UP FRONT
Hematology Link
In today’s health-care environment, no practitioner operates in a silo – and
that is particularly true for hematology. In “Hematology Link,” we will speak
with an outside specialist to examine where these medical specialties and
hematology meet.
Oral Health Complications of Chemotherapy
In this edition, ASH Clinical News
speaks with Nathanial Treister,
DMD, DMSc, assistant professor of Oral Medicine at Harvard
School of Dental Medicine and the
chief of the divisions of Oral Medicine and Dentistry at Brigham
& Women’s Hospital in Boston,
Massachusetts, about oral health
for his patients being treated for
hematologic malignancies.
Nathanial Treister, DMD, DMSc
What are the oral complications of cancer
therapy that hematologists/oncologists
should be aware of?
The treatments for hematologic malignancies – chemotherapy, combinations of
chemotherapy, or hematopoietic cell transplantation – are associated with a variety
of oral complications. First and foremost
is the risk of infection due to the profound
immunosuppressive and neutropenic effects
of chemotherapy. Ondotogenic infections
are very common in the general population,
and these infections can pose a significant
risk in patients with hematologic malignancies undergoing myelosuppressive therapies.
Other oral infections commonly encountered in these patients include oral candidiasis, as well as infection with recrudescent oral
herpes simplex virus infection (HSV-1). Oral
candidiasis is a common superficial mucosal
yeast infection that can be easily identified
and diagnosed by a hematologist or clinical
staff person and treated with appropriate
antifungal therapy. While the majority of
the adult population is asymptomatically
seropositive for HSV-1, during the immunosuppression associated with cancer
therapy, patients are at significant risk
for viral reactivation and recrudescence.
HSV-1 most commonly affects the lips, but
it is common in this patient population for
recrudescent ulcerations to develop inside
the mouth and on any mucosal surface.
Mucositis, a very painful and often
debilitating condition in which the mucosa
of the mouth and throat becomes inflamed
and ulcerated, is also a significant, noninfectious complication of cancer treatment
that can limit the ability to eat and swallow.
Other potential complications of
chemotherapy include dry mouth and taste
changes – although these symptoms are
highly variable and not well-defined. In
addition, a number of new targeted cancer
therapies are becoming more prevalent in
the treatment of blood cancers – some of
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ASH Clinical News
which have been associated with unique oral
toxicities that have the potential to interfere
with the delivery of care.
Aside from F