Oral infections seem to have no association with the risk of stem cell transplantation patients dying or getting a serious infection within six months of the procedure, report the University of Helsinki, the Helsinki University Hospital, the University of Basel, and the University Hospital Basel.
Hematopoietic stem cell transplantation is used to treat cancers as well as severe blood and autoimmune diseases. Due to the long period of recovery for the immune system after a stem cell transplantation procedure, these patients have a heightened risk of infection.
The study involved patients 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 procedures, all patients underwent a clinical and radiological dental examination to identify any potential foci of infection as well as the number of missing and filled teeth.
A total of 51 stem cell transplant patients died within six months of the procedure. The foci of infection, the number of missing or filled teeth, and the cases of periodontitis identified in the examinations completed before the transplantation were not associated with the survival of patients.
Also, the oral foci of infection and oral infections were not associated with infections requiring hospitalization or bacteremia identified by blood culture occurring within six months of the transplantation.
“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 University of Basel professor Tuomas Waltimo, DDS, who led the study.
The long-term and broad-spectrum antimicrobial therapy administered during treatment in this study was most likely able to prevent the spread of chronic infections of dental origin, the researchers said.
Yet Waltimo noted that the antibiotic resistance level of oral microbes must be monitored and that dental infections always should be treated as soon as possible, either conservatively or surgically.
“Even though the cause of dental infections must always be eliminated, our study demonstrates that teeth need not be extracted just before a stem cell transplantation procedure due to chronic but asymptomatic dental infections,” said Waltimo.
“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,” said Waltimo.
The findings cannot be applied to any other patient groups, Waltimo said, especially not to patients suffering from cancer in the region of the head and neck or the treatment of patients with a heart valve or a prosthetic joint. In such cases, the treatment of the oral foci of infections in good time is always well grounded.
“Based on our results, it seems that radical and extensive procedures to treat oral infections are not necessary before stem cell transplantations. Instead, such treatment can be postponed until after the transplantation,” said Matti Mauramo, LicMed, DDM, a physician specializing in pathology and the principal author of the study.
For the sake of the patient’s quality of life and treatment costs, dental infections should be prevented or treated as soon as possible, the researchers said. Antibiotic therapy given when immune defenses are impaired appears to make it possible to delay dental treatment by as much as several months after a stem cell transplantation procedure, they added.
The significance of cooperation between physicians and dentists must not be underestimated, the researchers emphasized, neither in terms of the patient’s quality of life nor in terms of infectious complications.
The study, “Associations of Oral Foci of Infections With Infectious Complications and Survival After Hematopoietic Stem Cell Transplantation,” was published by PLOS One.
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