Rhode Island Cancer and Oral Health Resource Guide
Oral Graft-Versus-Host Disease (Oral GVHD)
Non-dental Providers
Oral GVHD is a manifestation of graft-versus-host disease involving the oral mucosa and associated tissues following allogeneic hematopoietic stem cell transplantation (HSCT). It represents an immune-mediated reaction in which donor T-cells attack host oral epithelial and salivary gland tissues.
Acute vs. Chronic GVHD
Current medical guidelines define acute and chronic GVHD based on clinical signs and symptoms, rather than strictly by time (the historical 100-day cutoff is no longer used).
Acute GVHD may involve:
• Oral pain
• Mucositis
• Neutropenic ulcers
• Secondary infections
• Large mucoceles
Oral Manifestations of Chronic GVHD
The oral cavity is one of the most frequently affected sites in chronic GVHD, alongside systemic involvement.
Common presentations include:
• Lichenoid changes resembling oral lichen planus
• Mucosal changes resembling mucous membrane pemphigoid, pemphigus vulgaris, or erythema multiforme
• Infections presenting with erythema, ulcerations, and crusting
• Mucoceles
• Hyposalivation
• Dysgeusia (taste alterations)
• Neurosensory disturbances
• Mucosal atrophy and fibrosis
Diagnostic Criteria (Oral-Specific)
NIH Consensus (2014/2020 updates)
Previously, oral chronic GVHD was categorized by mucosal conditions, sclerodermatous
changes, and Sjögren-like features.
Current diagnostic features of oral cGVHD include:
• Lichen planus-like changes: Hyperkeratotic white lacy lesions on the oral mucosa, predominantly affecting the buccal mucosa and tongue, but can involve any intraoral surface or the vermilion lip.
• Erythema or ulceration may be present but are not considered diagnostic.
• Isolated hyperkeratotic plaques (leukoplakia) are no longer diagnostic, as they are recognized as a separate clinical entity with potential malignant risk.
• Reduced jaw opening due to skin sclerosis should be scored under skin involvement, not as an oral criterion.
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Distinctive (non-diagnostic) oral features include:
• Hyposalivation
• Mucoceles
• Mucosal atrophy/fibrosis
• Pseudomembranes/ulcers
• Oral infections
Treatment of Oral GVHD
Local/Topical Therapy
• Topical corticosteroid gels, creams, or ointments
• Topical calcineurin inhibitors for lip application
• Salivary stimulants, such as artificial saliva or xylitol-based sugar-free lozenges
• Analgesic rinses, such as viscous lidocaine or compounded mouth rinses, for pain relief
Systemic Therapy
• Indicated for moderate-to-severe, multisystem GVHD
• Prednisone, with or without other immunosuppressants
• Management should be coordinated with the transplant and oral medicine team
Oral Hygiene and Support
• Strict plaque control to reduce infection risk
• Frequent dental reviews (every 3–6 months)
• Fluoride supplementation and remineralization therapy to prevent caries
Survivorship and Long-Term Monitoring
What to Look For
• Functional issues
• Oral pain or ulcerations
• Nutritional impact
• Fibrosis/trismus
• Dental decay and periodontal disease
Prevention and Surveillance
• Chronic inflammation and prolonged immunosuppression increase the risk of secondary oral squamous cell carcinoma (SCC)
• Biopsy any persistent leukoplakia, erythroplakia, or ulcer >2 weeks
• Minimize long-term immunosuppressive exposure when possible
• Avoid risk factors: tobacco, alcohol, and excessive UV exposure (for lips)
• Regular oral cancer screening (every 6–12 months, lifelong)
• Encourage routine dental and self-examinations
For more information about oral GVHD, see these resources:
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Oral Chronic Graft-Versus-Host Disease - The American Academy of Oral Medicine
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Oral Chronic Graft-Versus-Host Disease - Brigham and Women's Hospital
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Importance of Good Oral Health Before, During, and After Cancer Care​
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The information on the Rhode Island Cancer and Oral Health Resource Guide, including but not limited to, text, graphics, images, and other external materials are for informational purposes only. The Partnership to Reduce Cancer in Rhode Island does not provide medical advice. The information on this website is not intended as a substitute for professional medical advice, diagnosis, or treatment.