem M. H.
AU - Rozema, Frederik R.
AU - Hazenberg, Mette D.
AU - Epstein, Joel B.
AU - Treister, Nathaniel S.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers. Methods: The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD). Results: Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management. Conclusions: General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration. Practical Implications: Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.
AB - Background: Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers. Methods: The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD). Results: Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management. Conclusions: General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration. Practical Implications: Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.
KW - Oral graft-versus-host-disease
KW - caries
KW - dental treatment
KW - hematopoietic stem cell transplantation
KW - hyposalivation
KW - oral candidiasis
KW - oral care
KW - trismus
KW - xerostomia
UR - http://www.scopus.com/inward/record.url?scp=85092532349&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.adaj.2020.08.001
DO - https://doi.org/10.1016/j.adaj.2020.08.001
M3 - Article
C2 - 33121606
SN - 0002-8177
VL - 151
SP - 846
EP - 856
JO - Journal of the American Dental Association (1939)
JF - Journal of the American Dental Association (1939)
IS - 11
ER -