Oral foci and their relationship with hospital stay after hematopoietic cell transplantation
Oral focus screening is recommended before HCT (hematopoietic cell transplantation). Acute foci are generally treated pre-HCT. However, it is unclear whether chronic foci should be treated pre-HCT. This study aimed to evaluate the association between number of foci and early post-HCT morbidity and mortality.
Patients receiving oral screening pre-HCT at Radboudumc between 2013 and 2023, with a recent panoramic radiograph, were included. Foci were defined as teeth or implants with deep pockets, furcation radiolucencies, periapical radiolucencies, deep caries, partial eruption, or retained roots. Dental interventions were provided pre-HCT if deemed necessary and possible. Hospital length of stay (LOS), mortality and oral exacerbations were assessed in the first hundred days post-HCT. Hospital LOS was log-transformed to normalize its skewed distribution. Multivariate regression analyses were performed.
500 patients were included (median age 58 years, 37% female, 56% allogeneic). Five acute foci in three patients remained untreated pre-HCT. 48% had at least one untreated chronic focus pre-HCT (mostly furcation radiolucencies and post-endodontic periapical lesions). Mean LOS was 22 days, twenty patients died, and four patients had an oral exacerbation before HCT day +100. After adjustment for conditioning intensity, age, socioeconomic status and number of teeth, HCT recipients with ≥3 foci had five additional days in the hospital compared to those without foci (ratio of means 1.21; 95% CI 1.00 – 1.46). The number of foci was not associated with early post-HCT mortality.
The presence of ≥3 oral foci is associated with extended hospital LOS in the first hundred days post-HCT.