Why you need dental care before you get a stem cell transplant?

An allogeneic stem cell transplant is a type of transplant that uses donor stem cells. Before you have an allogeneic stem cell transplant, you will need a dental check-up. Your mouth needs to be healthy before your transplant.

A stem cell transplant weakens your immune system. Your immune system fights infections in your body. When you have a weak immune system, you are more likely to get infections. If you already have any infections, they can get worse.

It is common to get these infections in your mouth. You may have infections in your mouth or teeth that you do not feel. Proper dental care can help prevent infections. If you get an infection, it could delay your treatment or cause problems during treatment.

At your dental check-up, the dentist will decide what dental care you may need before you get your transplant.

Dental care can include:

• teeth cleaning
• filling cavities (holes in your teeth)
• pulling teeth that are infected or damaged
• reviewing mouth or dental cleaning habit

Why visit the dentists in the Dental Oncology Clinic before your stem cell transplant?

Princess Margaret dentists are trained to treat cancer patients like you. Princess Margaret dentists work with your oncologists (cancer doctor) to provide the right dental care for you at the right time.

Before your stem cell transplant, your oncologist will give you a referral to see a Princess Margaret dentist for a complete mouth and x-ray exam.

How can a Princess Margaret dentist help prevent infections?

Princess Margaret dentists have easy access to your blood work. Blood work tells the dentist when it is safe for you to have dental work done.

Your blood work measures your blood counts. Dental work with low blood counts can lead to infection or bleeding. Low blood counts can come from your transplant, medicines or chemotherapy.

If your blood counts are low, you may not be able to have dental work done. If you need urgent dental care, Princess Margaret dentists will work with your oncologist to provide safe care.

Your blood counts can take time to return to normal. Princess Margaret dentists follow you before and after your transplant to watch your blood counts. You can return to your family dentist when your Princess Margaret dentist feels it is safe.

How can a Princess Margaret dentist help with side effects from your treatment?

Below is a list of side effects you may get in your mouth. Your Princess Margaret dentist can try to help you with these side effects. Most of the side effects from treatment are short-term.

Mouth sores

Mouth sores can be a side effect of chemotherapy. Some people may get a type of mouth sore (called mucositis).

Mucositis is when the lining of your mouth becomes red and sore. Mucositis can begin 1 week after you start chemotherapy treatment.

You can help prevent mucositis by having good oral health. You may need to have your teeth cleaned before your transplant to ensure good oral health. Our dentist will help you decide if a cleaning is needed and safe.

During chemotherapy when your immune system is weak, another type of mouth sore (called neutropenic ulcers) can occur.

Germs in the mouth can infect these sores. If this happens, your Princess Margaret dentists can prescribe a mouth rinse that contains medicine to help control the infection.

Sensitive teeth

It is common to have sensitive (painful) teeth after your transplant. You may notice sensitive teeth when drinking or eating cold foods. This is mostly a short-term change.

Princess Margaret dentists have simple ways to treat sensitive teeth and help relieve pain. One simple way that the dentist can relieve pain is to apply a desensitizing solution to your teeth.

A desensitizing solution covers up the tooth area that feels pain. The solution does not stay on your tooth for a long time, but it can ease your pain in the short-term.

Taste changes

Chemotherapy can also affect your taste buds. This means your food may taste different or odd. Taste changes are short-term and last for about one month after your treatment.

Sometimes taste changes happen because of a mouth infection called thrush.

Thrush can sometimes look like a white cheesy coating on the tongue.

There are many treatment options for thrush.Your dentist may ask you to:

• take an anti-thrush medicine, either in a pill or rinse
• disinfect dentures, if you have dentures

Here are some ways you can prevent thrush:

• Keep your mouth moist.
• If you have dentures, clean your dentures after every meal.
• Do not wear your dentures over night.

Many other mouth conditions can look like thrush. A Princess Margaret dentist will know if you have thrush or another condition.

Dry mouth

Dry mouth happens when your body does not make enough saliva to keep your mouth moist. Sometimes dry mouth can last a short time and sometimes it can last a long time.

Dry mouth can be mild (not too dry) or severe (very dry). Some signs of severe dry mouth include:

• waking up at night because of your dry mouth
• unable to eat dry foods without water

There are many ways to manage a dry mouth. Read the pamphlet: Taking Care of Your Mouth During Cancer Treatment to learn how to manage dry mouth. You can get this pamphlet from the Princess Margaret Patient & Family Library or from the Cancer Answers website.

Talk to a Princess Margaret dentist if you need help to manage dry mouth. A Princess Margaret dentist has different products to help you cope with a dry mouth.

If dry mouth lasts longer than 3 months, go see a Princess Margaret dentist. Dry mouth lasting longer than 3 months raises your risk for cavities (holes) in your teeth.

Your dentist may suggest further treatments such as fluoride treatments to help protect your teeth from cavities.

Graft Versus Host Disease (GVHD)

Graft Versus Host Disease is when the donor cells attack your body’s cells. The cells are the “graft”. Your body’s cells are the “host”.

There are 2 kinds of GVHD:

1. Acute GVHD

Acute GVHD most often starts in the first 100 days after transplant. Acute GVHD can progress to chronic GVHD.

Symptoms include:

• skin rash
• mouth ulcers
• nausea (feeling like throwing up)
• cramping in belly area
• vomiting (throwing up)

2. Chronic GVHD

Chronic GVHD most often starts after 100 days after transplant. Chronic GVHD can also start in the first few months.

Symptoms include:

• skin rashes
• trouble swallowing
• shortness of breath
• stiff joints
• sores
• changes to mucous membranes in the body, for example, in the mouth

Chronic GVHD can increase the risk of developing skin and oral cancer.

GVHD in the mouth

1. Acute GVHD in the mouth

Symptoms include sores in the mouth.

2. Chronic GVHD in the mouth

Symptoms include:

• white and red patches in the mouth
• sores
• loss of saliva
• feeling sensitive to food or oral hygiene products like toothpaste or mouthwash
• infections
• trouble opening your mouth fully

A Princess Margaret dentist will:

• Assess you for signs of oral GVHD after your transplant.
• If GVHD is found, the Princess Margaret dentist will inform your oncologist (cancer doctor).

Your oncologist will check to see if you have GVHD in another part of your body. If you have GVHD in other parts of your body, your oncologist may make changes to the medicines used to suppress your immune system.

GVHD can result in a change to how much saliva you produce. Less saliva can increase your risk for cavities. Your dentist may suggest fluoride treatments to help protect your teeth from cavities.

If needed, your dentist may refer you to an oral pathologist (an expert in finding the cause of oral diseases or conditions such as infections).

The oral pathologist will assess any areas in the mouth that do not seem normal. The oral pathologist can also help you manage any discomfort you have in your mouth.

What to bring to your dental appointment

Bring an up-to-date list of your medicines to all of your dental appointments. In certain types of cancers, the medicines you take can affect your dental treatment.

For patients with Multiple Myeloma, read the pamphlet: Understand How Bisphosphonates or Similar Medicines Can Affect Your Dental Care . You can get this pamphlet from the Princess Margaret Patient & Family Library or from the Cancer Answers website.

Clinic information

For more information or general questions, contact the number below:
Phone: 416 946 2198

Clinic hours:

Monday to Friday 8:30 am – 4:30 pm
Clinic is closed for lunch every day from 12:00 pm – 1:00 pm