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Survivorship Guide for Bone Marrow/Stem Cell Transplant
Coping with Late Effects

Mouth and Esophagus GVHD

Radiation that is given as part of the conditioning regimen before a transplant can reduce saliva production, as can GVHD.[37] Saliva has several important functions, including protecting against the bacteria that contribute to cavities, lubricating and breaking down food so that it can be tasted, moisturizing and binding food so that it can be easily swallowed, and initiating digestion. When the amount of saliva is reduced, people are at greater risk for dental cavities. They may also experience greater difficulties with tasting and swallowing.

GVHD can attack the cells lining your mouth causing mouth sores, irritation of the gums, ulcers, dryness, and chapped lips. This in turn can lead to a burning sensation and pain when you eat spicy foods or use toothpaste. Sometimes GVHD manifests as lichen planus, which appears as white, lacy streaks, bumps, or ulcerations in the mouth or on the lips. Good oral hygiene is very important to prevent infections and to maintain the health of your gums and teeth. Using a mouth rinse or toothpaste with corticosteroids may improve the symptoms of chronic GVHD of the mouth.

GVHD can also affect the esophagus, making it more difficult to swallow. If you have trouble swallowing, you may benefit from consulting with a physician specializing in problems of ears, nose, and throat or with a speech-language pathologist trained in problems of the esophagus.

My mouth is very dry, and I have had a lot of tooth decay. I now have numerous crowns.

I have sores in my mouth, my tongue feels swollen, and it is difficult to swallow. Even my speech is affected. I am going to see a GI specialist to see if my esophagus is constricted and if it can be stretched.

Caring for Your Mouth

Keeping your mouth clean and free of dental cavities is an important part of preventing infection and maintaining your general health. Make sure to consult with a dentist about the best way to care for your mouth, particularly if you are experiencing GVHD or other late effects from your transplant. In addition to letting your dentist know that you have had a transplant, you should also keep him or her informed of any medications you are taking. Certain medications may affect your gums or saliva and can affect your oral health. Getting a full list of the medications you are taking will help your dentist or oral hygienist better understand the changes in your mouth.

Good Oral Hygiene includes:

  • Regular brushing two times a day. An electric toothbrush with a two-minute timer is recommended by many dentists to remove plaque.
  • Daily flossing or cleaning with an interdental cleaner. This helps to remove plaque from between your teeth and under your gum line.[38] An oral irrigator (Waterpik) that uses a fine, high-pressure jet of water to clean the gum line and the spaces between the teeth is also effective.
  • Using a tongue scraper to remove food debris and bacteria from your tongue. A tongue scraper is a simple device that takes just a few seconds to stroke a few times across your tongue. Many of the bacteria that lead to plaque, tooth decay, and gum disease reside on the tongue. Regular tongue cleaning with a scraper can help reduce the coating on the tongue, and can improve bad breath and taste perception.[39] [40] Tongue scrapers may be made of plastic, metal, or wood. Many can be purchased very inexpensively, or they can sometimes be obtained free of charge from your dentist.
  • Get dental check-ups and cleanings at least twice a year. Make sure that your dentist or oral hygienist does a cancer screen by looking and feeling around your mouth for any unusual bumps or spots. If you are still taking immunosuppressants, and your dentist recommends prophylactic antibiotics, make sure you follow the directions about the appropriate doses and timing. You may be able to get the prescription and the antibiotics at your dentist’s office.

Ever since the transplant, my gums have been receding continuously. After several consults with dentists, I now have a regimen that seems to be keeping the progression at bay. I now spend close to ten minutes every night caring for my teeth – brushing for two minutes with a sonic toothbrush, flossing, then using an interdental cleaner to get remaining plaque, and cleaning with a tongue-cleaner.

Dry Mouth Solutions

  • Get adequate hydration. This can include water with lemon juice and herbal teas.
  • Eat foods that have a lot of liquid, such as soups and stews. Moisten your food by adding sauces and broths.
  • Take frequent sips of water and rinse your mouth regularly throughout the day.
  • Avoid alcohol and caffeine as they may aggravate dryness. Avoid hidden sources of alcohol in mouthwashes and medicines.
  • Moisten the air around you with a cool-air vaporizer to add humidity.
  • Use saliva substitutes, moisturizing gels, and special dry mouth toothpastes to provide temporary relief. Your dentist should be able to recommend helpful products.
  • Take medications to increase your saliva production. Consult with your physician or dentist about appropriate medications.
  • Chew on sugarless gum or suck on a piece of sugarless candy to stimulate salivary glands throughout the day.
  • Pure papaya and pineapple juice are known to break up thick saliva. Other fresh fruit can also help.[20]
  • Certain acupressure points may help stimulate saliva production.[41]

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