Oral characteristics and dental management of chronic GVHD patients: A case report

Abstract

Graft-versus-host disease (GVHD) is an allo-immune inflammatory process and a common complication following hematopoietic stem cell transplantation. Chronic GVHD affects many organs, of which the oral cavity is the most frequently affected site. Its major oral symptoms are lichenoid mucosal lesions, salivary gland dysfunction, trismus, and hyperkeratotic lesions. A 5-year-old patient with chronic GVHD visited the Department of Pediatric Dentistry, Yonsei University Dental Hospital with dysphagia and a tongue lesion. A white hyperkeratotic plaque on the tongue and rampant dental caries were observed on oral examination. Radiographic examination revealed congenitally missing upper second premolars and altered root development of upper and lower central incisors and first molars. A steroid gargle was prescribed for the tongue lesion. In two years, the lesion was observed to have spread to a wider area. The steroid treatment was replaced with supportive treatment such as saline gargle for xerostomia, and prophylaxis for dental caries/secondary infection was performed. It is essential to observe oral symptoms periodically and render supportive care in concurrence with steroid therapy.