Autologous Peripheral Stem Cell Transplant

The Role of Dentistry in the Autologous Peripheral Stem Cell Transplant

"I am going to be undergoing a bone a peripheral stem cell transplant. Why am I seeing the dentist before I am admitted to hospital?"

The stem cell transplant is a procedure that requires you to have high dose chemotherapy before you receive your stem cells. This regimen will make you more prone to all infections and if you have any current infections, they may spread and cause potentially serious complications while you are in the hospital. Your doctors have referred you to the dental clinic so that we can do a thorough oral and X-ray examination to make sure that your teeth will not be a source of infection. Also, there may be some side effects to your mouth that we can help you with. Not only does our dental team have the expertise and experience in looking after patients like you, we have easy access to your oncologists and your blood results. It is in your best interests to be treated by our dentists and hygienists until we feel it is safe for you to return to your family dentist. At that time, we will send your radiographs and pertinent information to him/her.

Central Venous Lines (Hickman)

A Hickman line will be placed before your transplant for delivery of the bone marrow/stem cells, intravenous medications, transfusions if necessary and for blood tests. It is important to inform your dentist if you have a Hickman line or a portocath so that he/she can give you appropriate antibiotics before any dental work. The dental work can lead to bleeding which can carry oral bacteria and infect your line. This may include fillings, cleaning, root canal or extractions.

Oral Side Effects

Mucositis

This refers to sores in your mouth that frequently occur after about 1 week of your hospital admission. This is due in part to the chemotherapy and its effects on your immune system. It has been shown that having good oral health with very clean teeth can help to minimize this effect. Good oral hygiene is very important to prevent bleeding gums as this may happen when the platelets in your blood drop in number. Our dental team can show you the necessary steps to achieve optimal oral and dental health.

Sensitive teeth

It is not unusual to have sensitive teeth after a transplant. This is most noticeable when drinking or eating cold foods. Generally, this is a temporary change, but it can be quite bothersome. We have simple measures to treat this to make you more comfortable.

Taste Changes

The chemotherapy may affect the taste buds on your tongue so that food may taste different. This is a temporary change and lasts for about one month after your treatment.

Xerostomia

Xerostomia means "dry mouth ". This is usually a temporary condition that results from the chemotherapy. However, if you receive total body radiation, this may last longer A dry mouth may influence your ability to swallow and will mean that you have to drink more water. It also means that you have to clean your teeth better and more frequently as food will tend to stick to your teeth. If the dryness lasts longer than 3 months, you may be at an increased risk for developing cavities along the root surfaces of your teeth. It is important to have regular and frequent dental check-ups to monitor this. We can measure your saliva and if it continues to be low, recommend special fluoride treatments to minimize dental decay.

Blood counts

After a transplant, your blood counts may take time to return to normal. This is variable from patient to patient. We will follow you after your transplant and monitor your blood counts. If you require any dental treatment and your blood counts are low, we will advise your oncologist and work with him/her to ensure you receive the best care in the medically safest manner.

In summary, optimal oral and dental health will not only make you feel better, but it will enhance your recovery and prevent problems secondary to your treatment. Your oncologist works closely with our dental staff to diagnose, monitor and manage the complications of therapy.