Improved Oral Health Can Improve Stem Cell Transplant Outcomes

Published January 2018 | Pediatric Blood Cancer

Convincing healthy children to brush their teeth regularly is challenging, but can be even harder for children with cancer. Chemotherapy and radiation treatments can lead to sores on the gums and mucosal tissues of the mouth that increase the risk of bloodstream infections. Undergoing a hematopoietic stem cell transplant can further weaken a child’s immune system.

However, researchers in the Division of Pediatric Dentistry are identifying preventive, oral-hygiene protocols that set up children for pre-transplant success.

For this study, the team tracked 19 pediatric cancer patients for mucositis, gingivitis and plaque accumulation before, day-of, and days 7, 14 and 28 post-transplant.

Of 16 children with identifiable oral disease after transplant: 85 percent developed progressive plaque accumulation, 85 percent severe gingivitis, 68 percent mucositis, and 58 percent oral ulcerations. Children with suboptimal oral health before the transplant had a higher incidence of mucositis and more serious infections than those with better oral health.

Gingivitis is a potential source of bloodstream infections, and mucositis is a significant cause of transplant-related morbidity, despite improvements in supportive care, says Sarat “Bobby” Thikkurissy, DDS, MS, the division’s residency program director.

“A lot of physicians forget that the mouth is an easy ‘in’ for bacteria,” he says. “Our goal is to eliminate the mouth as a source of bloodstream infections by actually changing the flora in the mouth.”

His team screens patients pre-transplant to identify and treat oral infections. They recommend oral rinses and finger wipes to care for teeth pre- and post-transplant—protocols that are easier than tooth brushing.

The division is collaborating with oncologists to identify similar measures to prevent bloodstream infections from IV and port sites.