Key Points
-
Provides an introduction to the use of haematopoietic stem cell transplants in the management of patients with haematological malignancies.
-
Describes the RCS guidelines for the oral care of these patients.
-
Outlines the aims of pre-transplant dental assessment and treatment.
-
Highlights the issues affecting the provision of dental care in these patients and the role of special care dentists in their treatment.
Abstract
Objective To assess the treatment needs of patients undergoing pre-haematopoietic stem cell transplant (HSCT) dental assessment, to collate the examination findings and treatment provided and to define the management issues impacting on care.
Design Single centre retrospective analysis.
Setting Salaried Primary Care Dental Service, Western General Hospital, Edinburgh, UK.
Subjects and methods One hundred and sixteen available charts of patients who attended for pre-transplant dental assessment during April 2004-June 2007 were examined.
Results Ninety-four patients, 52 men (55.3%) and 42 women (43.6%), were included. Patients were referred a mean of 31.5 (SD 18.82) days before admission for transplant. Dental assessment occurred, on average, 7.88 days (SD 6.78) following referral. Eighty-eight (93.6%) patients were dentate, while six (6.3%) were edentulous. Eighty-eight (93.6%) patients presented with oral disease; 89 (94.7%) patients received dental care. Issues impacting on care were medical (n = 88, 93.6%), time constraints (n = 73, 77.7%), no GDP (n = 25, 26.7%), dental complexity (n = 5, 5.3%) and anxiety management (n = 1, 1.1%).
Conclusion The majority of patients required dental care, most of which, for healthy adults, would normally be completed within a primary care setting. However, the issues surrounding the care of patients destined for HSCT indicate that there is a place for a dedicated dental service as part of the multidisciplinary team.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Sonis S, Kunz A . Impact of improved dental services on the frequency of oral complications of cancer therapy for patients with non-head and neck malignancies. Oral Surg Oral Med Oral Pathol 1988; 65: 19–22.
Toljanic J A, Bedard J F, Larson R A, Fox J P . A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intense chemotherapy for cancer. Cancer 1999; 85: 1843–1848.
Rosenberg S W . Oral complications of cancer chemotherapy: a review of 398 patients. J Oral Med 1986; 41: 93–97.
Bochud P Y, Calandra T, Francioli P . Bacteremia due to viridians streptococci in neutropenic patients: a review. Am J Med 1994; 97: 256–264.
Carter L, Lowis E . Death from overwhelming odontogenic sepsis: a case report. Br Dent J 2007; 203: 241–242.
Vasanthan A, Nadeem D . Periodontal treatment considerations for cell transplant and organ transplant patients. Periodontol 2000 2007; 44: 82–102.
Morimoto Y, Niwa H, Imai Y, Kirita T . Dental management prior to hematopoietic stem cell transplantation. Spec Care Dentist 2004; 24: 287–292.
Royal College of Surgeons of England. Clinical guidelines: the oral management of oncology patients requiring radiotherapy, chemotherapy, and bone marrow transplantation. London: Royal College of Surgeons of England, 1999.
Lockhart P B, Clark J . Pretherapy dental status of patients with malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol 1994; 77: 236–241.
Barker D, Donachie M A . The need for dental treatment in a group of patients undergoing treatment for malignancies other than of the head and neck. Eur J Prosthodont Restor Dent 2005; 13: 182–185.
Yamagata K, Onizawa K, Yanagawa T et al. A prospective study to evaluate a new dental management protocol before haematopoietic stem cell transplantation. Bone Marrow Transplant 2006; 38: 237–242.
Melkos A B, Massenkeil G, Arnold R, Reichart P A . Dental treatment prior to stem cell transplantation and its influence on post-transplantation outcome. Clin Oral Investig 2003; 7: 113–115.
Woo S-B, Matin K. Off-site dental evaluation program for prospective bone marrow transplant recipients. J Am Dent Assoc 1997; 128: 189–193.
Elad S, Garfunkel A A, Or R, Michaeli E, Shapira M Y, Galili D . Time limitations and the challenge of providing infection-preventing dental care to hematopoietic stem-cell transplantation patients. Support Care Cancer 2003; 11: 674–677.
Adult Dental Health Survey: Oral Health in the United Kingdom 1998. London: National Office for Statistics, 2000.
Treasure E, Kelly M, Nuttall N, Nunn J, Bradnock G, White D . Factors associated with oral health: a multivariate analysis of results from the 1998 Adult Dental Health Survey. Br Dent J 2001; 190: 60–68.
Hancock P, Epstein J, Sadler G . Oral and dental management related to radiation therapy for head and neck cancer. J Can Dent Assoc 2003; 69: 585–590.
Miller C S, Epstein J B, Hall E H . Changing oral care needs in the United States: the continuing need for oral medicine. Oral Surg Oral Med Oral Pathol 2001; 91: 34–44.
Coulthard P, Koron R, Kazakou I, Macfarlane T V . Patterns and appropriateness of referral from general dental practice to specialist oral and maxillofacial surgical services. Br J Oral Maxillofac Surg 2000; 38: 320–325.
Cottrell D A, Reebye U N, Blyer S M, Hunter M J, Mehta N . Referral patterns of general dental practitioners for oral surgical procedures. J Oral Maxillofac Surg 2007; 65: 686–690.
Foley J . The way forward for dental sedation and primary care? Br Dent J 2002; 193: 161–164.
Peters E, Monopoli M, Woo S-B, Sonis S. Assessment of the need for treatment of post-endodontic asymptomatic periapical radiolucencies in bone marrow transplant patients. Oral Surg Oral Med Oral Pathol 1993; 76: 45–48.
Akintoye S, Brenhan M, Graber C et al. A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoetic stem cell and bone marrow transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 581–588.
Massler C F Jr. Preventing and treating the oral complications of cancer therapy. Gen Dent 2000; 48: 652–655.
Author information
Authors and Affiliations
Corresponding author
Additional information
Refereed paper
Rights and permissions
About this article
Cite this article
Durey, K., Patterson, H. & Gordon, K. Dental assessment prior to stem cell transplant: treatment need and barriers to care. Br Dent J 206, E19 (2009). https://doi.org/10.1038/sj.bdj.2009.304
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.2009.304
This article is cited by
-
Oral microbial changes and oral disease management before and after the treatment of hematological malignancies: a narrative review
Clinical Oral Investigations (2023)
-
Periodontal diseases, caries, and dental abscesses prevalence in hematopoietic stem cell transplant recipients
Bone Marrow Transplantation (2021)
-
Dental status and risk of odontogenic complication in patients undergoing hematopoietic stem cell transplant
Supportive Care in Cancer (2021)
-
Oral health of adult patients undergoing hematopoietic cell transplantation. Pre-transplant assessment and care
Annals of Hematology (2017)
-
YOUTUBE videos on oral care of the organ or hematopoietic stem cell transplant patients
Supportive Care in Cancer (2017)
