Hani Mawardi, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi ArabiaFollow
Nathaniel Treister, Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA
Osama Felemban, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
Waleed Alamoudi, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
Ghada Algohary, King Khalid University Hospital, Riyadh, Saudi Arabia
Abdulrahman Alsultan, National Guard Hospital, Riyadh, Saudi Arabia
Nawal Alshehri, King Fahad Medical City, Riyadh, Saudi Arabia
Illias Tazi, Department, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco
Marwan Shaheen, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Mohamed Alsharani, Military Hospital, Riyadh, Saudi Arabia
Salem Alshemmari, Kuwait Cancer Center, Kuwait City, Kuwait
Mutlu Arat, Florence Nightingale Hospital, HSCT Unit, Istanbul, Turkey
Mohamed Amine Bekadja, EHU 1st November, Oran, Algeria
Murtadha Al-Khabori, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
Samar Okaily, American University of Beirut, Beirut, Lebanon
Natasha Ali, Aga Khan University, Karachi, Pakistan
Husam Abujazar, King Hussein Cancer Center, Amman, Jordan
Wasil Jastaniah, King Abdulaziz Medical City, Jeddah, Saudi Arabia
Amir Ali Hamidieh, Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Sharukh Hashmi, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Mahmoud Aljurf, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia


Introduction: The oral cavity is one of the most common sites impacted by hematopoietic stem cell transplantation (HSCT) with acute complications including mucositis, bleeding, salivary gland dysfunction, infection, and taste alteration. These complications may result in significant morbidity and can negatively impact outcomes such as length of stay and overall costs. As such, oral care during HSCT for prevention and management of oral toxicities is a standard component of transplant protocols at all centers. The objective of this study was to evaluate the current oral care practices for patients during HSCT at different transplant centers within the Eastern Mediterranean region. Material and methods: An internet-based survey was directed to 30 transplant centers in the Eastern Mediterranean region. The survey included five sections asking questions related to (1) transplant center demographics; (2) current oral care protocol used at the center and type of collaboration (if any) with a dental service; (3) use of standardized oral assessment tools and grading systems for mucositis; (4) consultations for management of oral complications; and (5) oral health needs at each center. Data are presented as averages and percentages. Results: A total of 16 responses from 11 countries were collected and analyzed, indicating a response rate of 53%. Eight centers reported that a dentist was part of the HSCT team, with four reporting oral medicine specialists specifically being part of the team. Almost all centers (15/16; 93%) had an affiliated dental service to facilitate pre-HSCT dental clearance with an established dental clearance protocol at 14 centers (87%). Dental extraction was associated with the highest concern for bleeding and the need for platelet transfusion. With respect to infection risk, antibiotic prophylaxis was considered in the setting of low neutrophil counts with restorative dentistry and extraction. All centers provide daily reinforcement of oral hygiene regimen. The most frequently used mouth oral rinses included sodium bicarbonate (68%) and chlorhexidine gluconate (62%), in addition to ice chips for dry mouth (62%). The most frequently used mucositis assessment tools were the World Health Organization scale (7/16; 43%) and visual analogue scale for pain (6/16; 37%). Mucositis pain was managed with lidocaine solution (68.8%), magic mouth wash (68.8%) and/or systemic pain medications (75%). Conclusions: Scope and implementation of oral care protocols prior to and during HSCT varied between transplant centers. The lack of a universal protocol may contribute to gaps in oral healthcare needs and management for this group of patients. Further dissemination of and education around available oral care guidelines is warranted. Clinical relevance. Considering oral care during HSCT a standard component of transplant protocols, the current study highlights the common oral care practices for patients at centers within the Eastern Mediterranean region.

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