Subjective Oral Dryness following Hematopoietic Cell Transplantation: A Report from the Orastem Study.

Xerostomia, or subjective oral dryness, is a serious complaint after hematopoietic cell transplantation (HCT). Xerostomia is rated as one of the most bothersome symptoms by HCT recipients, negatively affecting quality of life. This substudy of the Orastem study, a prospective longitudinal, international, observational, multicenter study, aimed to describe the prevalence and severity of xerostomia following HCT. Furthermore, the effect of the conditioning regimen, type of transplantation, and oral mucosal changes related to chronic graft-versus-host disease (cGVHD) in the development of xerostomia were studied. All HCT recipients rated xerostomia on a scale of 0 to 10 before the conditioning regimen, several times early post-HCT, and at 3 months post-HCT, and only allogeneic HCT recipients also rated xerostomia at 6 and 12 months post-HCT. In addition, stimulated whole mouth saliva was collected several times. Linear regression models and longitudinal mixed-effects models were created to investigate the influence of risk indicators on xerostomia. A total of 99 autologous and 163 allogeneic HCT recipients were included from 6 study sites in Sweden, Canada, the Netherlands, and the United States. The prevalence of xerostomia was 40% before the conditioning regimen, 87% early post-HCT, and 64% at 3 months post-HCT. Complaints after autologous HCT were transient in nature, while the severity of xerostomia in allogeneic HCT recipients remained elevated at 12 months post-HCT. Compared to autologous HCT recipients, allogeneic HCT recipients experienced 1.0 point more xerostomia (95% confidence interval [CI], .1 to 2.0) early post-HCT and 1.7 points more (95% CI, .4 to 3.0) at 3 months post-HCT. Allogeneic HCT recipients receiving a high-intensity conditioning regimen experienced more xerostomia compared to those receiving a nonmyeloablative or reduced-intensity conditioning regimen. The difference was 2.0 points (95% CI, 1.1 to 2.9) early post-HCT, 1.8 points (95% CI, .3 to 3.3) after 3 months, and 1.7 points (95% CI, .0 to 3.3) after 12 months. Total body irradiation as part of the conditioning regimen and oral mucosal changes related to cGVHD did not significantly influence the severity of xerostomia. Conditioning regimen intensity was a significant risk indicator in the development of xerostomia, whereas total body irradiation was not. Allogeneic HCT recipients experienced more xerostomia than autologous HCT recipients, a difference that cannot be explained by a reduction in stimulated salivary flow rate or the development of oral mucosal changes related to cGVHD.

The effect of conditioning regimen and prescribed medications on hyposalivation in haematopoietic cell transplantation (HCT) patients: an 18-month prospective longitudinal study.

OBJECTIVES: Haematopoietic cell transplantation (HCT) preceded by a conditioning regimen is an established treatment option for (non)malignant haematologic disorders. We aim to describe the development of hyposalivation over time in HCT recipients, and determine risk indicators. MATERIALS AND METHODS: A multi-centre prospective longitudinal observational study was conducted. Unstimulated (UWS) and stimulated (SWS) whole saliva was collected before HCT, early post-HCT, and after 3, 6, 12, and 18 months. The effect of type of transplantation (allogeneic vs autologous) and intensity (full vs reduced) of the conditioning regimen on hyposalivation (UWS < 0.2 mL/min; SWS < 0.7 mL/min) was explored. RESULTS: A total of 125 HCT recipients were included. More than half of the patients had hyposalivation early post-HCT; a quarter still had hyposalivation after 12 months. The conditioning intensity was a risk indicator in the development of hyposalivation of both UWS (OR: 3.9, 95% CI: 1.6-10.6) and SWS (OR: 8.2, 95% CI: 2.9-24.6). After 3 and 12 months, this effect was not statistically significant anymore. CONCLUSIONS: Hyposalivation affects the majority of patients early post-HCT. The conditioning intensity and the type of transplantation were significant risk indicators in the development of hyposalivation. The number of prescribed medications, total body irradiation as part of the conditioning regimen and oral mucosal graft-versus-host disease did not influence hyposalivation significantly. CLINICAL RELEVANCE: Because of the high prevalence of hyposalivation, HCT recipients will have an increased risk of oral complications. It might be reasonable to plan additional check-ups in the dental practice and consider additional preventive strategies.

The effect of hematopoietic stem cell transplantation on patient-reported subjective oral dryness: a systematic review focusing on prevalence, severity and distress.

OBJECTIVE: The aim of the present systematic review is to assess the prevalence and severity of and distress caused by xerostomia over time in adult hematopoietic stem cell transplantation (HSCT) recipients. METHODS: PubMed, Embase, and the Cochrane Library were searched for papers published between January 2000 and May 2022. Clinical studies were included if patient-reported subjective oral dryness was reported in adult autologous or allogeneic HSCT recipients. Risk of bias was assessed according to a quality grading strategy published by the oral care study group of the MASCC/ISOO, resulting in a score between 0 (highest risk of bias) and 10 (lowest risk of bias). Separate analysis focused on autologous HSCT recipients, allogeneic HSCT recipients receiving a myeloablative conditioning (MAC), and those receiving a reduced intensity conditioning (RIC). RESULTS: Searches yielded 1792 unique records; 22 studies met the inclusion criteria. The quality scores ranged between 1 and 7, with a median score of 4. The prevalence, severity, and distress of xerostomia increased shortly after HSCT. Severity of xerostomia in allogeneic MAC recipients was higher compared to allogeneic RIC recipients 2-5 months post-HSCT (mean difference: 18 points on 0-100 scale, 95% CI: 9-27); after 1-2 years, there was no significant difference anymore. CONCLUSION: The prevalence of xerostomia in HSCT recipients is high in comparison to the general population. The severity of complaints is raised during the first year post-HSCT. The intensity of the conditioning plays a key role in the short-term development of xerostomia, while factors affecting the recovery in the long term remain largely unknown.

Caries, periodontitis and tooth loss after haematopoietic stem cell transplantation: A systematic review.

OBJECTIVE: A systematic review was conducted to assess scientific knowledge concerning the effect of haematopoietic stem cell transplantation (HSCT) on the occurrence of caries, periodontal conditions and tooth loss, and to evaluate the prevalence of these diseases in adult HSCT survivors (PROSPERO 152906). METHODS: PubMed and Embase were searched for papers, published from January 2000 until November 2020 without language restriction, assessing prevalence, incidence or parameters of caries, periodontal conditions and tooth loss in HSCT recipients (≥80% transplanted in adulthood). Bias risk was assessed with checklists from Joanna Briggs Institute, and data synthesis was performed by narrative summary. RESULTS: Eighteen papers were included (1618 subjects). Half were considered at high risk of bias. Longitudinal studies did not show caries progression, decline in periodontal health or tooth loss after HSCT. The prevalence in HSCT survivors ranged from 19% to 43% for caries, 11% to 67% for periodontitis, and 2% to 5% for edentulism. Certainty in the body of evidence was very low. CONCLUSIONS: Haematopoietic stem cell transplantation, on the short term, may have little to no effect on caries, periodontal conditions and tooth loss. Caries and periodontitis may be more common in HSCT survivors compared with the general population, whereas edentulism may be comparable. However, the evidence for all conclusions is very uncertain.

Caries Progression after Haematopoietic Stem Cell Transplantation and the Role of Hyposalivation.

Haematopoietic stem cell transplantation (HSCT) preceded by a conditioning regimen is an established treatment option for many haematological diseases. Decreased salivary flow rates after HSCT may increase caries risk. We aim to estimate the extent to which caries lesions develop or progress in adult HSCT recipients and assess its association with salivary flow rates. A multi-centre prospective observational study was conducted in which patients receiving HSCT were followed up for 18 months. We included 116 patients (median age 56 years, 43% female) from two medical centres in the Netherlands. Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected, and full caries charts were made before HSCT and 3, 6, 12, and 18 months post-HSCT. Caries was scored according to the ICDAS criteria by trained dentist-examiners. New dentine lesions or lesion progression into dentine (ICDAS ≥4 or cavitated root lesions) occurred in 32% of patients over 18 months. The median number of affected surfaces was 2 (range: 1-12) per patient with caries progression. The influence of hyposalivation of unstimulated saliva (<0.2 mL/min) and stimulated saliva (<0.7 mL/min) at baseline and after 3 months on caries progression was determined with a negative binomial regression model. Hyposalivation of SWS 3 months after HSCT was a significant risk indicator for caries progression (incidence rate ratio: 5.30, 95% CI: 2.09-13.4, p < 0.001), while hyposalivation of SWS at baseline and hyposalivation of UWS were not. We conclude that caries progression is a common oral complication in patients after HSCT, and stimulated hyposalivation shortly after treatment is a significant risk indicator for caries progression.

A randomized controlled trial of manual versus powered tooth brushing during haematopoietic stem cell transplantation.

AIM: To compare manual and powered tooth brushing (MT and PT) with respect to patient compliance to brushing frequency advice, plaque removal and severity of oral mucositis (OM) in patients undergoing hematopoietic stem cell transplantation (HSCT) after high-dose chemotherapy. MATERIALS & METHODS: A randomized controlled trial was conducted. Forty-six patients scheduled to receive myeloablative conditioning regimen before autologous HSCT were included and randomly assigned to control (MT, n = 23) or test (PT, n = 23) groups. Starting at day 1 (day of hospital admission for HSCT), brushing frequency (patient recorded diary), plaque scores (Plaque Control Index) and oral mucositis (Oral Mucositis Nursing Index) were recorded daily. Data for days 1 to 17 were analysed using regression analysis and general linear models. RESULTS: Few patients maintained 4 times per day brushing, but most brushed at least 2 times per day throughout the study. In PT, overall plaque scores were lower by 6.98% (p = .006) as compared to MT. No differences were seen in OM scores between the groups (p = .968). A small but significant positive correlation was found between plaque scores and OM severity: R2 =0.15 (p < .01). CONCLUSIONS: Powered tooth brushing resulted in lower plaque scores, but was not associated with reduced OM severity. Individual plaque scores were positively related to OM severity.

Periodontal breakdown inter-tooth relationships in estimating periodontitis-related tooth loss.

OBJECTIVES: The reasons for tooth extraction are rarely recorded in epidemiological datasets. It poses a diagnostic challenge to determine if tooth loss is related to periodontal disease (TLPD). The present study aimed to assess the inter-tooth relationships based on the periodontal characteristics of existing teeth. METHODS: A cross-sectional dataset of 8,978 participants with complete periodontal examination (including probing pocket depth [PPD] and clinical attachment loss [CAL]) in the NHANES 2009-2014 was used in this study. Spearman rank correlation was applied to assess the inter-tooth correlations of PPD/CAL among 28 teeth after adjustment for relevant confounders. We further verify our findings in the Java Project on Periodontal Disease with TLPD information available (the number of TLPD = 12). RESULTS: Strong PPD/CAL correlations were observed in adjacent teeth (r for PPD = 0.652, r for CAL = 0.597; false discovery rate [FDR] <0.05) rather than those on non-adjacent teeth (r for PPD = 0.515, r for CAL = 0.476; FDR <0.05). The correlations increased among severe periodontitis cases (CAL ≥5 mm or PPD ≥6 mm). In line with this, we further observed that the teeth adjacent to the TLPD tooth had the most alveolar bone loss in the Java dataset. CONCLUSION: The periodontitis parameters (PPD/CAL) of adjacent teeth could be a potential indicator to estimate TLPD when actual reasons for tooth extraction are unknown. CLINICAL SIGNIFICANCE: Periodontally compromised teeth adjacent to a lost tooth may help estimate whether the loss could be related to periodontal disease when the actual extraction reasons are unknown.

Trends in socioeconomic inequality of periodontal health status among Dutch adults: a repeated cross-sectional analysis over two decades.

BACKGROUND: Studies exclusively focusing on trends in socioeconomic inequality of oral health status in industrialized countries are relatively sparse. This study aimed to assess possible differences in oral hygiene and periodontal status among people of different socioeconomic status (SES) in the Netherlands over two decades. METHODS: A repeated cross-sectional analysis of 3083 participants aged 25-54 years was conducted on the Dutch National Oral Health Surveys of 1995, 2002, 2007, and 2013. Plaque-free was defined according to the Simplified Oral Hygiene Index (OHI-S = 0). Periodontal status was classified in two different ways, either periodontal health/disease (probing pocket depth index [PDI] = 0/ ≥ 1) or with/without deep pockets (PDI = 2). We used the regression-based absolute and relative effect index to measure the absolute and relative socioeconomic inequalities. Multivariable logistic regressions were used to explore temporal trends in oral hygiene and periodontal status by low- and high-SES groups. RESULTS: Age-standardized percentages of individuals with plaque-free increased in the whole population from 1995 to 2013 (12.7% [95% CI 10.5-14.9] to 28.1% [24.8-31.5]). Plaque-free showed significant socioeconomic differences in absolute and relative inequalities in 2007 and 2013. Between 1995 and 2013, age-standardized percentage of periodontal health increased (from 51.4% [48.1-54.7] to 60.6% [57.0-64.1]). The significant absolute inequalities for periodontal health were seen in 2002 and 2013. The relative scale presented a similar pattern. Regarding deep pockets, there was little difference in the age-standardized overall prevalence in 1995 versus 2013 (from 6.5% [4.9-8.2] to 5.4% [3.7-7.0]). The significant absolute and relative inequalities in deep pockets prevalence were found in 1995. Yet, all interaction terms between survey year and SES did not reach significance (plaque-free: P = .198; periodontal health: P = .490; deep pockets: P = .678). CONCLUSIONS: Socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands in the last two decades.

Definitions used for a healthy periodontium-A systematic review.

OBJECTIVE: To investigate the explicitness and variability of the definition of periodontal health in the current scientific literature. MATERIAL AND METHODS: The authors conducted a systematic literature review using PubMed and CENTRAL (2013-01/2019-05) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the guidelines of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. RESULTS: A total of 51 papers met the predefined inclusion criteria. Of these, 13 papers did not report any explicit definitions of periodontal health. Out of the 38 remaining articles, half of them used a reference to support their definition and half of them not. The studies published in periodontics-related journals or those that scored a low risk of bias for the methodical quality presented more explicit and valid definitions. Probing pocket depth was the most frequently used individual parameter for defining periodontal health. However, there were substantial variations in the methods of measurement and cut-off values. CONCLUSIONS: Given the diversity of periodontal health definitions, a cross-study comparison is difficult. The results of this review may be useful in making others aware of the significance of standardizing the definition of a healthy periodontium.

Prevalence of noncarious cervical lesions among adults: A systematic review.

OBJECTIVES: This study aims to systematically review the literature on noncarious cervical lesions (NCCLs) and calculate an overall prevalence estimate. METHODS: The protocol of this systematic review was prepared according to PRISMA and MOOSE guidelines. The MEDLINE-PubMed and Cochrane-CENTRAL databases were searched. Relevant published papers that provided information regarding the prevalence or number of NCCLs among general or specific populations were included. RESULTS: The initial search identified 569 titles and abstracts, 24 of which met the eligibility criteria involving 14,628 participants. The weighted mean prevalence of NCCLs among the whole studied population was 46.7 % (95 % CI: 38.2; 55.3 %), ranging from 9.1%-93%. Based on sub-analyses, studies with populations older than 30 years revealed higher weighted prevalence (53 %) than those with populations younger than 30 years (43 %). Regarding the diagnostic method, when visual or tactile clinical examination was used, the prevalence was lower than when the Smith and Knight tooth wear index was used. When different definitions were used, the weighted mean prevalence varied from 28 % to 62 %. As to the terms used to address the lesions, the prevalence was higher when "noncarious cervical lesion" was used and lower when "root defects," "abrasion," or "abfraction" were used. When geographical regions were compared, South America had the highest reported prevalence of NCCLs, while the United States had the lowest. Moreover, general populations presented the highest prevalence, slightly higher than dental populations, whose members frequented dental practices. CONCLUSION: The overall prevalence of NCCLs was 46.7 % and higher in older populations. Visual and tactile clinical examination underestimate this prevalence compared to the established index. The terms and definitions used also influenced the prevalence data. Distinct geographical differences were observed, and general populations were more inclined to present NCCLs.

Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review.

AIM: The objectives of this review were as follows: What are characteristics used to define various forms of periodontal biotypes? What are their anatomic dimensions in relation to the definition? In addition, what is the association between these various characteristics in relation to the periodontal biotypes? Furthermore, what is the prevalence of various forms of periodontal biotypes in the population? MATERIAL AND METHODS: The PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE databases were searched through up and till June 2013 to identify any appropriate studies regarding the aim. Appropriate studies were those reporting characteristics of various forms of periodontal biotype and its dimensions. These characteristics were gingival thickness (GT), gingival morphotype (GM), tooth dimensions (TD), keratinized tissue (KT) and bone morphotype (BM). RESULTS AND CONCLUSIONS: The search yielded 2581 unique papers, after selection resulted in 12 publications that met the eligibility criteria. In general, the available definitions are found to be unclear and sometimes inconsistent. However, based on the available literature, the three biotypes thin scalloped, thick flat and thick scalloped seem a comprehensive categorization in defining periodontal biotypes in the population. The dental, gingival and osseous dimensions have a weak to moderate association. Only between gingival thickness, keratinized tissue and bone morphotype uniform positive associations are found.

Effect of ethylene oxide sterilization on enamel and dentin demineralization in vitro.

For in situ studies into caries prevention, sterilization of tooth samples is essential. However, sterilization may influence the caries process itself. The aim of this study was to assess the effect of sterilising sound human enamel and dentin with ethylene oxide on lesion depth and mineral loss before and after in vitro demineralization. Lesion depth and mineral loss were measured using transversal microradiography (TMR). The experiment was carried out with 32 enamel and 32 dentin samples. We found a significant reduction of lesion depth due to sterilization in demineralized enamel (-9.8microm; 95% CI: -15.1 to -4.4microm). The small effect of sterilization on demineralized enamel is considered to be irrelevant for in situ studies of de- and remineralization.