ABSTRACT Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team.

ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

JUSTIFICATIVA E OBJETIVOS: Os pacientes internados em unidades de terapia intensiva (UTI), na maioria das vezes, não possuem higienização oral adequada. Esta condição de deficiência de higiene oral em pacientes graves desencadeia freqüentemente periodontites, gengivites e outras complicações sistêmicas e orais. O objetivo deste estudo foi avaliar a eficiência da ação antimicrobiana da solução bucal com sistema enzimático associada à higiene oral, em pacientes totalmente dependentes de cuidados internados em UTI. MÉTODO: Estudo piloto prospectivo duplamente encoberto, realizado com 20 pacientes internados em UTI, divididos em 2 grupos com protocolos de higienização bucal com a mesma técnica, mas utilizando-se soluções diferentes, sendo o grupo de estudo (n = 10) utilizando solução bucal com sistema enzimático e o grupo controle (n = 10) utilizando solução bucal à base de cetilpiridínio. RESULTADOS: Os resultados microbiológicos das culturas coletadas nos grupos de estudo e controle, antes e após o uso da solução enzimática, mostraram que não houve diferença significativa entre os grupos (p = 0,41). Na avaliação clínica do Índice de Higiene Oral Simplificada (IHOS) houve significância estatística pelo teste Exato de Fisher (p = 0,01), quando comparados os grupos de estudo e controle. O valor de significância estatística foi estabelecido em 5%, ou p < 0,05. CONCLUSÔES: O uso de solução enzimática à base de lactoperoxidase, mostrou ser eficiente na avaliação clínica para higiene oral de pacientes totalmente dependentes de cuidados em ambiente hospitalar. Este estudo reflete a importância de se desenvolverem mais pesquisas quanto aos cuidados bucais com este grupo de pacientes.

BACKGROUND AND OBJECTIVES: Patients admitted to an intensive care unit (ICU), in most cases do not have a proper oral hygiene. This deficient condition of oral hygiene in critical patients often triggers periodontitis, gingivitis and other systemic and oral complications. This research aimed to evaluate the efficiency of the antimicrobial action of a solution with bioactive enzymatic system for oral hygiene, in totally care-dependent patients admitted to ICU. METHODS: A prospective, double blind pilot study was conducted with 20 patients admitted to an ICU, divided into 2 groups with the same technique of oral hygiene, protocols but using different solutions: the study group (n = 10) using an oral solution with enzymatic system and the control group (n = 10) using an oral solution based on cetylpyridinium. RESULTS: Results of microbiological cultures collected in the study group and control group, before and after the use of enzymatic solution, showed no significant difference between groups (p = 0.41). In clinical evaluation of the Simplified Oral Hygiene Index (SOHI) statistical significance was found by the Fisher Exact test (p = 0.01) when comparing the study group and control group. The value of statistical significance was set at 5%, or p < 0.05. CONCLUSIONS: The use of oral rinse with the lactoperoxidase enzyme was effective in the clinical evaluation of the oral hygiene of patients totally care-dependent in the hospital. This study stresses the importance of developing more research on the oral care of these patients.