Research Report on Patients Who Underwent an Intraoral Examination Prior to Hematopoietic Stem Cell Transplantation
With hematopoietic stem cell transplantation, chemotherapy and total-body irradiation are carried out as conditioning chemotherapies, making it likely for bacterial infection to develop during the initial to medium period following transplantation1). Moreover, stomatitis is likely to develop along with oral mucosa impairment following transplant2). Accordingly, the source of infection inside the mouth needs to be removed. We herein report on this study in which an investigation was carried out regarding patients that underwent intraoral examination prior to hematopoietic stem cell transplantation.
2 .Materials and method
Subjects: From among patients admitted to the Department of Hematology at our hospital from 2009 to December 2013 for the purpose of transplant, 98 patients (men: 59 cases, women: 39 cases, average age: 64.2 ± 8.1 years old) that consulted our department requesting intraoral examination prior to transplant.
Method: An investigation was carried out regarding the following based on medical records: (1) Hematologic disease; (2) Transplantation method; (3) Dental treatment 1)Presence 2) Content; (4) Stomatitis following transplant 1) Presence 2) Onset days, day of disappearance 3) Granulocyte count at generation and disappearance; and (5) Average number of days from initial dental amination to transplant.
3. Data analysis method
The T-test and U-test were used to compare the average. IBM SPSS ver20 was used as the statistical software.
4. Result
(1) Hematologic disease: AML: 46 patients, MDS over AML: 11 patients, ALL: 8 patients, ML: 8 patients, MDS: 4 patients, MM: 3 patients, myelofibrosis: 3 patients, AA: 2 patients, other: 13 patients
(2) Transplantation method: cord blood transplantation: 85, peripheral stem cell transplantation: 13
(3) Dental treatment:
1) Presence: Yes: 89 patients, None: 9 patients
2) Treatment content (including overlaps): dental tartar removal: 60, caries treatment: 49, tooth extraction: 24, denture treatment: 22
(4) Stomatitis following transplantation:
1) Presence: Yes: 48 patients, No: 50 patients
2) Onset days, day of disappearance:10.5 ± 5.2 days, 26.2 ± 13.3 days
3) Granulocyte count at generation and disappearance:0.56×103/μl, 2.45×103/μl
(5) Average number of days from initial dental examination to transplant
1) Relation of the presence of dental treatment: dental treatment: Yes: 52.5 ± 50.3 days, No: 21.8 ± 8.7 days
2) Relation with the treatment content:
Dental tartar removal: Yes: 57.3 ± 55.4 days, No: 37.6 ± 33.1 days
Tooth extraction: Yes: 75.8 ± 71.3 days, No: 41.1 ± 35.6 days
Caries treatment: Yes: 49.5 ± 45.0 days, No: 49.8 ± 52.8 days
Denture treatment: Yes: 62.2 ± 63.9 days, No: 46.0 ± 43.3 days
5. Conclusion
In this study, cases that underwent dental treatment required a greater number of days from initial dental examination to transplant compared to those without. This trend was particularly observed in patients requiring tooth extraction and dental tartar removal. It is very important to carry out appropriate oral management on a regular basis in order to carry out transplant at an early period. Moreover, stomatitis generates within 7 to 14 days following commencement of chemotherapy. Once generated, intake of food and drugs becomes difficult, along with this becoming a portal of entry of pathogenic bacteria into the body. Accordingly, both prevention and treatment are required. In this study as well, stomatitis occurred 10.5 days following transplant. As a result, simultaneous active intervention of oral care was therefore considered to be necessary.
1. Young, J.A.H: Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone, New York, 2010, pp3821-3837.
2. Junichi S et al: Management of oral mucositis after allogeneic stem cell transplantation. J. germfree life gnotobiol vol41 No1:48-53, 2011.