Patients who have received transplants are at risk of graft-versus-host disease.

Graft-versus-host disease (GVHD) is a reaction of donated bone marrow or stem cells against the patient's tissue. Symptoms of oral GVHD include the following:

• Sores that appear in the mouth 2 to 3 weeks after the transplant.
• Dry mouth.
• Pain from spices, alcohol, or flavoring (such as mint in toothpaste).

Biopsies taken from the lining of the mouth and salivary glands may be needed to diagnose oral GVHD. Treatment of oral GVHD may include the following:

• Topical rinses, gels, creams, or powders.
• Antifungal drugs taken by mouth or injection.
• Psoralen (a drug used with ultraviolet light to treat skin disease).
• Drugs that promote the production of saliva.
• Fluoride treatments.
• Treatments to replace minerals lost from teeth by acids in the mouth.

Dentures, braces, and oral appliances require special care during high-dose chemotherapy and/or stem cell transplant.

The following are guidelines for the care and use of dentures, braces, and other oral appliances during high-dose chemotherapy and/or stem cell transplant:

• Remove brackets, wires, and retainers before high-dose chemotherapy begins.



• Wear dentures only when eating during the first 3 to 4 weeks after the transplant.



• Brush dentures twice a day and rinse them well.



• Soak dentures in an antibacterial solution when they are not being worn.



• Clean denture soaking cups and change denture soaking solution every day.



• Remove appliances or dentures when cleaning the mouth.



• If mouth sores are present, avoid wearing removable appliances until the mouth is healed.

Dental treatments may be resumed when the transplant patient's immune system returns to normal.

Routine dental treatments, including scaling and polishing, should be delayed until the transplant patient's immune system returns to normal. Caution is advised for at least a year after the transplant.

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