Periodontal health influences stem cell transplant success

Jan 25 2013

By Joanna Lyford, Senior medwireNews Reporter

Periodontal infection can increase the risk for developing bacteremia during the neutropenic phase of allogeneic hematopoietic stem cell transplantation (HSCT), research suggests.

Noting that the role of periodontal infection in influencing HSCT outcomes may have been underestimated, Judith Raber-Durlacher (University of Amsterdam, the Netherlands) and team write: "The results of this study point to the importance of an oral evaluation before HSCT as well as interventions before and during HSCT to reduce the microbiological load (eg, by periodontal treatment and meticulous oral hygiene measures) and thereby reducing gingival inflammation.

"This may significantly reduce the overall risk for complications, including OVS [oral viridans streptococci] and CONS [coagulase-negative staphylococci] bacteremia."

For their prospective, observational study, the researchers recruited 18 patients scheduled to receive a myeloablative allogeneic HSCT for the treatment of cancer.

All patients underwent a detailed oral, dental, and periodontal examination before HSCT. Five (28%) patients were found to be periodontally healthy while the remainder had gingivitis and/or periodontitis. None had extensive dental caries or any oral mucosal inflammatory or infectious condition, including pericoronitis.

At baseline, the mean plaque index was 1.36 and the mean percentage of sites with bleeding on probing (BOP) was 17.6%, Raber-Durlacher et al note in Supportive Care in Cancer.

Following transplantation, 12 (67%) patients developed bacteremia. In all but one case, bacteremia was due to CONS, most often Staphylococcus epidermidis, OVS, or both. The other patient developed Escherichia coli bacteremia, and no anaerobes were detected in any of the blood cultures.

Raber-Durlacher et al found that patients with periodontal disease were significantly more likely to develop bacteremia during neutropenia than those with a healthy periodontium. In addition, average BOP scores were significantly higher in patients with bacteremia than in those without (21.7 vs 11.1).

However, there were no significant differences between patients who did and did not develop bacteremia with regard to the number of pockets with a probing depth of 4 mm or greater, the amount of dental plaque before HSCT, severity or duration of oral mucositis, prevalence and duration of fever, and length of hospital stay.

The researchers conclude that "gingivitis and periodontitis, particularly gingival inflammation assessed by BOP, may represent a risk factor for bacteremia due to OVS and CONS during the neutropenic phase of HSCT." They recommend that thorough periodontal exams be routinely performed before neutropenia takes place.

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