Oral complications of pediatric hematopoietic cell transplantation: diagnosis and management

Oral complications are a significant cause of morbidity and potential morta lity for children undergoing hematopoietic cell transplant (HCT). Oral comp lications can occur at all stages of HCT and can interfere significantly wi th transplant recovery. Mucosal disease caused by conditioning regimen toxi city and infection are frequent clinical problems. Untreated dental caries and periodontal disease may result in severe infections of the mouth and/or life-threatening systemic spread of the microbial pathogens. In the course of chronic graft-versus-host disease (GVHD), which can complicate HCT, lic henoid and ulcerative lesions of the mucosa are observed. Furthermore, tota l-body irradiation utilized in the conditioning regimens can cause early xe rostomia and consequent dental decay and also result in significant dental and skeletal developmental anomalies. The dental health care team should ha ve a key role in the support of HCT patients. The team's primary responsibi lities are those related to the prevention of severe infections originating in the mouth, which includes providing instruction on oral prophylaxis and hygiene as well as direct intervention. Prevention and/or diagnosis and ma nagement of oral complications of HCT by the dental team can improve the su ccess of a transplant by reducing morbidity, improving the quality of life, and reducing the cost of care. The authors present specific protocols for the diagnosis and prevention and for the management of oral complications i n pediatric HCT.