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ArticleIssues in Dental Hygiene Practice

A Review of Oral Chronic Graft-Versus-Host Disease: Considerations for dental hygiene practice

Lisa Bennett Johnson, Uhlee Oh, Marilynn Rothen, Herve Y. Sroussi, David R Dean, C. Michele Lloid, Katelyn Cintron, Stephanie J. Lee, Corey S. Cutler and Nathaniel S. Treister
American Dental Hygienists' Association April 2022, 96 (2) 6-17;
Lisa Bennett Johnson
Research dental hygienist at Brigham and Women’s Hospital and adjunct faculty in the graduate program at the the Forsyth School of Dental Hygiene and the Master of Public Health Program at MCPHS University, Boston, MA, USA.
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  • For correspondence: lbennettjohnson@bwh.harvard.edu
Uhlee Oh
Clinical associate professor at the Forsyth School of Dental Hygiene at MCPHS University and a clinical research dental hygienist at Brigham and Women’s Hospital, Boston, MA, USA.
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Marilynn Rothen
Clinical professor of Oral Health Sciences and Research Implementation Manager of the Regional Clinical Dental Research Center, University of Washington School of Dentistry, Seattle, WA, USA.
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Herve Y. Sroussi
Director of Research, Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital and an associate professor of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
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David R Dean
Clinical associate professor and the Graduate Program Director, University of Washington School of Dentistry and the Director of Oral Medicine Services, Seattle Cancer Care Alliance, Seattle, WA, USA.
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C. Michele Lloid
Clinical associate professor of Oral Medicine and Oral Health Sciences, University of Washington School of Dentistry and Clinician/Manager Oral Medicine Service Seattle Cancer Care Alliance, Seattle, WA, USA.
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Katelyn Cintron
Research assistant, Brigham and Women’s Hospital, Boston, MA, USA.
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Stephanie J. Lee
Associate Director and a professor in the Division of Clinical Research, Fred Hutchinson Cancer Research Center, Division of Medical Oncology, University of Washington, Seattle, WA, USA.
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Corey S. Cutler
Medical Director, Stem Cell Transplantation, Dana-Farber Cancer Institute and an associate professor of Medicine, Harvard Medical School, Boston, MA, USA.
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Nathaniel S. Treister
Chief of the Division of Oral Medicine and Dentistry, Clinical Director of Oral Medicine and Oral Oncology, Dana-Farber/Brigham and Women’s Hospital and an associate professor of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
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Abstract

Purpose: Allogeneic hematopoietic cell transplantation (alloHCT), also known as stem cell or bone marrow transplantation, is a cellular therapy performed to treat a variety of malignant and non-malignant hematologic diseases. Chronic graft-versus-host disease (cGVHD) is a common immune-mediated complication of alloHCT that can affect various organs of the body, with approximately 70% of affected patients presenting with oral features. Oral manifestations of cGVHD include lichenoid lesions (diagnostic feature), erythema, pseudomembranous ulcerations, superficial mucoceles, salivary gland hypofunction, xerostomia, orofacial sclerosis, trismus, and increased sensitivity to spicy, acidic, hard, and crunchy foods. Patients with oral cGVHD are also at increased risk for developing secondary conditions, such as oral candidiasis, dental caries, and oral squamous cell carcinoma. Given these complex oral health challenges, the dental hygienist can play a key role in optimizing patients’ oral health care from pre-stem cell transplantation through survivorship. Optimal care includes a comprehensive health history assessment, thorough extraoral and intraoral examinations, detailed hard and soft tissue evaluations, oral hygiene, and dietary assessment, along with the delivery of patient-centered, oral health instruction and preventive therapies. Appropriate monitoring and management of oral cGVHD require a collaborative care approach between dental, oncology, and oral medicine providers. As part of a multidisciplinary care team, dental hygienists play an important role in the management of patients with oral cGVHD. The purpose of this review is to provide an overview of alloHCT and its oral health considerations, with a focus on oral cGVHD etiology, signs and symptoms, and management considerations for the dental team.

  • graft-versus-host disease
  • allogeneic hematopoietic stem cell transplantation
  • oral medicine
  • dental hygienist
  • Received April 2, 2021.
  • Accepted December 23, 2021.
  • Copyright © 2022 The American Dental Hygienists’ Association

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American Dental Hygienists' Association: 96 (2)
American Dental Hygienists' Association
Vol. 96, Issue 2
April 2022
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A Review of Oral Chronic Graft-Versus-Host Disease: Considerations for dental hygiene practice
Lisa Bennett Johnson, Uhlee Oh, Marilynn Rothen, Herve Y. Sroussi, David R Dean, C. Michele Lloid, Katelyn Cintron, Stephanie J. Lee, Corey S. Cutler, Nathaniel S. Treister
American Dental Hygienists' Association Apr 2022, 96 (2) 6-17;

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A Review of Oral Chronic Graft-Versus-Host Disease: Considerations for dental hygiene practice
Lisa Bennett Johnson, Uhlee Oh, Marilynn Rothen, Herve Y. Sroussi, David R Dean, C. Michele Lloid, Katelyn Cintron, Stephanie J. Lee, Corey S. Cutler, Nathaniel S. Treister
American Dental Hygienists' Association Apr 2022, 96 (2) 6-17;
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Keywords

  • graft-versus-host disease
  • allogeneic hematopoietic stem cell transplantation
  • oral medicine
  • dental hygienist

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ISSN #: 1553-0205

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