Supportive Care in Cancer

, Volume 21, Issue 6, pp 1621–1627 | Cite as

Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study

  • Judith E. Raber-DurlacherEmail author
  • Alexa M. G. A. Laheij
  • Joel B. Epstein
  • Matthew Epstein
  • Gerard M. Geerligs
  • Gordon N. Wolffe
  • Nicole M. A. Blijlevens
  • J. Peter Donnelly
Original Article



This study was aimed to investigate whether any association could be found between the presence of an inflamed and infected periodontium (e.g., gingivitis and periodontitis) and the development of bacteremia during neutropenia following allogeneic hematopoietic stem cell transplantation (HSCT).


Eighteen patients underwent a periodontal examination before HSCT. Patients were classified as periodontally healthy [all periodontal pocket depths (PPD) ≤ 4 mm and bleeding on probing (BOP) ≤ 10 %) or as having gingivitis/periodontitis (PPD ≥ 4 mm and BOP > 10 %]. Oral mucositis (OM) was scored using the daily mucositis score. Blood cultures were taken at least twice weekly.


Five patients were periodontally healthy, while 13 patients had gingivitis or periodontitis. Twelve patients (67 %) developed bacteremia during neutropenia, of which 11 patients (61 %) had one or more episodes of bacteremia due to coagulase-negative staphylococci (CONS, most often Staphylococcus epidermidis) or to oral viridans streptococci (OVS), or both. Patients with gingivitis/periodontitis more often had bacteremia than those with a healthy periodontium (p = 0.047), and BOP was associated with bacteremia (p = 0.049). All patients developed ulcerative OM, but its severity and duration were not associated with bacteremia. OM duration and the length of stay in the hospital were strongly correlated (R = 0.835, p ≤ 0.001).


This study indicates that periodontal infections may contribute to the risk of developing OVS and CONS bacteremia during neutropenia following HSCT. While our results point to the importance of periodontal evaluation and management before HSCT, further studies on periodontal contribution to systemic infectious complications are warranted.


Periodontal disease Gingivitis Bacteremia Hematopoietic stem cell transplantation Coagulase negative staphylococci Viridans streptococci 



No disclosures with a potential conflict of interest with the present observational study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Judith E. Raber-Durlacher
    • 1
    • 2
    Email author
  • Alexa M. G. A. Laheij
    • 3
  • Joel B. Epstein
    • 4
  • Matthew Epstein
    • 5
  • Gerard M. Geerligs
    • 6
  • Gordon N. Wolffe
    • 7
  • Nicole M. A. Blijlevens
    • 8
  • J. Peter Donnelly
    • 8
  1. 1.Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and VU University AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Oral and Maxillofacial Surgery, Academic Medical Center AmsterdamUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Preventive Dentistry, ACTAAmsterdamThe Netherlands
  4. 4.Division of Otolaryngology and Head and Neck SurgeryCity of HopeDuarteUSA
  5. 5.Department of Oral and Maxillofacial SurgerySt. Joseph’s Regional Medical CenterPatersonUSA
  6. 6.Ministry of Defence, Royal Netherlands Army, Military Dental Center Amersfoort, Department of Periodontology and ImplantologyAmersfoortThe Netherlands
  7. 7.Hemel HempsteadUK
  8. 8.Department of HaematologyUniversity Medical Centre St. RadboudNijmegenThe Netherlands

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