Introduction

The oral cavity is a frequentsite of infectious and noninfectious complications during and after stemcell transplantation. Good dental hygiene before and after HSCT isimportant. Risk of developing complications is dependent on a number offactors, including pretransplant dental health, HSV seropositivity, age,graft source, conditioning regimen intensity, development ofgraft-versus-host disease (GVHD), and the need for long-termimmunosuppressive therapy. Patients should be routinely monitored for oralcavity changes and symptoms at all stages of transplantation.Transplantation programs can benefit greatly from the inclusion of oralmedicine as part of the care team, in particular for diagnosis andmanagement of patients with oral conditions of unclear etiology, or forthose that do not respond to standard first-line therapies.

Pretransplant dental evaluation

The dentition is a potentialsource of infection during transplantation and prolonged periods of profoundimmunosuppression. In order to reduce risk, all patients should undergo acomprehensive dental evaluation by a dentist prior to transplantation. Theevaluation should consist of a full mouth series of intraoral radiographsand hard and soft tissue examination with special attention to caries,defective restorations, mobile teeth and teeth with deep pocketing(periodontal disease), third molars, and periapical pathology (Figures 21.1and 21.2). All patients should receive a dental prophylaxis and any teethwith caries should be treated. Sharp edges should be smoothed to reduce riskof soft tissue injury which might contribute to mucositis. Teeth withperiapical pathology require endodontic therapy or extraction. Third molarswith a prior history of pericoronitis (infection/swelling of surroundinggingiva) should be considered for extraction (Figure 21.3). The foregoinginformation is summarized in Table 21.1.