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Radical oral intervention not necessary before stem cell transplants, study says

By Dental Tribune International
January 15, 2020

BASEL, Switzerland/HELSINKI, Finland: Haematopoietic stem cell transplantation is used to treat cancers and severe blood and autoimmune diseases. Owing to slow immune system recovery after the transplantation, patients have a heightened risk of infection. However, a recent study has reported that the presence of acute or chronic oral foci of infection before the transplantation does not affect the patient’s survival rate within six months of the procedure.

The study was conducted by the University of Helsinki, the Helsinki University Hospital, the University of Basel, and the University Hospital Basel. It involved patients who had been treated at the University Hospital Basel, of whom 341 had received an allogeneic stem cell transplantation and 125, an autologous stem cell transplantation.

The procedures were carried out between 2008 and 2016. Before the transplantation, all patients underwent a clinical and radiographic dental examination to identify any potential foci of infection and the number of missing and filled teeth.

A total of 51 stem cell transplant patients died within six months of the procedure. However, the data showed that the foci of infection, the number of missing or filled teeth, and the cases of periodontitis identified in the examinations were not associated with the patients’ lower survival rates.

“Contrary to our assumptions, untreated oral infections had no connection with post-stem cell transplantation survival during the six-month follow-up period. Another surprise was that they had no link with any serious infectious complications occurring during the follow-up period,” said lead author Prof. Tuomas Waltimo, assistant lecturer in the Department of Biomedical Engineering at the University of Basel.

“However, the patient’s health permitting, and if the wound has enough time to heal before chemotherapy, the radical treatment of such infections is justified. Other than that, conservative, non-radical treatment that eliminates the infection carried out by a dentist familiar with the case appears to be the lowest-risk option in terms of infectious and bleeding complications,” Waltimo noted.

According to Waltimo, the study findings cannot be applied to any other patient groups, especially not to patients suffering from cancer in the region of the head and neck, or those with a heart valve or a prosthetic joint.

The study, “Associations of oral foci of infections with infectious complications and survival after hematopoietic stem cell transplantation,” was published on 18 December 2019 in PLOS ONE.

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