Mouth Care for Bone Marrow Transplant Patients

Good mouth care is very important before, during, and after a bone marrow transplant. Keeping your mouth clean helps lower the risk of infection, bleeding, pain, and serious complications while your immune system is weak.

Dental Care Before the Bone Marrow Transplant

Why This Matters

Dental problems such as cavities, gum disease, or tooth infections can allow bacteria to enter your bloodstream. This can cause serious infections during chemotherapy or transplant.

Finding and treating dental problems early helps prevent:

• Mouth pain
• Infections in the mouth
• Bloodstream infections

When to See a Dentist

• As soon as possible after learning you will need chemotherapy or transplant.
• Ideally, when blood counts are safe.
• Patients with leukemia often need to be in remission before non‑urgent dental work.

Important Notes

• Dental exams and X‑rays are usually safe, even if blood counts are low
• If dental treatment is needed:
  • Your dentist must talk with your oncologist first.
  • Treatment will be planned for a safe time.
• You may see your regular dentist or a hospital‑based dentist.

Tell your doctor right away if you have tooth pain, swelling, or have not had regular dental care.

Mouth Care During Bone Marrow Transplant

Keeping your mouth clean can reduce mouth sores, infection and bleeding.

Before Hospital Admission

• A professional dental cleaning 1–2 weeks before transplant is recommended.
• This must be approved by your oncologist.

Daily Mouth Care

• Use a super‑soft toothbrush.
• Brush gently in small circles at the base of the tooth at gumline.
• Soften toothbrush bristles with warm water.
• Brush:
  • All teeth
  • Gums
  • Tongue
  • Roof of mouth

Toothbrush Care

When white blood cell counts are low.

• Clean toothbrush before each use:
  • Soak in fresh bleach solution
    (1 tablespoon bleach in ½ cup water), or
  • Wash with antimicrobial soap or chlorhexidine rinse.
• Rinse toothbrush well before use.
• Change toothbrush every week.

If Your Platelets Are Low (Below 50,000)

Do not:

• Floss.
• Use electric toothbrushes.
• Use medium or hard toothbrushes.

You may:

• Use a water flosser/irrigating device on the lowest setting.

Mouth Rinses

• Use salt and baking soda rinses often:
  • 1 teaspoon salt + 1 teaspoon baking soda in 1 quart of water.
• Chlorhexidine rinse may be prescribed for gum disease.
• Avoid alcohol‑based mouthwashes.

Mouth Pain or Sores

• Numbing medicine (lidocaine or “magic mouthwash”) may be prescribed.
• Use 15 minutes before eating.
• Take small bites and chew carefully.

Lips and Dentures

• Use water‑based lip moisturizer.
• Avoid petroleum jelly.
• Remove dentures if mouth is sore.
• Clean dentures before each use:
  • Use antimicrobial denture cleanser or chlorhexidine
  • Dentures without metal may be soaked in bleach solution
    (1 tablespoon bleach in ½ cup water)
• Rinse dentures well before wearing.

Important Medication Information

Some patients with multiple myeloma or bone cancer receive IV bone‑strengthening medicines such as Zometa®.

• These medications can affect the jawbone.
• Always tell your dentist if you have taken them.

Dental Care After Bone Marrow Transplant

When Dental Work Is Safe

• Platelets above 75,000:
  • Cleanings, fillings, root canals, and extractions are usually safe.
  • Must be approved by your oncologist.
• Platelets below 50,000:
  • Emergency dental care may require a platelet transfusion.

Antibiotics Before Dental Visits

You may need antibiotics before dental care if:

• You have a central line catheter.
• Your white blood cell count is low.

Check with your oncologist first.

Daily Fluoride Is Very Important

Dry mouth is common after transplant and can cause cavities.

You Should Use Daily Fluoride If You Have:

• Radiation to head or neck
• Total body irradiation
• Donor (allogeneic) transplant
• Long‑term chemotherapy
• Dry mouth
• Tooth sensitivity or cavities
• Chronic graft‑versus‑host disease

Recommended Fluoride:

• Prescription 1.1% sodium fluoride

How to Use Daily Fluoride

1. Use fluoride at bedtime
2. Remove dentures
3. Brush teeth well with a soft toothbrush
   (Floss only if approved by your care team)
4. Apply fluoride:
   • In a custom tray or
   • Brush directly onto teeth
5. Leave fluoride on teeth 5–10 minutes
6. Spit out excess
7. Do not rinse, eat, or drink for 30 minutes

• Start fluoride soon after transplant.
• Use daily for life if you have natural teeth.