Allogeneic Bone Marrow/Stem Cell Transplant

The allogeneic bone marrow or stem cell transplant is a medical procedure which involves high dose chemotherapy and often total body irradiation prior to the infusion of the donor’s (usually related) stem cells or bone marrow. This treatment is usually used for apalstic anemia, acute leukemias, non-Hodgkin’s lymphoma and myelodysplasia or myelofibrosis. This is a procedure that carries significant morbidity and mortality.

This requires the insertion of a central venous line (usually a Hickman line) and a period of hospitalization of approximately 4 weeks in isolation for recovery during which time there will be pancytopenia. The chemotherapy places the patient at risk of infection and with the low blood counts, dental care is not safe. Therefore, the patient requires a thorough dental and radiographic examination to remove potential sources of odontogenic infection. Obvious active dental disease requires treatment and optimal oral health should be attained before hospitalization. The duration of the immunosuppressed period is variable and can be up to one year or more after the transplant. These patients may have the central venous line in situ for this time period and may require frequent transfusions or intravenous drug therapy. For these reasons, safe dental care in the private office setting is variable.

Factors to consider in the delivery of safe dental treatment include:

  1. blood counts, particularly platelets and neutrophils
  2. presence of a Hickman line (requiring prophylactic antibiotics)
  3. immunosuppressant medications
  4. presence of graft versus host disease

Complications related to bone marrow transplantation include chronic graft versus host disease (GVHD) and oral lesions secondary to opportunistic infections. The oral lesions of GVHD may have significant impact on his oral/dental health and include xerostomia, (which would predispose to caries), atrophy of the gingiva and oral mucosal lichenoid lesions with or without ulceration. An increase in the incidence of oral herpetic infections, human papilloma virus infections (e.g. condyloma acuminatum) and candidiasis may also occur. Also, should GVHD develop, medical therapy (systemic) would include immunosuppressant agents. If this occurs, prophylactic antibiotics (as per the current AHA regimen) are advised for dental procedures which will result in gingival bleeding.

If the patient recovers completely and is not being treated for GVHD, he/she can be seen as normal with the caveat that the medical history is always updated and there is no recurrent disease or complication related to their disease.