Graft vs Host Disease - oral sideffects

Bone Marrow Transplant and Oral Care

People who have had a bone marrow transplant have a highly suppressed (reduced) immune system. This means that he or she will have a high risk of developing acute oral complications, particularly mucositis, ulcerations, hemorrhage, infection, xerostomia (dry mouth) and viral or fungal infection. These problems begin to improve as your blood counts stabilize but the immunosuppression may last for up to a year after the transplant, so your risk of oral complications continues. It is very important for you to continue to receive careful oral/dental attention during this period in order to increase your chances for the fastest, complication-free recovery as possible.

Graft versus Host Disease

People who have received transplants are at risk of graft-versus-host disease. GVHD is a reaction of donated bone marrow or stem cells against your own tissue. Symptoms of oral GVHD include the following:

  • sores that appear in the mouth 2 to 3 weeks after the transplant
  • dry mouth
  • pain from spices, alcohol, or flavoring (such as mint in toothpaste)

Biopsies taken from the lining of the mouth and salivary glands may be needed to diagnose oral GVHD. Treatment of oral GVHD may include:

  • topical rinses, gels, creams, or powders
  • antifungal drugs taken by mouth or injection
  • psoralen (a drug used with ultraviolet light to treat skin disease)
  • drugs that promote the production of saliva
  • fluoride treatments
  • treatments to replace minerals lost from teeth by acids in the mouth

Chronic Graft versus Host Disease

Chronic GVHD typically occurs anywhere from 100 days or more after an allogeneic (the transplant comes from a donor) cell transplant. In those people who do get chronic GVHD, about 90% will have some problems in the oral cavity, which can include redness, ulcers, lesions, xerostomia, and pain. Speak to your doctor and dentist about how to manage this condition should you develop chronic GVHD.

Routine dental treatments should be delayed until your immune system returns to normal. Caution is advised for at least a year after the transplant.

When to Call Us

Take time each day to check how your mouth looks and feels. Call us as soon as you notice any of the problems listed below or if a known condition gets worse.

  • Sores or pain in your mouth or throat
  • Dry mouth
  • Signs of infection – fever of 100.5°F or above, redness, swelling, pain, or a sticky, white film in your mouth
  • Difficulty eating
  • Bleeding
  • Muscle stiffness (when you try to chew)
  • Vomiting
  • Tooth pain