Brushing and flossing is performed when tolerated by the patient. These are discontinued if:
(1) the absolute granulocyte count is < 500 per µL
(2) the platelet count is < 20,000 per µL
(3) significant pain is present
(4) bleeding occurs
Alternative dental care is given 4 times a day until the bone marrow has recovered or brushing can be resumed:
(1) Teeth are cleaned with a dilute hydrogen peroxide solution on cotton swabs.
(2) Soft disposable cleaning sponges are used to clean hard and soft oral surfaces.
(3) The mouth is rinsed with a saline solution.
(4) A small amount of mouthwash is then used to rinse the mouth (for flavoring).
Moderate pain is treated with oral NSAIDS and severe pain with parenteral narcotics. In addition patients with moderate or severe pain receive a topical anesthetic (viscous 2% lidocaine, other).
Decayed or infected teeth are removed.
Patients received prophylactic oral antifungal therapy to reduce the risk of Candida infection.
Monitoring is performed for:
(1) bacterial infection
(2) Candida or other fungal infection
(3) Herpes simplex virus (HSV) infection
Specific therapy is given once an infection is identified. An exception is a mild, localized HSV infection.
Xerostomia may develop with graft vs host disease and is treated by:
(1) use of an artificial saliva substitute
(2) daily fluoride application to teeth
