1
|
Mauramo M, Uutela P, Sorsa T, Tervahartiala T, Bornstein MM, Waltimo T. Oral active matrix metalloproteinase-8 immunotest may be less accurate in haemato-oncologic patients. Oral Dis 2024; 30:624-630. [PMID: 35925017 DOI: 10.1111/odi.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examines the associations of active matrix metalloproteinase-8 (aMMP-8) point-of-care immunotest (Periosafe) outcomes with oral health of patients with haemato-oncologic diseases. METHODS Adult patients diagnosed with haematological diseases aimed to be treated with haematopoietic stem cell transplantation (HSCT) between 2018 and 2019 were included in the study. Clinical and radiological dental examination were taken immediately prior to transplantation. The presence of oral foci of infections, caries or periodontitis was examined and compared with the outcomes of aMMP-8 immunotest. RESULTS Acute oral infection foci were present in 11.9%, chronic in 44.1% and periodontitis in 42.0% of the 143 subjects. aMMP-8 immunotest was positive in 13.3% of all the 143 subjects. Among subjects with periodontitis (n = 60), the aMMP-8 immunotest was also positive in 13.3% of these subjects. However, the subjects with positive aMMP-8 immunotest (n = 19) had more often acute or chronic infection foci and more than one of the examined dental treatment needs compared with subjects with negative immunotest (all p < 0.05). There were no differences in age, sex, hyposalivation, DMFT-index values nor with plasma levels of leukocytes, neutrophils or C-reactive protein between subjects with positive or negative aMMP-8 immunotest. CONCLUSIONS aMMP-8 immunotest accuracy might be reduced, in relation to periodontitis, in haemato-oncologic patients.
Collapse
Affiliation(s)
- Matti Mauramo
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Pauliina Uutela
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Institute of Dentistry, Helsinki, Finland
- Department of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Institute of Dentistry, Helsinki, Finland
| | - Michael M Bornstein
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Tuomas Waltimo
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| |
Collapse
|
2
|
Correa MEP, Granzotto FCN, Innocentini LMAR, Reis TDC, de Lima EM, Varanda RDF, Santos PSDS, Junior LAVS, Bezinelli LM, Eduardo FDP, Melo WR, Antunes HS, De Macedo LD. Brazilian dental consensus on dental management in hematopoietic stem cell transplantation - Part I - pre-HSCT. Hematol Transfus Cell Ther 2023; 45:358-367. [PMID: 37295969 PMCID: PMC10499583 DOI: 10.1016/j.htct.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 06/12/2023] Open
Abstract
The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Paulo Sérgio da Silva Santos
- Departamento de Cirurgia, Estomatologia, Patologia e Radiologia da Faculdade de Odontologia de Bauru da Universidade de São Paulo, Bauru, São Paulo, Brazil
| | | | | | | | | | | | - Leandro Dorigan De Macedo
- Serviço de Odontologia e Estomatologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Brazil; Faculdade de Medicina de Ribeirão Preto-USP, Brazil.
| |
Collapse
|
3
|
Sabancı A, Kuku İ. Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:242-248. [PMID: 36344391 DOI: 10.1016/j.oooo.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT. STUDY DESIGN Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT. RESULTS Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05). CONCLUSIONS The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.
Collapse
Affiliation(s)
- Arife Sabancı
- Department of Periodontology, Inonu University, Malatya, Turkey.
| | - İrfan Kuku
- Department of Internal Medicine-Hematology, Inonu University, Malatya, Turkey
| |
Collapse
|
4
|
Skallsjö K, von Bültzingslöwen I, Hasséus B, Johansson JE, Öhman J, Raber-Durlacher JE, Huysmans MCDNJM, Laheij AMGA, van Leeuwen SJM, Hovan AJ, Garming Legert K, Nguyen HM, Turk PJ, Rozema FR, Blijlevens NMA, Brennan MT. Oral health in patients scheduled for hematopoietic stem cell transplantation in the Orastem study. PLoS One 2023; 18:e0285615. [PMID: 37200298 DOI: 10.1371/journal.pone.0285615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
Despite advances in transplant medicine, prevalence of complications after hematopoietic stem cell transplantation (HSCT) remains high. The impact of pre-HSCT oral health factors on the incidence and severity of complications post-HSCT is poorly understood. The aim of this prospective, observational study was to analyze oral health in patients planned for HSCT. Patients ≥18 years requiring HSCT were included from five sites between 2011-2018. General health, oral findings and patient-reported symptoms were registered in 272 patients. Oral symptoms around disease onset were reported by 43 patients (15.9%) and 153 patients (58.8%) reported oral complications during previous chemotherapy. One third of patients experienced oral symptoms at the oral examination before conditioning regimen and HSCT. In total, 124 (46.1%) patients had dental caries, 63 (29.0%) had ≥one tooth with deep periodontal pockets, 147 (75.0%) had ≥one tooth with bleeding on probing. Apical periodontitis was observed in almost 1/4 and partially impacted teeth in 17 (6.3%) patients. Oral mucosal lesions were observed in 84 patients (30.9%). A total of 45 (17.4%) of 259 patients had at least one acute issue to be managed prior to HSCT. In conclusion, oral symptoms and manifestations of oral disease were prevalent in patients planned for HSCT. The extent of oral and acute dental diseases calls for general oral screening of patients pre-HSCT.
Collapse
Affiliation(s)
- Kristina Skallsjö
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger von Bültzingslöwen
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Erik Johansson
- Department of Hematology and Coagulation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Öhman
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Stephanie J M van Leeuwen
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Allan J Hovan
- Oral Oncology and Dentistry, British Columbia Cancer, Vancouver, British Columbia, Canada
| | | | - Hieu M Nguyen
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, United States of America
| | - Philip J Turk
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michael T Brennan
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, United States of America
- Department of Otolaryngology/Head and Neck Surgery, Wake Forest University School of Medicine, Wake Forest, North Carolina, United States of America
| |
Collapse
|
5
|
Empowerment of Primary Healthcare Providers on the Prevention and Management of Dental or Oral Health Issues among Postchemotherapy Patients in Pandemic. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9087776. [PMID: 35310187 PMCID: PMC8930226 DOI: 10.1155/2022/9087776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
Objectives. The study aim was to evaluate the empowerment of primary healthcare providers on the prevention and management of dental or oral health issues among postchemotherapy (PC) patients, in selected rural regions, India, during a pandemic. Methods. Initially, 240 PHPs were recruited by convenient and snow ball sampling with 90.3% response rate. A descriptive, cross-sectional study was adopted using a self-administered questionnaire with 5 sections: demographics, identification of dental/oral health issues, knowledge, attitude, and practice on prevention and management of dental/oral health problems in PC patients. Statistical Packages for Social Sciences (SPSS) version 23.0 was used for statistical analysis. Results. The overall knowledge was better among nurses (64.56%), followed by pharmacists (54.5%). 81.65% of PHPs were willing to learn more and expressed the need for collaboration with dentists. In the past 3 months, 18.81% of them had PC patients with dental/oral health issues, but only 3.5% of nurses and 0.8% of pharmacists treated them. The logistic regression model revealed higher scores in mucositis/mucosal pain (OR = 1.41), altered taste sensation (OR = 1.34), sensitive gums (OR = 1.71), and dental caries (OR = 1.32) domains (
). Those who had readiness to learn (OR = 5.37), nurses and pharmacists, and having less years of experience (OR = 1.31) and higher degree (OR = 1.4) had a positive attitude (
). Conclusion. PHPs had limited empowerment in terms of knowledge and practice but showed a positive attitude toward the prevention and management of dental/oral health issues of PC patients. For better practice, continuing education and collaboration with dental professionals is essential.
Collapse
|
6
|
Oral Mucositis Association with Periodontal Status: A Retrospective Analysis of 496 Patients Undergoing Hematopoietic Stem Cell Transplantation. J Clin Med 2021; 10:jcm10245790. [PMID: 34945086 PMCID: PMC8703781 DOI: 10.3390/jcm10245790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) can induce serious oral complications, including oral mucositis (OM). The presence of periodontal inflammation before HSCT is believed to be associated with OM. The aim of our study was to determine the prevalence and severity of OM in patients undergoing HSCT and its relation to periodontal status. PATIENTS AND METHODS This is a retrospective study of patients who underwent HSCT and a detailed dental examination between 2007 and 2015. The dental and periodontal status of all patients was evaluated by clinical and radiographic examination prior to HSCT. Oral health was assessed with the gingival index, the the community periodontal index, presence of plaque-related gingivitis, and marginal periodontitis. During the HSCT period, patients were examined daily for the presence of OM, which was graded according to World Health Organization (WHO) classification if present. The patients were assigned to the groups according to type of transplantation: autologous HSCT, myeloablative allogeneic HSCT, and non-myeloablative allogeneic HSCT. RESULTS A total of 496 patients were included in the study. OM was present in 314 of 496 patients (63.3%): 184/251 (73.3%) in the autologous group, 100/151 (66.2%) in the myeloablative allogeneic group, and 30/94 (31.9%) in the nonmyeloablative allogeneic group. Significantly more patients suffered from OM in the autologous and myeloablative groups versus the nonmyeloablative conditioning group (p < 0.001). The presence of periodontal inflammation did not significantly differ among the groups. There was only a borderline trend for the higher prevalence of OM in the non-myeloablative allogeneic nonmyeloablative group when periodontal inflammation was present (0.073939). CONCLUSIONS Oral mucositis prevalence and severity after stem cell transplantation is not widely affected by the oral hygiene and periodontal disease presence before HSCT. We confirmed the wide-known connection of the conditioning regimen intensity to the prevalence of OM.
Collapse
|
7
|
Kawajiri J, Nagata K, Nakamura A, Fujieda A, Ino K, Nomura J, Arai N, Ohishi K, Katayama N, Nakase K. Clinical utility of oral management in allogeneic hematopoietic stem cell transplantation recipients: microbiological evidence based on molecular analysis of oral bacteria. Support Care Cancer 2021; 30:757-764. [PMID: 34374846 DOI: 10.1007/s00520-021-06462-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to clarify the clinical utility of oral management to prevent bloodstream infections by oral bacteria microbiologically in patients undergoing allogeneic hematopoietic stem cell transplantation (ASCT). METHODS Ten consecutive patients with hematological malignancies undergoing ASCT were enrolled in this study. We implemented dental treatments before transplantation, if required, and carried out oral hygiene instructions and oral management every other day after transplantation. Molecular analysis of bacterial DNA for seven oral species using a polymerase chain reaction (PCR) assay was performed for oral samples and peripheral blood once a week for 3 weeks after transplantation. RESULTS Periodontitis was found in all 10 patients (mild grade in 3 and middle grade in 7) for whom basic periodontal therapy was conducted. Necessary dental procedures, including tooth extraction were performed in 5 patients. After transplantation, oral mucositis occurred in 10 patients (grade 1 in 3, grade 2 in 2, and grade 3 in 5) for whom oral hygiene instruction and oral care were continued every other day. PCR-identified three to six bacterial species in oral samples from nine patients, but none in peripheral blood from any patient during the observation period. CONCLUSIONS Our study suggests that oral management could prevent bloodstream infections by oral bacteria in ASCT recipients despite the existence of periodontitis or oral mucositis. Its utility was confirmed by microbiological evidence based on molecular data.
Collapse
Affiliation(s)
- Jumpei Kawajiri
- Faculty of Nursing, Suzuka University of Medical Science, Mie, Japan.,Department of Translational Medical Science, Mie University Graduate School of Medicine, Mie, Japan
| | - Kokoro Nagata
- Department of Oral and Maxillofacial Surgery, Mie University Hospital, Mie, Japan
| | - Akiko Nakamura
- Central Clinical Laboratories, Mie University Hospital, Mie, Japan
| | - Atsushi Fujieda
- Department of Hematology and Oncology, Mie University Hospital, Mie, Japan
| | - Kazuko Ino
- Department of Hematology and Oncology, Mie University Hospital, Mie, Japan
| | - Jouji Nomura
- Department of Oral and Maxillofacial Surgery, Mie University Hospital, Mie, Japan
| | - Naoya Arai
- Department of Oral and Maxillofacial Surgery, Mie University Hospital, Mie, Japan
| | - Kohshi Ohishi
- Transfusion Service, Mie University Hospital, Mie, Japan
| | - Naoyuki Katayama
- Faculty of Nursing, Suzuka University of Medical Science, Mie, Japan.,Department of Hematology and Oncology, Mie University Hospital, Mie, Japan
| | - Kazunori Nakase
- Department of Hematology and Oncology, Mie University Hospital, Mie, Japan. .,Cancer Center, Mie University Hospital, Mie, Japan.
| |
Collapse
|
8
|
Hansen HJ, Estilo C, Owosho A, Solano AK, Randazzo J, Huryn J, Yom SK. Dental status and risk of odontogenic complication in patients undergoing hematopoietic stem cell transplant. Support Care Cancer 2021; 29:2231-2238. [PMID: 32901321 PMCID: PMC8432266 DOI: 10.1007/s00520-020-05733-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Dental evaluation and management prior to hematopoietic stem cell transplant (HSCT) plays a vital role in identifying and treating infections that may be life-threatening. The purpose of this study is to describe the dental management of patients undergoing pre-HSCT examination with the Dental Service at Memorial Sloan Kettering Cancer Center (MSKCC) and to report on odontogenic complications. METHODS Patients referred for evaluation as part of the standard preparation for HSCT were included. Following clinical and radiological examination, patients were assigned to one of three groups based on risk of odontogenic infection, and treatment was provided as indicated. Patients were followed, and their medical records were reviewed for odontogenic complications during the transplant admission. RESULTS Of the 375 patients evaluated, 350 patients underwent HSCT: allogeneic 143 (40.9%) and autologous 207 (59.1%). The distribution of primary cancer diagnosis was as follows: multiple myeloma 104 (29.7%), leukemias 95 (27.1%), Hodgkin's lymphoma 28 (8.0%), non-Hodgkin's Lymphoma 99 (28.3%), and other conditions 24 (6.9%). The median time from dental evaluation to transplant was 29 days. The median Decayed, Missing, Filled Teeth Index was 17. The median Community Periodontal Index was 1. Based on dental status, 145 patients (41.4%) were classified as low risk, 133 (38%) as moderate risk and 72 (20.6%) as high risk of odontogenic infection. One hundred fourteen patients (32.6%) required dental treatment prior to HSCT, and 100 of these (28.6%) completed treatment. Two (0.57%) patients had odontogenic complications. CONCLUSIONS With conservative pre-HSCT dental treatment based on an infection risk classification system, a low odontogenic complication rate was observed.
Collapse
Affiliation(s)
- Heidi J Hansen
- Department of Surgery, Division of Oral & Maxillofacial Surgery and Dentistry, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA.
| | - Cherry Estilo
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adepitan Owosho
- Missouri School of Dentistry and Oral Health, Kirksville, MO, USA
| | - Armand Karl Solano
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Randazzo
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Huryn
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - SaeHee K Yom
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
9
|
Mawardi H, Treister N, Felemban O, Alamoudi W, Algohary G, Alsultan A, Alshehri N, Tazi I, Shaheen M, Alsharani M, Alshemmari S, Arat M, Bekadja MA, Al-Khabori M, Okaily S, Ali N, Abujazar H, Jastaniah W, Hamidieh AA, Hashmi S, Aljurf M. Current practice of oral care for hematopoietic stem cell transplant patients: A survey of the Eastern Mediterranean Blood and Marrow transplantation group. Hematol Oncol Stem Cell Ther 2021; 16:42-51. [PMID: 36634283 DOI: 10.1016/j.hemonc.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The oral cavity is one of the most common sites impacted by hematopoietic stem cell transplantation (HSCT) with acute complications including mucositis, bleeding, salivary gland dysfunction, infection, and taste alteration. These complications may result in significant morbidity and can negatively impact outcomes such as length of stay and overall costs. As such, oral care during HSCT for prevention and management of oral toxicities is a standard component of transplant protocols at all centers. The objective of this study was to evaluate the current oral care practices for patients during HSCT at different transplant centers within the Eastern Mediterranean region. MATERIAL AND METHODS An internet-based survey was directed to 30 transplant centers in the Eastern Mediterranean region. The survey included five sections asking questions related to (1) transplant center demographics; (2) current oral care protocol used at the center and type of collaboration (if any) with a dental service; (3) use of standardized oral assessment tools and grading systems for mucositis; (4) consultations for management of oral complications; and (5) oral health needs at each center. Data are presented as averages and percentages. RESULTS A total of 16 responses from 11 countries were collected and analyzed, indicating a response rate of 53%. Eight centers reported that a dentist was part of the HSCT team, with four reporting oral medicine specialists specifically being part of the team. Almost all centers (15/16; 93%) had an affiliated dental service to facilitate pre-HSCT dental clearance with an established dental clearance protocol at 14 centers (87%). Dental extraction was associated with the highest concern for bleeding and the need for platelet transfusion. With respect to infection risk, antibiotic prophylaxis was considered in the setting of low neutrophil counts with restorative dentistry and extraction. All centers provide daily reinforcement of oral hygiene regimen. The most frequently used mouth oral rinses included sodium bicarbonate (68%) and chlorhexidine gluconate (62%), in addition to ice chips for dry mouth (62%). The most frequently used mucositis assessment tools were the World Health Organization scale (7/16; 43%) and visual analogue scale for pain (6/16; 37%). Mucositis pain was managed with lidocaine solution (68.8%), magic mouth wash (68.8%) and/or systemic pain medications (75%). CONCLUSIONS Scope and implementation of oral care protocols prior to and during HSCT varied between transplant centers. The lack of a universal protocol may contribute to gaps in oral healthcare needs and management for this group of patients. Further dissemination of and education around available oral care guidelines is warranted. CLINICAL RELEVANCE Considering oral care during HSCT a standard component of transplant protocols, the current study highlights the common oral care practices for patients at centers within the Eastern Mediterranean region.
Collapse
Affiliation(s)
- Hani Mawardi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Osama Felemban
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waleed Alamoudi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | | | - Illias Tazi
- Department, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco
| | - Marwan Shaheen
- Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Mutlu Arat
- Florence Nightingale Hospital, HSCT Unit, Istanbul, Turkey
| | | | - Murtadha Al-Khabori
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | | | | | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharukh Hashmi
- Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| |
Collapse
|
10
|
Costa ALF, Santos BA, Torregrossa VR, Miranda ECM, Vigorito AC, Palmieri M, Ricardo ALF, Sarmento DJS, Mamana AC, Tozetto-Mendoza TR, Correa MEP, Braz-Silva PH. Oral shedding of CMV and HSV-1 in hematopoietic stem cell transplantation patients. Oral Dis 2020; 27:1572-1579. [PMID: 33085827 DOI: 10.1111/odi.13690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the oral shedding of herpesviruses in patients undergoing hematopoietic stem cell transplantation (HSCT) and correlate it with oral mucositis (OM). METHODS Saliva samples were collected before the HSCT and on day D + 8. Multiplex Polymerse Chain Reaction (PCR) was performed to detect herpes simplex virus (HSV)-1 and HSV-2, Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Variella-zoster virus (VZV), and human herpesvirus (HHV)-6, HHV-7, and HHV-8. OM was assessed according to WHO criteria. RESULTS Thirty one patients were enrolled, in which 20 of 31 (64.5%) were males; median age was 50 (21-70) years; 16 of 31 (51.6%) underwent allo-HSCT; and 15 of 31 (48.4%) underwent auto-HSCT. On D + 8, OM grades III and IV were observed in 8 of 31 (25.8%) patients. In the first salivary collection, EBV was found in 24 of 31 (77.4%), followed by HHV-6 (7/31, 22.6%) and HHV-7 (8/31 25.8%). In the second collection, EBV was found in 24 of 27(89%), followed by HSV-1 (8/27, 30%) and CMV, HHV-6, and HHV-7 (5/27, 18.5%, each one). On D + 8, OM grades II and IV were associated with the presence of HSV-1. HSV-1 was also associated with worsening degrees of OM on D + 15. CONCLUSION The presence of HSV-1 and CMV in oral samples was more frequent on day D + 8 after HSCT. HSV-1 detection was associated with severity and worsening of OM. HSV-1 and CMV seem to be associated with oral dysbiosis due to HSCT.
Collapse
Affiliation(s)
- Andre L F Costa
- Postgraduate Program in Dentistry, Cruzeiro Do Sul University (UNICSUL), São Paulo, Brazil
| | - Bruna A Santos
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Eliana C M Miranda
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Afonso C Vigorito
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Michelle Palmieri
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil
| | - Ana L F Ricardo
- Postgraduate Program in Dentistry, Cruzeiro Do Sul University (UNICSUL), São Paulo, Brazil
| | - Dmitry J S Sarmento
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.,Department of Stomatology, School of Dentistry, State University of Paraíba, Araruna, Brazil
| | - Ana C Mamana
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Tania R Tozetto-Mendoza
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - M Elvira P Correa
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paulo H Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.,Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
11
|
Pauliina U, Jakob P, Joda T, Weiger R, Matti M, Tuomas W. Oral disorders in patients with newly diagnosed haematological diseases. Clin Oral Investig 2020; 24:3085-3091. [PMID: 31897707 DOI: 10.1007/s00784-019-03178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to examine saliva flow rates and prevalence of dental and periodontal diseases of patients with newly diagnosed severe haematological diseases and compare these findings with age-matched controls of normal population. METHODS A total of 149 patients diagnosed with haematological diseases aimed to be treated with haematological stem cell transplantation between 2008 and 2018 and 154 controls were included in the study. A dental examination was performed for patients within a maximum of 6 months after diagnosis. Differences were compared in terms of the stimulated salivary flow rate (SSFR); decayed, missing and filled teeth (DMFT) index; number of teeth; caries prevalence; presence of periodontitis and acute infections. RESULTS The mean SSFR of the patient group was significantly lower (1.1 ml/min ± 0.7 ml/min) than the mean SSFR of the controls (1.3 ml/min ± 0.5 ml/min; p = 0.004). The number of caries lesions was significantly higher in the patient group (mean ± SD, 1.1 ± 1.9) than in the control group (mean ± SD, 0.4 ± 1.2; p < 0.001). There were fewer teeth and a higher DMFT index in the patient group compared to the control group, but the differences were not significant. Acute symptomatic infections were observed in eight (5.4%) patients and in none of the controls (p < 0.01). CONCLUSIONS AND CLINICAL RELEVANCE Oral examinations in patients with newly diagnosed severe haematological disease demonstrated a higher prevalence of caries, acute infections and lower mean SSFR compared with the controls. These findings support the recommendations for early dental examination at the time of diagnosis.
Collapse
Affiliation(s)
- Uutela Pauliina
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Hebelstrasse 3, CH-4055, Basel, Switzerland.
| | - Passweg Jakob
- Department of Hematology, University Hospital, Basel, Switzerland
| | - Tim Joda
- Department of Reconstructive Dentistry, School of Dental Medicine, UZB University Center for Dental Medicine, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, UZB University Center for Dental Medicine, Basel, Switzerland
| | - Mauramo Matti
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pathology, Haartman Institute and HUSLab, Helsinki University Central Hospital, Helsinki, Finland
| | - Waltimo Tuomas
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Hebelstrasse 3, CH-4055, Basel, Switzerland
| |
Collapse
|
12
|
Uutela P, Passweg J, Halter J, Gerull S, Weiger R, Mauramo E, Waltimo T, Mauramo M. Common oral diseases, hyposalivation and survival post‐HSCT, a longitudinal study. Eur J Haematol 2019; 103:300-306. [DOI: 10.1111/ejh.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Pauliina Uutela
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel University of Basel Basel Switzerland
| | - Jakob Passweg
- Department of Hematology University Hospital Basel Switzerland
| | - Jörg Halter
- Department of Hematology University Hospital Basel Switzerland
| | - Sabine Gerull
- Department of Hematology University Hospital Basel Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology University Center for Dental Medicine Basel, University of Basel Basel Switzerland
| | - Elina Mauramo
- Department of Public Health University of Helsinki Helsinki Finland
| | - Tuomas Waltimo
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel University of Basel Basel Switzerland
| | - Matti Mauramo
- Department of Oral and Maxillofacial Diseases Helsinki University Hospital, University of Helsinki Helsinki Finland
- Department of Pathology Haartman Institute and HUSLab, Helsinki University Central Hospital Helsinki Finland
| |
Collapse
|
13
|
da Fonseca MA. Oral and Dental Care of Local and Systemic Diseases. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
14
|
Hickey V, Flesch L, Lane A, Pai AL, Huber J, Badia P, Davies SM, Dandoy CE. Token economy to improve adherence to activities of daily living. Pediatr Blood Cancer 2018; 65:e27387. [PMID: 30051581 PMCID: PMC6150780 DOI: 10.1002/pbc.27387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Participation in key activities of daily living (ADL), including daily bathing, physical activity, and oral hygiene, can decrease the risk of bloodstream infections, oral complications, and deconditioning in pediatric patients undergoing hematopoietic stem cell transplant (HSCT). However, many patients fail to perform ADL during their inpatient stay. To improve inpatient adherence to ADL, we tested a token economy to engage patients, families, and the clinical team in improving adherence to these important health behaviors during this critical time. METHODS We used a controlled before-after study design to test our hypothesis. All patients were prescribed three ADL. We used an "all or none" measurement for each component of the ADL 1-2-3 initiative to measure adherence. HSCT patients with poor ADL adherence (<20%) were eligible to receive the intervention, which consisted of rewarding patients through an ADL via a token economy. RESULTS Twenty-one patients participated in the study. ADL adherence for the 14 days prior to intervention in study subjects (n = 294 inpatient days) averaged 0.51 ADL per day (95% CI 0.45-0.57). In the 14 days postinitiation of the token economy intervention (n = 294 inpatient days), the average adherence was 2.5 ADL per day (95% CI 2.4-2.5; P = <0.001). DISCUSSION Positive reinforcement through a token economy system is associated with improved adherence to ADL in hospitalized pediatric patients who demonstrated poor ADL adherence at baseline. We believe this intervention can positively impact adherence to targeted health behaviors with the ability to correlate with improved health outcomes.
Collapse
Affiliation(s)
- Victoria Hickey
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Laura Flesch
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Adam Lane
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ahna L.H. Pai
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John Huber
- Information Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Priscila Badia
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stella M Davies
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher E Dandoy
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
15
|
Treatment of systemic diseases and oral focal infection. INFECTION INTERNATIONAL 2018. [DOI: 10.2478/ii-2018-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractOral lesions are highly correlated with the occurrence and development of many diseases. In addition, the treatment of systemic diseases may aggravate oral focal infections, affect the life quality of patients, interfere with the treatment of systemic diseases, and even cause systemic infection in serious cases. Treatment strategies for systemic diseases may induce or aggravate oral local lesion infections. In specific, administration of oral antiepileptic drugs and immunosuppressive drugs may induce gingivitis, radiotherapy or chemotherapy for malignant tumors may cause oral mucositis, long-term use of bisphosphonates for inhibition of tumor bone metastasis or prevention of osteoporosis may cause osteonecrosis of the jaw, and allogeneic hematopoietic stem cell transplantation may cause oral rejection reactions.
Collapse
|
16
|
Abstract
A diagnosis of head and neck cancer (HNC) is typically followed by therapy that is associated with immediate and long-lasting toxic consequences. HNC patients' oral health needs may be complex and are best addressed in multidisciplinary collaborative teams including surgical, medical, and radiation oncologists, dental providers, nutrition, speech/swallow specialists, and physical therapists. Oral health maintenance also requires patient compliance and caregiver support. The role of dental providers begins prior to cancer diagnosis and continues through survivorship. This includes oral screening and health maintenance, management of common oral complications such as mucositis, pain, infection, salivary dysfunction, altered taste, and dental decay, as well as complex issues that include soft tissue fibrosis, osteoradionecrosis of the jaw, dysphagia, and recurrent/new primary malignancies. As the number of potential therapeutic interventions for HNC increase, so do the spectrum of side effects affecting the oral cavity, oropharynx, and dentition. Specific approaches to oral care must be tailored to the idiosyncrasies of the patient and his/her therapy and condition. Oral and dental care is impacted by the patient's oral and dental status prior to cancer therapy, as well as the specific cancer type, location, stage, and its treatment and potential comorbid conditions. Communication between the dental professional and the oncology team is required for appropriate therapy and is best accomplished by integrated healthcare teams.
Collapse
Affiliation(s)
- Joel B Epstein
- Cedars-Sinai Health System, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA.
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, USA.
| | - Andrei Barasch
- Dept of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
17
|
Kishimoto M, Akashi M, Tsuji K, Kusumoto J, Furudoi S, Shibuya Y, Inui Y, Yakushijin K, Kawamoto S, Okamura A, Matsuoka H, Komori T. Intensity and duration of neutropenia relates to the development of oral mucositis but not odontogenic infection during chemotherapy for hematological malignancy. PLoS One 2017; 12:e0182021. [PMID: 28750016 PMCID: PMC5531589 DOI: 10.1371/journal.pone.0182021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background D-index which combines the intensity and duration of neutropenia is reported as a tool for evaluating the dynamics of neutropenia. This study aimed to analyze the relationship between D-index and oral complications (i.e., oral mucositis [OM] and odontogenic infection [OI]) during chemotherapies for hematological malignancies. Methods A total of 421 chemotherapeutic courses in 104 patients were analyzed. Chemotherapeutic courses in patients who finished all of the prophylactic dental treatments were defined as “treatment Finish”. Chemotherapeutic courses in patients who did not finish prophylactic dental treatments were defined as “treatment not-Finish”. OM was evaluated according to the Common Terminology Criteria for Adverse Events, version 4.0. D-index was compared between chemotherapeutic courses with versus without oral complications. Results D-index was significantly higher in chemotherapeutic courses with grade 1 or 2 OM (p < 0.001) than courses without OM. In contrast, higher D-index did not relate to the development of OI (p = 0.18). The occurrence of OI (p < 0.001) but not OM (p = 0.56) during chemotherapy was significantly higher in chemotherapeutic courses without the completion of dental intervention. Conclusions Higher D-index relates to the development of OM. In contrast, OI occurs due to untreated odontogenic foci, and its occurrence does not relate to higher D-index.
Collapse
Affiliation(s)
- Megumi Kishimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- * E-mail:
| | - Kazuyuki Tsuji
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuyuki Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yumiko Inui
- Department of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Yakushijin
- Department of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Kawamoto
- Department of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuo Okamura
- Division of Medical Oncology/Hematology, Kakogawa West City Hospital, Kakogawa, Japan
| | - Hiroshi Matsuoka
- Department of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
18
|
Nuernberg MAA, Rodrigues SC, Perdoncini NN, Funke VAM, Bonfim CMS, Nabhan SK, Torres-Pereira CC. Periodontal status of candidates for allogeneic hematopoietic stem cell transplantation. SPECIAL CARE IN DENTISTRY 2017; 37:187-193. [DOI: 10.1111/scd.12229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Samir Kanaan Nabhan
- Avenida Prefeito Lothário Meissner; 632, Jardim Botânico Curitiba Paraná Brazil, 80210-170
| | | |
Collapse
|
19
|
Wang Y, Ji X, Leak RK, Chen F, Cao G. Stem cell therapies in age-related neurodegenerative diseases and stroke. Ageing Res Rev 2017; 34:39-50. [PMID: 27876573 PMCID: PMC5250574 DOI: 10.1016/j.arr.2016.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/26/2016] [Accepted: 11/04/2016] [Indexed: 02/06/2023]
Abstract
Aging, a complex process associated with various structural, functional and metabolic changes in the brain, is an important risk factor for neurodegenerative diseases and stroke. These diseases share similar neuropathological changes, such as the formation of misfolded proteins, oxidative stress, loss of neurons and synapses, dysfunction of the neurovascular unit (NVU), reduction of self-repair capacity, and motor and/or cognitive deficiencies. In addition to gray matter dysfunction, the plasticity and repair capacity of white matter also decrease with aging and contribute to neurodegenerative diseases. Aging not only renders patients more susceptible to these disorders, but also attenuates their self-repair capabilities. In addition, low drug responsiveness and intolerable side effects are major challenges in the prevention and treatment of senile diseases. Thus, stem cell therapies-characterized by cellular plasticity and the ability to self-renew-may be a promising strategy for aging-related brain disorders. Here, we review the common pathophysiological changes, treatments, and the promises and limitations of stem cell therapies in age-related neurodegenerative diseases and stroke.
Collapse
Affiliation(s)
- Yuan Wang
- Departments of Neurology, Xuanwu Hospital, Capital University of Medicine, Beijing 100053, China
| | - Xunming Ji
- Departments of Neurosurgery, Xuanwu Hospital, Capital University of Medicine, Beijing 100053, China
| | - Rehana K Leak
- Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA 15282, United States
| | - Fenghua Chen
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Guodong Cao
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States; Geriatric Research Education and Clinical Centers, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, United States.
| |
Collapse
|
20
|
López-Jornet P, Pons-Fuster E, Ruiz-Roca JA. YOUTUBE videos on oral care of the organ or hematopoietic stem cell transplant patients. Support Care Cancer 2016; 25:1097-1101. [DOI: 10.1007/s00520-016-3497-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
|
21
|
Abstract
Oral chronic graft versus host disease (cGVHD) is often refractory to systemic therapies. Additional topical treatment is commonly required. The potency of the agent, the vehicle and formulation in which it is delivered are all critical factors in determining the effectiveness of topical therapies. High potency of budesonide, combined with its very low bioavailability when absorbed through mucosal surfaces, increased the potential role in topical application for oral cGVHD. Viscous formulation increases mucosal contact time resulting in a greater decrease in mucosal inflammation. This short communication suggests that oral viscous budesonide should be considered as a potential new therapy in the management of oral cGVHD.
Collapse
|
22
|
Samim F, Epstein JB, Zumsteg ZS, Ho AS, Barasch A. Oral and dental health in head and neck cancer survivors. CANCERS OF THE HEAD & NECK 2016; 1:14. [PMID: 31093344 PMCID: PMC6460838 DOI: 10.1186/s41199-016-0015-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/03/2016] [Indexed: 01/29/2023]
Abstract
Therapeutic improvements and epidemiologic changes in head and neck cancer (HNC) over the last three decades have led to increased numbers of survivors, resulting in greater need for continuing management of oral and dental health in this population. Generally, the HNC patient oral health needs are complex, requiring multidisciplinary collaboration among oncologists and dental professionals with special knowledge and training in the field of oral oncology. In this review, we focus on the impact of cancer treatment on oral health, and the oral care protocols recommended prior to, during and after cancer therapy. The management of oral complications such as mucositis, pain, infection, salivary function, taste and dental needs are briefly reviewed. Other complications and their management, including osteonecrosis of the jaw and recurrent/new primary malignancies are also described. This review offers clinical protocols and information for medical providers to assist in understanding oral complications and their management in HNC patients and survivors, and their oral and dental health care needs. Oral and dental care is impacted by the patient's initial oral and dental status, as well as the specific cancer location, type, and its treatment; thus, close communication between the dental professional and the oncology team is required for appropriate therapy.
Collapse
Affiliation(s)
- Firoozeh Samim
- Department of Oral Medicine Oral Pathology, University of British Columbia, Vancouver, BC Canada
| | - Joel B. Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Zachary S. Zumsteg
- Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Allen S. Ho
- Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Andrei Barasch
- Department of Medicine, Weill Cornell Medical College, New York, NY USA
| |
Collapse
|
23
|
Toro JJ, Gushiken FC, Schneider D, Lee S, Haile DJ, Freytes CO. Edentulism and transplant-associated complications in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation. Support Care Cancer 2016; 24:3411-5. [PMID: 26984247 DOI: 10.1007/s00520-016-3168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/07/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients undergoing autologous hematopoietic stem cell transplantation (HSCT) are at risk for oral complications which may cause significant morbidity. The aim of this study was to compare the incidence of toxicities and complications in edentulous and dentate patients undergoing autologous HSCT for multiple myeloma. METHODS We conducted a retrospective case-control study to analyze the incidence of bacteremia, fever, and oral mucositis, between edentulous and dentate patients. All patients underwent dental evaluation, received dental treatment if indicated, and were cleared before transplantation. The two groups were matched for age, gender, ethnicity, disease stage, time from diagnosis to transplant, performance status, and conditioning regimen. RESULTS A total of 45 edentulous and 90 dentate patients were enrolled. All patients were male with a median age of 60 years and a mean performance status by Karnofsky score of 90 %. Two thirds had stage III MM with a median time from diagnosis to transplantation of 12 months, and all received melphalan as part of the conditioning regimen. The incidence of bacteremia (p = 0.553), fever (p = 0.245), severity of oral mucositis (p = 0.465), and other post-transplant toxicities were similar between both groups. CONCLUSIONS There were no significant differences in the incidence of bacteremia, fever, severity of oral mucositis, or other complications between edentulous and dentate patients with multiple myeloma after autologous HSCT.
Collapse
Affiliation(s)
- Juan Jose Toro
- Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA.
| | - Francisca Cecilia Gushiken
- Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA
| | - Deanna Schneider
- Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA
| | - Shuko Lee
- Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA
| | - David Johannes Haile
- Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA
| | - Cesar Ovidio Freytes
- Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA
| |
Collapse
|
24
|
Nuernberg MAA, Nabhan SK, Bonfim CMS, Funke VAM, Torres-Pereira CC. Access to oral care before hematopoietic stem cell transplantation: understand to improve. Support Care Cancer 2016; 24:3307-13. [DOI: 10.1007/s00520-016-3142-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
|
25
|
Dental treatment in patients with leukemia. JOURNAL OF ONCOLOGY 2015; 2015:571739. [PMID: 25784937 PMCID: PMC4345074 DOI: 10.1155/2015/571739] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/23/2014] [Accepted: 01/11/2015] [Indexed: 12/18/2022]
Abstract
Dental treatment of patients with leukemia should be planned on the basis of antineoplastic therapy which can be chemotherapy with or without radiotherapy and bone marrow transplantation. Many are the oral manifestations presented by these patients, arising from leukemia and/or treatment. In addition, performing dental procedures at different stages of treatment (before, during, or after) must follow certain protocols in relation to the haematological indices of patients, aimed at maintaining health and contributing to the effectiveness of the results of antineoplastic therapy. Through a literature review, the purpose of this study was to report the hematological abnormalities present in patients with leukemia, trying to correlate them with the feasibility of dental treatment at different stages of the disease. It is concluded in this paper that dental treatment in relation to haematological indices presented by patients with leukemia must follow certain protocols, mainly related to neutrophil and platelet counts, and the presence of the dentist in a multidisciplinary team is required for the health care of this patient.
Collapse
|
26
|
Allareddy V, Venugopalan SR, Eswaran SVK, Rampa S, Anamali S, Nalliah RP, Shin K, Allareddy V, Elangovan S. Important impact of gingival and periodontal conditions on outcomes in SCT recipients. Bone Marrow Transplant 2015; 50:604-6. [PMID: 25599170 DOI: 10.1038/bmt.2014.311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- V Allareddy
- Department of Orthodontics, College of Dentistry - The University of Iowa, Iowa City, IA, USA
| | - S R Venugopalan
- Department of Orthodontics and Dentofacial Orthopedics, University of Missouri - Kansas City, Kansas City, MO, USA
| | - S V K Eswaran
- Department of Periodontics, The University of Texas at Houston, Houston, TX, USA
| | - S Rampa
- Department of Health Management and Policy, College of Public Health - University of Nebraska Medical Center, Omaha, NE, USA
| | - S Anamali
- Department of Preventive Dentistry - College of Dentistry, The University of Iowa, Iowa City, IA, USA
| | - R P Nalliah
- Office of Global Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - K Shin
- Department of Orthodontics, College of Dentistry - The University of Iowa, Iowa City, IA, USA
| | | | - S Elangovan
- Department of Periodontics, College of Dentistry - The University of Iowa, Iowa City, IA, USA
| |
Collapse
|
27
|
Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan RM, Potting CMJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 2015; 23:223-36. [PMID: 25189149 PMCID: PMC4328129 DOI: 10.1007/s00520-014-2378-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/30/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. METHODS This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. RESULTS The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. CONCLUSION Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol.
Collapse
Affiliation(s)
- Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave., Rochester, NY, 14620, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Tayyem AQM. Cryotherapy effect on oral mucositis severity among recipients of bone marrow transplantation: a literature review. Clin J Oncol Nurs 2014; 18:E84-7. [PMID: 25095309 DOI: 10.1188/14.cjon.e84-e87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral mucositis is a distressing toxic effect of cancer therapy and one of the major side effects of the myeloablative conditioning used to prepare patients for bone marrow transplantation (BMT). Oral cryotherapy is one of the recent modalities used to prevent and manage oral mucositis. The purpose of this review is to clarify the cryotherapy effect on oral mucositis severity among patients receiving myeloablative conditioning followed by BMT. A literature search was performed using six different electronic databases: CINAHL®, MEDLINE®, Nursing Ovid, PubMed, Springer, and Science Direct. Six articles were deemed relevant and included in this review. Oral mucositis increases mortality rate, length of hospital stay, opioid use, and the need for parenteral nutrition usage. It also decreases patient's quality of life and his or her desire to complete treatment. However, oral cryotherapy significantly minimizes the incidence and severity of oral mucositis and decreases secondary oral mucositis complications. Using oral cryotherapy concurrently with a regular oral care protocol can improve its efficacy for preventing and managing oral mucositis. Additional studies should be conducted to create standard oral cryotherapy protocols.
Collapse
|
29
|
Oral complaints and dental care of haematopoietic stem cell transplant patients: a qualitative survey of patients and their dentists. Support Care Cancer 2014; 23:13-9. [DOI: 10.1007/s00520-014-2297-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/26/2014] [Indexed: 12/31/2022]
|
30
|
Oral complications in hematopoietic stem cell recipients: the role of inflammation. Mediators Inflamm 2014; 2014:378281. [PMID: 24817792 PMCID: PMC4003795 DOI: 10.1155/2014/378281] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/27/2014] [Indexed: 11/30/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is widely used as a potentially curative treatment for patients with various hematological malignancies, bone marrow failure syndromes, and congenital immune deficiencies. The prevalence of oral complications in both autologous and allogeneic HSCT recipients remains high, despite advances in transplant medicine and in supportive care. Frequently encountered oral complications include mucositis, infections, oral dryness, taste changes, and graft versus host disease in allogeneic HSCT. Oral complications are associated with substantial morbidity and in some cases with increased mortality and may significantly affect quality of life, even many years after HSCT. Inflammatory processes are key in the pathobiology of most oral complications in HSCT recipients. This review article will discuss frequently encountered oral complications associated with HSCT focusing on the inflammatory pathways and inflammatory mediators involved in their pathogenesis.
Collapse
|
31
|
Fernandes LLD, Torres SR, Garnica M, de Souza Gonçalves L, Junior AS, de Vasconcellos ÁC, Cavalcanti W, Maiolino A, de Barros Torres MCM. Oral status of patients submitted to autologous hematopoietic stem cell transplantation. Support Care Cancer 2013; 22:15-21. [DOI: 10.1007/s00520-013-1940-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
|
32
|
Akashi M, Shibuya Y, Kusumoto J, Furudoi S, Inui Y, Yakushijin K, Okamura A, Matsuoka H, Komori T. Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia. BMC Oral Health 2013; 13:41. [PMID: 23957921 PMCID: PMC3751758 DOI: 10.1186/1472-6831-13-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 08/14/2013] [Indexed: 01/15/2023] Open
Abstract
Background Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection. Methods 37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated. Results Two patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections. Conclusions The simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed.
Collapse
Affiliation(s)
- Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Microbiology and epidemiology of oral yeast colonization in hemopoietic progenitor cell transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:354-8. [PMID: 23312542 DOI: 10.1016/j.oooo.2012.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/09/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We monitored the epidemiology and microbiology of oral yeast colonization in patients undergoing hemopoietic progenitor cell transplantation (HPCT) to examine associations between yeast colonization and oral mucositis. STUDY DESIGN One hundred twenty-one consecutive HPCT patients were sampled for oral yeasts prior to fluconazole (FLC) prophylaxis, at transplantation, and weekly until discharge. Clinical oral mucositis screenings were performed triweekly. RESULTS Yeast colonization was evident at 216 of 510 total visits. Candida albicans and Candida glabrata were the predominant organisms. Eight patients showed elevated minimal inhibitory concentrations to FLC. One patient developed fungal septicemia. Patients with oral mucositis assessment scale scores <20 had higher colonization rates than those with higher scores. CONCLUSIONS FLC is effective in controlling a variety of oral yeasts in HPCT recipients. FLC-resistant yeasts do emerge and can be the source of fungal sepsis. A positive association was not shown between yeast colonization and the presence or severity of oral mucositis.
Collapse
|
34
|
Elad S, Zeevi I, Finke J, Koldehoff M, Schwerdtfeger R, Wolff D, Mohrbacher R, Levitt M, Greinwald R, Shapira MY. Improvement in Oral Chronic Graft-versus-Host Disease with the Administration of Effervescent Tablets of Topical Budesonide—An Open, Randomized, Multicenter Study. Biol Blood Marrow Transplant 2012; 18:134-40. [DOI: 10.1016/j.bbmt.2011.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
|
35
|
Laaksonen M, Ramseier A, Rovó A, Jensen S, Raber-Durlacher J, Zitzmann N, Waltimo T. Longitudinal Assessment of Hematopoietic Stem Cell Transplantation and Hyposalivation. J Dent Res 2011; 90:1177-82. [DOI: 10.1177/0022034511414156] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hyposalivation is a common adverse effect of anti-neoplastic therapy of head and neck cancer, causing impaired quality of life and predisposition to oral infections. However, data on the effects of hematopoietic stem cell transplantation (HSCT) on salivary secretion are scarce. The present study determined stimulated whole-saliva flow rates in HSCT recipients in comparison with a healthy control group. Stimulated whole-saliva flow rates of 228 allogeneic HSCT recipients (134 males, 94 females; mean age, 43 yrs) were examined pre-HSCT and 6, 12, and 24 months post-HSCT. Healthy individuals (n = 144; 69 males, 75 females; mean age, 46 yrs) served as the control group. Stimulated saliva flow rates (mL/min) were measured and analyzed statistically, stratifying for hematological diagnoses and conditioning therapy. Hyposalivation (≤ 0.7 mL/min) was found in 40% (p < 0.00001), 53% (p < 0.00001), 31% (p < 0.01), and 26% (n.s.) of the recipients pre-HSCT, and 6, 12, and 24 months post-HSCT, respectively, whereas 16% of the control individuals had hyposalivation. Severe hyposalivation (≤ 0.3 mL/min) was found in 11%, 18%, 4%, and 4% of the recipients pre-HSCT, and 6, 12, and 24 months post-HSCT, respectively. Additionally, conditioning regimen and sex had an impact on saliva flow. In conclusion, hyposalivation was observed to be a common but generally reversible complication among HSCT recipients.
Collapse
Affiliation(s)
- M. Laaksonen
- Institute of Preventive Dentistry and Oral Microbiology, School of Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland
| | - A.M. Ramseier
- Institute of Preventive Dentistry and Oral Microbiology, School of Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland
| | - A. Rovó
- Department of Hematology, University Hospital Basel, Switzerland
| | - S.B. Jensen
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, University of Copenhagen, Denmark
| | | | - N.U. Zitzmann
- Department of Periodontology, Endodontology and Cariology, School of Dentistry, University of Basel, Switzerland
| | - T. Waltimo
- Institute of Preventive Dentistry and Oral Microbiology, School of Dental Medicine, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland
| |
Collapse
|
36
|
Yamagata K, Onizawa K, Yanagawa T, Takeuchi Y, Hasegawa Y, Chiba S, Bukawa H. Prospective study establishing a management plan for impacted third molar in patients undergoing hematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2011; 111:146-52. [PMID: 21237433 DOI: 10.1016/j.tripleo.2010.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/25/2010] [Accepted: 09/06/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although dental treatment before hematopoietic stem cell transplantation (HSCT) is essential to prevent serious infections from oral sources, the best management plan for impacted third molar (ITM) is unclear. STUDY DESIGN This study was planned to establish a management plan for ITM. Eighty-four candidates for HSCT therapy were consecutively enrolled in the prospective trial. The management plan, which was evidence based and prospectively decided, was to extract the symptomatic ITMs and to leave the asymptomatic ones untreated, regardless of their impacted position. RESULTS Eighty-seven ITMs were observed in 35 patients. The ITMs were in the maxilla of 25 patients and the mandible of 28 patients. Dental extraction of 7 teeth was performed in 6 patients without complications. All of the patients received the scheduled HSCT therapy and none experienced odontogenic infection while myelosuppressed. CONCLUSIONS This management plan for ITM appears to be appropriate for pre-HSCT patients. Moreover, the experienced dental provider is suggested as a necessary and valuable part of the HSCT team.
Collapse
Affiliation(s)
- Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
| | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Eduardo FDP, Bezinelli LM, Hamerschlak N, Andrade CT, Morelli LR, Corrêa L. Oral care in Brazilian bone marrow transplant centers. Rev Bras Hematol Hemoter 2011; 33:15-20. [PMID: 23284237 PMCID: PMC3521429 DOI: 10.5581/1516-8484.20110008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/05/2010] [Indexed: 11/30/2022] Open
Abstract
Background Oral care is a fundamental procedure for the success of the hematopoietic stem cell transplantation, particularly regarding the control of oral infectious diseases. Information about oral care protocols and the inclusion of dental professionals in transplantation medical staff is poorly known. Objective The aim of this study was to carry out a survey about the protocols of Brazilian dental professionals with regard to oral care of HSCT patients. Methods A questionnaire was mailed to 36 Brazilian transplant centers with questions about basic oral care protocols, the indication of specific mouthwashes, antibiotic therapy regimens, laser therapy, and treatment of oral mucositis and graft-versus-host disease. All the respondent centers (n = 12) have dentists as members of the HSCT medical staff. Results The majority indicate non-alcoholic chlorhexidine (n = 9; 75.0%) and sodium bicarbonate (n = 5; 41.7%) as routine mouthwashes. Laser therapy was frequently indicated (n= 9; 75.0%), mainly in the prevention of oral mucositis and in oral pain control. In the post-transplant period, antibiotic therapy was only indicated for invasive dental treatments (n= 8; 66.7%). Several treatments for graft-versus-host disease were mentioned without a trend towards establishing a standard protocol. Conclusion Basic oral care constitutes regular assessment in the routine treatment of hematopoietic stem cell transplantation patients in Brazilian centers.
Collapse
|
39
|
Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation. Br Dent J 2009; 207:E17; discussion 428-9. [DOI: 10.1038/sj.bdj.2009.977] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2009] [Indexed: 12/23/2022]
|