Dental Implants in Patient with Graft Versus Host Disease: Guidance?

Dr. S. asks:
I have a new patient who presents with a history of leukemia and a bone marrow transplant. He is currently suffering from graft versus host disease (GVHD). His salivary flow is minimal and his entire dentition has been destroyed by caries and he has an increased susceptibility to infection. He also has a limited opening. I would like to install implants and have the case restored. The problem is that I cannot find any guidance from the peer reviewed literature in how to proceed with the implant installation. I will consult with the patientâ€™s physicians but I would first like to have some guidance on how to proceed. What laboratory tests should I order? Are there any limitations or precautions that I should follow? I would appreciate any guidance from those of you who have had experience with this kind of a case.

5 Comments on Dental Implants in Patient with Graft Versus Host Disease: Guidance?

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Dr. J. D.

1/30/2012

Do you live near a medical center with an oral surgery department? This case is way beyond what I would ever consider tackling alone. I would speak with the oral surgeon and see what he thinks is appropriate.

Dr. S

1/31/2012

Dear Dr. J.D. Your recommendation to refer to an oral surgery department is a good one. I was thinking though that someone out there may have dealt with a case like this and I was looking for some information. I would agree that this is something that is probably beyond the skills of any one practioner. It certainly is certainly the most difficult case I have yet encountered.

Theodore Grossman DMD

1/31/2012

Establish communication with his hematologist/oncologist and obtain a history of the present illness along with a clinical history of any soft & hard tissue healing events. Obtain past and current CBC's. Note if the white cell count is continually increasing. Is he taking immunosuppressive meds, steroids, etc.? What type of restoration is planned?If conditions allow you may consider placing one or two implants to evaluate the response of relatively dry soft tissues. Construct a detailed consent form.

carlos boudet

1/31/2012

GVHD is classified in stages I Through IV, with IV being the worst and having a poor prognosis. Treatment of GVHD usually means Intravenously administered glucocorticoids which suppresses the immune system and results in immunocompromised patients that are at high risk for infections. Due to the severity of the symptoms and damage to organs such as liver, lungs, GI tract. skin, mucosa, etc..., the patient has more important needs than "implant installation". I think your role as a dentist at this time should be a supportive one until the patient's condition improves and gets clearance by the physician for oral surgery.

Baker vinci

2/1/2012

Good advice Carlos , we see these patients on a relatively routine basis and they are rarely ever implant candidates. Could we please see ,at least a panaramic radiograph. I would be willing to "bet" that he has at least one tooth on either side of each arch, that could be restored. Trismus, tends to get worse with these people, as does their oh.. Save what you can and don't turn him into a surgical patient. Two retained canines, works every bit as good as two implants and sometimes better. I know this is an implant site, but the best surgeons are the ones, that no when not to operate. Bv

Dental Implants in Patient with Graft Versus Host Disease: Guidance?

5 Comments on Dental Implants in Patient with Graft Versus Host Disease: Guidance?

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