Changes in the periodontal status of patients undergoing bone marrow transplantation

Background: Patients receiving an HLA-matched bone marrow transplant (BMT) from a relative or unrelated donor undergo a permanent alteration of their immune system, followed by a prolonged period of immunodeficiency. This stu dy aimed to examine alterations in the periodontal status of patients over 6 months post-bone marrow transplantation. Methods: Thirty-seven patients scheduled for bone marrow transplantation pa rticipated in this study. One calibrated examiner carried out periodontal e xaminations (clinical and radiographic) immediately prior to and at 3 and 6 months after transplantation. All patients followed an intense oral care p rogram. Subgingival plaque samples were analyzed by enzyme-linked immunosor bent assay (ELISA) for the presence of Porphyromonas gingivalis, Actinobaci llus actinomycetemcomitans, and Prevotella intermedia. Data were subjected to statistical analyses to determine the relationships between the frequenc y distribution of the radiographic and clinical variables over time. Results: Gains in clinical attachment level (CAL) of greater than or equal to2 mm at 4 or more sites from baseline to 6 months post-BMT were noted in 9/16 patients (56%), while 6/16 (38%) patients experienced a loss of CAL gr eater than or equal to2 mm at 4 or more sites in the same period. At a site level, 4.8% of sites exhibited a gain in CAL greater than or equal to2 mm between baseline and 3 months post-BMT while 2.3% of sites showed a loss of CAL greater than or equal to2 mm in the same period. From baseline to 6 mo nths, a gain in CAL of greater than or equal to2 mm was recorded at 3.1% of sites, and 2.4% of sites experienced a loss of greater than or equal to2 m m. A significant improvement in the gingival index occurred between all seq uential time periods when assessed at a site level. At a patient level, 11/ 18 (61%) patients showed a significant change in gingival index between bas eline and 3 months and 10/16 (63%) between baseline and 6 months. There was no significant relationship between clinical changes and the prevalence of the periodontal pathogens at the various time periods. Conclusions: An improvement in periodontal health was recorded between base line and 6 months post-transplantation. Most of the improvement in periodon tal status was noted in the first 3 months after BMT, with a slight decline in periodontal health between 3 and 6 months post-transplant. No significa nt alteration was noted in the prevalence of periodontal pathogens during t he study period.