Abstract
Aims: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT). Materials and Methods: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical exploration and radiology were carried out and oral photographs were taken. This evaluated the extent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index) DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O’Leary’s Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT. Results: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations. Conclusions: The state of prior oral health can influence decisively the mucositis suffered during transplantation. Key words: Hematopoietic progenitor cell transplantation, mucositis, state of oral health.
Highlights
An ageing population, the increased occurrence of certain malignant tumors and the longer survival rates of cancer sufferers, has lead to a significant increase in the numbers of patients suffering malignant neoplasias. (1)
In 2003 the WDF, the World Health Organization (WHO) and the IADR, drew up a plan fixing a series of dental health targets to be met in the new millennium (17). Amongst these are: reduction in the death rate due to oral and craniofacial disease, reduction of the impact of oral pathologies on systemic disease and the integration of buccodental health care into other medical disciplines. In accord with these last two objectives, the present study focuses on evaluating the level of oral health in patients prior to hematopoietic progenitor cell transplantation (HPCT) and its influence on mucosa affectation during the transplantation procedure
In a literature review dealing with oral mucositis, Gabriel et al (2) refer to a number of authors who affirm that the majority of patients suffer severe levels of mucositis during HPCT
Summary
The increased occurrence of certain malignant tumors and the longer survival rates of cancer sufferers, has lead to a significant increase in the numbers of patients suffering malignant neoplasias. (1). Treatment of hematologic aplasia includes chemotherapy (CT), radiotherapy (RT) and often a combination of both Most of these patients will undergo hematopoietic progenitor cell transplantation (HPCT) for the eradication of the cancer and to soften the side effects of the high levels of radiation and the cytostatics involved in treatment. The occurrence of mucositis has always been explained as a combination of factors associated with and giving rise to this situation These factors include: high index of epithelial buccal cell replacement, a direct effect of radiation and cytostatics on the tissues involved (toxicity), vascular disturbances that compromise healing processes, altered immune responses due to myelosuppression and lastly, modifications to buccal flora due to hypoplasia and the administration of prophylactic drugs (antibiotics, antifungals, and antivirals). Several studies (2-6) suggest that various factors that may influence the grade of mucositis in patients undergoing HPCT, some of these have not been confirmed: - Intensity of the conditioning regime prior to HPTC
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