Table 3.60.
Key considerations in dental management for graft versus host disease (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 3 | Infection; bleeding tendency |
| Appropriate dental care | 3/4 | Only emergency oral care during acute phase; individualised assessment |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | |
| – Conscious sedation | 2 | |
| – General anaesthesia | 3/4 | |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 0 | |
| – Patient positioning | 1 | Upright position if pulmonary involvement |
| Treatment modification | ||
| – Oral surgery | 3/4 | Dryness; GVHD prognosis |
| – Implantology | 3–5 | |
| – Conservative/Endodontics | 3 | GVHD prognosis |
| – Fixed prosthetics | 3/5 | GVHD prognosis |
| – Removable prosthetics | 3/5 | Mucosal involvement |
| – Non-surgical periodontology | 3–5 | GVHD prognosis |
| – Surgical periodontology | 3–5 | GVHD prognosis |
| Hazardous and contraindicated drugs | 2 | Some patients receive methotrexate, ciclosporin or corticosteroids |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.