Skip to main content

Advertisement

Log in

Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goal of work

Little is known about the effects of professional oral health care (POHC) on the outcome of hematopoietic stem cell transplantation (HSCT). We evaluated the effects of POHC given by dentists and dental hygienists on the development of oral mucositis and febrile neutropenia (FN) after allogeneic bone marrow transplantation (BMT).

Patients and methods

We retrospectively studied 140 adult patients who had received allogeneic BMT, with or without POHC, in our hospital consecutively between February 2002 and December 2009. Oral mucositis was evaluated according to the World Health Organization scale.

Main results

The incidence of oral mucositis was 66.7% (52/78) in the patients who had received POHC, compared to 93.5% (58/62) in the non-POHC group (P < 0.001). The incidence of FN and the maximal level of CRP were also significantly lower in the POHC group. Multivariate analysis revealed that the POHC was significantly associated with the incidence of oral mucositis (odds ratio, 7.58; 95%CI, 2.45–23.34; P < 0.001).

Conclusions

We concluded that POHC reduced the incidences of oral mucositis and FN by upgrading the overall oral hygiene during HSCT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Donnelly JP, Muus P, Schattenberg A, De Witte T, Horrevorts A, DePauw BE (1992) A scheme for daily monitoring of oral mucositis in allogeneic BMT recipients. Bone Marrow Transplant 9:409–413

    PubMed  CAS  Google Scholar 

  2. Blijlevens NM, Donnelly JP, De Pauw BE (2000) Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 25:1269–1278

    Article  PubMed  CAS  Google Scholar 

  3. Wardley AM, Jayson GC, Swindell R, Morgenstern GR, Chang J, Bloor R, Fraser CJ, Scarffe JH (2000) Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. Br J Haematol 110:292–299

    Article  PubMed  CAS  Google Scholar 

  4. Dodd MJ, Dibble S, Miaskowski C, Paul S, Cho M, MacPhail L, Greenspan D, Shiba G (2001) A comparison of the affective state and quality of life of chemotherapy patients who do and do not develop chemotherapy-induced oral mucositis. J Pain Symptom Manage 21:498–505

    Article  PubMed  CAS  Google Scholar 

  5. Scully C, Sonis S, Diz PD (2006) Oral mucositis. Oral Dis 12:229–241

    Article  PubMed  CAS  Google Scholar 

  6. Gruber U, Fegg M, Buchmann M, Kolb HJ, Hiddemann W (2003) The long-term psychosocial effects of haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 12:249–256

    CAS  Google Scholar 

  7. Sonis ST, Oster G, Fuchs H, Bellm L, Bradford WZ, Edelsberg J, Hayden V, Eilers J, Epstein JB, LeVeque FG, Miller C, Peterson DE, Schubert MM, Spijkervet FK, Horowitz M (2001) Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 19:2201–2205

    PubMed  CAS  Google Scholar 

  8. Sonis ST (2004) Oral mucositis in cancer therapy. J Support Oncol 2:3–8

    PubMed  Google Scholar 

  9. Rubenstein EB, PetersonDE SM, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100(9 Suppl):2026–2046

    Article  PubMed  Google Scholar 

  10. Keefe DM, Schubert M, Elting LS, Sonis ST, Epstein J, Raber-Durlacher JE, Migliorati CA, McGuire D, Hutchins RD, Peterson DE (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831

    Article  PubMed  CAS  Google Scholar 

  11. Elad S, Garfunkel AA, Or R, Michaeli E, Shapira MY, Galili D (2003) Time limitations and the challenge of providing infection-preventing dental care to hematopoietic stem-cell transplantation patients. Support Care Cancer 11:674–677

    Article  PubMed  Google Scholar 

  12. Yeager KA, Webster J, Crain M, Kasow J, McGuire DB (2000) Implementation of an oral care standard for leukemia and transplantation patients. Cancer Nurs 23:40–47

    Article  PubMed  CAS  Google Scholar 

  13. Melkos AB, Massenkeil G, Arnold R, Reichart PA (2003) Dental treatment prior to stem cell transplantation and its influence on the posttransplantation outcome. Clin Oral Investig 7:113–115

    Article  PubMed  CAS  Google Scholar 

  14. Toubai T, Tanaka J, Mori A et al (2004) Efficacy of etoposide, cyclophosphamide, and total body irradiation in allogeneic bone marrow transplantation for adult patients with hematological malignancies. Clin Transplant 18:552–557

    Article  PubMed  Google Scholar 

  15. Shigematsu A, Kondo T, Yamamoto S et al (2008) Excellent outcome of allogeneic hematopoietic stem cell transplantation using a conditioning regimen with medium-dose VP-16, cyclophosphamide and total-body irradiation for adult patients with acute lymphoblastic leukemia. Biol Blood Marrow Transplant 14:568–575

    Article  PubMed  CAS  Google Scholar 

  16. Masaoka T (2004) Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary. Clin Infect Dis 39:49–52

    Article  Google Scholar 

  17. Spielberger R, Stiff P, Bensinger W et al (2004) Palifermin for oral mucisitis after intensive therapy for hematologic cancers. N Engl J Med 351:2590–2598

    Article  PubMed  CAS  Google Scholar 

  18. Fanning SR, Rybicki L, Kalaycio M et al (2004) Severe mucositis is associated with reduced survival after autologous stem cell transplantation for lymphoid malignancies. Br J Haematol 135:374–381

    Article  Google Scholar 

  19. Ohbayashi Y, Imataki O, Ohnishi H, Iwasaki A, Ogawa T, Inagaki N, Shigeta H, Ohue Y, Tasaka T, Kitanaka A, Kubota Y, Tanaka T, Ishida T, Miyake M (2008) Multivariate analysis of factors influencing oral mucositis in allogeneic hematopoietic stem cell transplantation. Ann Heamatol 87:837–845

    Article  Google Scholar 

  20. Velden WJFM, Blijlevens NMA, Feuth T, Donnely JP (2009) Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant 43:55–60

    Article  PubMed  Google Scholar 

  21. Shigematsu A, Yamamoto S, Sugita J, Kondo T et al (2010) Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen. Transplant Infect Dis 12(5):412–420

    Article  CAS  Google Scholar 

  22. Adachi M, Ishihara K, Abe S, Okuda K (2007) Professional oral health care by dental hygienists reduces respiratory infections in elderly persons requiring nursing care. Int J Dent Hygiene 5:69–74

    Article  CAS  Google Scholar 

  23. Bondi E, Baroni C, Prete A, Gatti M, Carrassi A, Lodi G, Porter SR (1997) Local antimicrobial therapy of oral mucositis in paediatric patients undergoing bone marrow transplantation. Oral Oncol 33:322–326

    Article  PubMed  CAS  Google Scholar 

  24. Ferretti GA, Ash RC, Brown AT, Largent BM, Kaplan A, Lillich TT (1987) Chlorhexidine for prophylaxis against oral infections and associated complications in patients receiving bone marrow transplants. J Am Dent Assoc 114:461–467

    PubMed  CAS  Google Scholar 

  25. Weisdorf DJ, Bostrom B, Raether D, Mattingly M, Walker P, Pihlstrom B, Ferrieri P, Haake R, Goldman A, Woods W et al (1989) Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. Bone Marrow Transplant 4:89–95

    PubMed  CAS  Google Scholar 

  26. Foote RL, Loprinzi CL, Frank AR, O’Fallon JR, Gulavita S, Tewfik HH, Ryan MA, Earle JM, Novotny P (1994) Randomized trial of a chlorhexidine mouthwash for alleviation of radiationinduced mucositis. J Clin Oncol 12:2630–2633

    PubMed  CAS  Google Scholar 

  27. Pihlstrom BL, Michalowicz BS, Johnson NW (2005) Periodontal diseases. Lancet 366:1809–1820

    Article  PubMed  Google Scholar 

  28. Landa AS, van der Mei HC, Busscher HJ (1997) Detachment of linking film bacteria from enamel surfaces by oral rinses and penetration of sodium lauryl sulphate through an artificial oral biofilm. Adv Dent Res 11:528–538

    Article  PubMed  CAS  Google Scholar 

  29. Hellstrom MK, Ramberg P, Krok L, Lindhe J (1996) The effect of supragingival plaque control on the subgingival microflora in human periodontitis. J Clin Periodontol 23:934–940

    Article  PubMed  CAS  Google Scholar 

  30. Yoneyama T, Yoshida M, Matsui T, Sasaki H, Group Oral Care Working (1999) Oral care and pneumonia. Lancet 354:515

    Article  PubMed  CAS  Google Scholar 

  31. Yoneyama T, Yoshida M, Ohrui T et al (2002) Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430–433

    Article  PubMed  Google Scholar 

  32. Yoneyama T, Hashimoto K, Fukuda H, Ishida M, Arai H, Sekizawa K, Yamaya M, Sasaki H (1996) Oral hygiene reduces respiratory infections in elderly bed-bound nursing home patients. Arch Gerontol Geriatr 22:11–19

    Article  PubMed  CAS  Google Scholar 

  33. Adachi M, Ishihara K, Abe S, Okuda K, Ishikawa T (2002) Effect of professional oral health care on the elderly living in nursing homes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:191–195

    Article  PubMed  Google Scholar 

  34. Abe S, Ishihara K, Okuda K (2001) Prevalence of potential respiratory pathogens in the mouths of elderly patients and effects of professional oral care. Arch Gerontol Geriatr 32:45–55

    Article  PubMed  Google Scholar 

  35. Abe S, Ishihara K, Adachi M, Sasaki H, Tanaka K, Okuda K (2006) Professional oral health reduces influenza infection in elderly. Arch Gerontol Geriatr 43:157–164

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Ms. M Yanome for help in preparing the manuscript, and Ms. E Nakayama, and Ms. M Morosawa for their technical assistance.

Financial disclosure

This work was supported in part by Grant-in-Aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Haruhiko Kashiwazaki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kashiwazaki, H., Matsushita, T., Sugita, J. et al. Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer 20, 367–373 (2012). https://doi.org/10.1007/s00520-011-1116-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1116-x

Keywords

Navigation