Table 4

Guidelines for screening, prevention, and management of late complications in patients with oral cGVHD

Late complicationPreventionScreeningManagement
Oral squamous cell carcinoma Smoking cessation
Moderate alcohol consumption 
Annual clinical examination
Biopsy of atypical/suspicious lesions 
Referral to multidisciplinary head and neck oncology center 
Rampant dental caries Minimize intake of refined carbohydrates (especially sugar-containing soft drinks)
Brush at least twice daily, after eating when possible
Floss daily
Fluoride 1.1% gel paint on or in custom trays, daily
Remineralizing agent, apply with fluoride Professional fluoride varnish application 
Increased risk in patients with significant salivary gland cGVHD
Increased risk in patients with orofacial sclerotic cGVHD
Increased risk in patients were severe mucosal disease and avoidance of oral hygiene
Examine teeth for evidence of cervical demineralization/decay
Twice annual dental visits
  • Soft and hard tissue examination

  • Bitewing radiographs (annual)

 
Treat dental caries as soon as diagnosed Careful follow-up for new or recurrent caries Reinforce oral hygiene and dietary habits Reinforce daily preventive measures 
Fibrosis No known preventive measures Ask patient if aware of tightness/limited opening Physical therapy 
  Extensive sclerotic skin disease, especially with neck involved Intralesional steroid therapy
Surgery 
  Examine for intraoral buccal fibrotic bands by palpation Systemic therapy for systemic involvement 
Late complicationPreventionScreeningManagement
Oral squamous cell carcinoma Smoking cessation
Moderate alcohol consumption 
Annual clinical examination
Biopsy of atypical/suspicious lesions 
Referral to multidisciplinary head and neck oncology center 
Rampant dental caries Minimize intake of refined carbohydrates (especially sugar-containing soft drinks)
Brush at least twice daily, after eating when possible
Floss daily
Fluoride 1.1% gel paint on or in custom trays, daily
Remineralizing agent, apply with fluoride Professional fluoride varnish application 
Increased risk in patients with significant salivary gland cGVHD
Increased risk in patients with orofacial sclerotic cGVHD
Increased risk in patients were severe mucosal disease and avoidance of oral hygiene
Examine teeth for evidence of cervical demineralization/decay
Twice annual dental visits
  • Soft and hard tissue examination

  • Bitewing radiographs (annual)

 
Treat dental caries as soon as diagnosed Careful follow-up for new or recurrent caries Reinforce oral hygiene and dietary habits Reinforce daily preventive measures 
Fibrosis No known preventive measures Ask patient if aware of tightness/limited opening Physical therapy 
  Extensive sclerotic skin disease, especially with neck involved Intralesional steroid therapy
Surgery 
  Examine for intraoral buccal fibrotic bands by palpation Systemic therapy for systemic involvement