Blood cancers

Dental checks missed for blood and marrow transplant survivors

Recipients of allogeneic blood and marrow transplantation (BMT) have high rates of oral and dental complications but miss out on dentist check-ups that could help detect and treat them, an Australian study has found.

Dry mouth, tooth decay and mouth ulcers are just a few of the long term oral and dental manifestations of chronic graft versus host disease (GVHD) reported by 441 patients following allogeneic BMT.

In the surveys, carried out in NSW patients over a 12-year period up to 2012, almost 70% of BMT recipients had a diagnosis of GVHD, with patients reporting problems such as dry mouth (45%), dental caries 37%), mouth ulcers (35%), gingivitis (16%), tooth abscess (6%) and oral cancer (1.5%).

But despite the high rates of oral and dental disease and guideline recommendations for dental reviews as part of long term follow up, one third of patients did not visit a dentist regularly. The main reasons given by patients for not having dental checks were cost (36%), lack of awareness that dental checks are necessary (37%) and not being advised by their treating team (20%).

The authors of the study, from the NSW Blood and Marrow Transplant Network in Sydney, said the rates of oral chronic GVHD reported by Australian patients were high compared to levels reported in other international studies.

And the finding that many patients were not having regular dental checks – or having them less frequently than recommended – “has the potential to cause avoidable health related burdens for survivors and is economically costly for the state,” they said.

It was not surprising that the cost of dental visits was a barrier to having check-ups, but the lack of education of patients by their clinicians was a surprising finding, they wrote in the Australian Dental Journal.

“Patient education represents a cheap, and easily implementable strategy for improving the oral health of BMT survivors,” they wrote.

“These results emphasise the need for improved oral health education for both survivors and clinicians, the importance of regular dental checks, and improvement in the delivery of dental health services in Australia for BMT survivors,” they added.

“The need to improve dental care for BMT survivors is self-evident – what is required is action,” they concluded.

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