Review article

https://doi.org/10.20471/acc.2026.65.03.13

Dental Evaluation Prior to Hematopoietic Stem Cell Transplantation

Ivana Jurčić Čulina ; University of Applied Health Sciences, Zagreb, Croatia
Boris Aurer ; Dental polyclinic Zagreb, Zagreb, Croatia
Lana Desnica ; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ante Vulić ; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Barbara Dreta ; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Sandra Bašić-Kinda ; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Dino Dujmović ; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Toni Valković ; Faculty of Medicine, University of Rijeka, Rijeka, Croatia; Department of Internal Medicine, Pula General Hospital, Pula, Croatia
Josip Batinić ; Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia *

* Corresponding author.

Abstract

Hematopoietic stem cell transplantation (HSCT) is an established treatment
for various hematologic malignancies, but is associated with significant mucosal
complications related to immunosuppression and toxicity. The oral cavity
is both a frequent site of HSCT-related adverse effects and a potential source
of systemic infection. Consequently, pretransplant dental evaluation has traditionally
been recommended to eliminate oral foci that may increase morbidity
and mortality. However, most existing guidelines were developed during an era
of more intensive conditioning regimens, prolonged neutropenia, and higher
treatment-related mortality than is typical today. This review examined current
evidence regarding the risks and benefits of dental evaluation and intervention
prior to HSCT, with particular attention paid to differences between autologous
(ASCT) and allogeneic stem cell transplantation (AlloSCT). While there is general
agreement that acute or symptomatic oral infections should be treated before
conditioning, the management of asymptomatic dental disease remains controversial.
The available literature includes a few randomized controlled trials and
suggests a low incidence of oral-origin infections during HSCT. Non-randomized
studies and systematic reviews question the benefit of extensive dental clearance,
particularly when it may delay transplantation or increase morbidity. Current
evidence supports a selective, risk-adapted dental approach. For AlloSCT
recipients, targeted intervention for high-risk conditions appears appropriate,
whereas low-risk asymptomatic lesions may be monitored. In ASCT, transplantation
may often proceed safely without comprehensive dental clearance. Overall,
individualized decision-making may be preferable to uniform aggressive
dental protocols.

Keywords

Hematopoietic stem cell transplantation; Pretransplant dental evaluation; Oral infection risk

Hrčak ID:

351394

URI

https://hrcak.srce.hr/351394

Publication date:

28.9.2026.

Article data in other languages: croatian

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