Stomatitis in the bone marrow transplant patient. An overview and proposed oral care protocol

Bone marrow transplantation (BMT) is a treatment modality associated with a wide spectrum of gastrointestinal complications. One effect is painful stomatitis. Stomatitis is defined as an inflammatory and ulcerative reaction of the oral cavity. Stomatitis in the transplant patient is attributable to one, several, or all of the following: effects of high-dose chemotherapy and/or radiotherapy delivered pretransplant; infection; acute or chronic graft-versus-host disease (in the allogeneic transplant recipient); the condition of the oral cavity pretransplant; and side effects of other medications or treatments used during the transplant process. Frequency of oral complications in the BMT population has been looked at in several studies. Most studies showed changes beginning immediately before transplant day, peaking 1-2 weeks posttransplant, and gradually improving. Published studies have not included colony-stimulating factors in the treatment regime, nor have they addressed the effect of these agents on oral complications. A survey of BMT centers showed that no standard protocol is in place for stomatitis prevention and management. The literature shows that no agent has been shown to be superior to any other. Frequency of care given and reinforcement of care needed have been shown to be related to improvement in oral condition. Based on the review of the literature, a protocol for oral care is proposed. This protocol would then establish a program to which other agents can be compared.