Oral and Dental Evaluation of Bone Marrow Transplant Patients: A Retrospective Observational Study

February 12 2026

 

Introduction

Bone marrow transplant (BMT) patients often experience compromised immune systems and oral complications due to their underlying disease and intensive treatment regimens. Understanding the prevalence and types of oral conditions in these patients is crucial for developing appropriate preventive strategies.

Hematopoietic cell transplantation (HCT) is one of the frequent procedures used for the treatment of malignant and non-malignant blood diseases, autoimmune disorders, and certain solid tumors. Acute, delayed, and late side effects of the transplantation regimen affect approximately 80% of patients.

In the oral cavity, these side effects are significant. During the early post-transplantation period, mucositis resulting from conditioning is the main clinical symptom. Its degree and severity depend primarily on the intensity of the conditioning regimen.

Within the first year after transplantation, delayed complications such as hyposalivation, taste disorders, and dentin hypersensitivity may occur, often decreasing the patient’s quality of life. There is also a high risk of infection and bleeding during this period.

At later stages, long-term complications such as oral chronic graft versus host disease (cGvHD) may develop. This can contribute to sicca syndrome, mastication impairment, malabsorption syndrome, and lichen planus lesions. Advanced periodontal disease, rapid caries progression, and taste disorders are also common. Additionally, there is a risk of secondary cancers.

Although oral problems can compromise treatment protocols and, in some cases, affect survival, they are often underestimated and undertreated.

Methods

A retrospective analysis was conducted on the records of 100 BMT patients who visited Sri Shankara Cancer Hospital, Bengaluru, between January 2022 and December 2022.

Data collected included the presence of:

• Root canal treatments

• Extractions

• Squamous cell carcinoma cases

• Oral prophylaxis procedures

• Restorations

Descriptive statistics such as pie charts, bar graphs, and flowcharts were generated to present the findings.

Results

Among the 100 BMT patients observed, the following oral and dental conditions were identified:

• Root Canal Treatments: 3 patients (3%)

• Extractions: 2 patients (2%)

• Squamous Cell Carcinoma: 2 patients (2%)

• Oral Prophylaxis Procedures: 80 patients (80%)

• Restorations: 5 patients (5%)

The majority of patients required oral prophylaxis procedures, highlighting the importance of preventive dental care in this population.

Discussion

The findings demonstrate a significant prevalence of oral prophylaxis procedures, with 80% of patients requiring such interventions. This underscores the importance of regular dental cleaning and preventive care for BMT patients.

A smaller percentage required root canal treatments (3%) and extractions (2%), while 2% were diagnosed with squamous cell carcinoma. These results indicate the need for:

• Specialized oral care protocols

• Early detection of oral cancers

• Timely management of dental infections

Oral Care Before Hematopoietic Cell Transplantation

Before transplantation, a comprehensive medical check-up should include meticulous oral cleaning performed by an experienced dentist, ideally as part of the transplant team.

The dental process should include:

• Clinical examination

• Treatment planning

• Necessary dental procedures

• Patient education about therapy side effects

• Oral hygiene instructions

• Fluoride prevention measures

• Antibacterial mouthwash recommendations

Standard pre-transplant procedures should focus on detecting and removing active or potential sources of infection within the stomatognathic system, as well as eliminating factors that could cause trauma, pain, or bleeding.

Ideally, all potential sources of pain and bleeding should be addressed before conditioning begins. However, complete oral sanitation is not always possible due to urgency, patient health status, blood counts, disease complexity, financial constraints, motivation, or limited access to dental care.

There is no universally defined protocol regarding specific dental procedures before HCT, especially in cases involving chronic pulpal or periodontal pathology.

Extraction or Treatment?

One of the most controversial decisions is whether to extract or treat compromised teeth.

Some authors recommend a radical approach, suggesting removal of all teeth with uncertain prognosis. Others advocate minimally invasive pre-HCT dental treatment, where acute pathologies and non-restorable teeth are prioritized for removal.

It has been emphasized that untreated chronic dental pathologies do not have a statistically significant influence on post-HCT infections. However, tooth extraction carries risks such as bleeding, prolonged wound healing, infection, and possible delay in medical treatment.

Multiple extractions may negatively affect long-term health and quality of life by compromising nutrition, occlusion, and esthetics.

Dental treatment should ideally be completed at least two weeks before the conditioning regimen. However, due to urgent referrals, dental examinations often occur close to the HCT procedure, limiting available treatment time.

When full sanitation is not possible, priority should be given to:

• Eliminating active infections

• Removing potential sources of bleeding and pain

• Extracting non-restorable teeth

Elective treatments can be postponed until the patient’s condition stabilizes.

Extended indications for extraction are suggested in cases of:

1. High risk of early complications due to high-dose cytotoxic conditioning and expected acute GvHD

2. High risk of long-term complications, especially chronic GvHD

3. Poor patient motivation for oral hygiene

Conclusion

This retrospective observational study provides important insights into the oral and dental conditions of 100 bone marrow transplant patients. The findings emphasize the significant need for preventive dental care, particularly oral prophylaxis procedures, in this vulnerable group.

Patients undergoing hematopoietic stem cell transplantation frequently experience oral health issues resulting from their disease or treatment. These complications can pose serious health risks and may even be life-threatening during the HCT process.

Currently, there are no universally accepted guidelines for dental examination and treatment before HCT. It is recommended that each transplant center develop and implement its own dental care protocol based on available research and clinical experience.

For optimal outcomes, skilled dental professionals should be permanent members of transplantation teams to ensure comprehensive and specialized oral care for BMT patients.