Minimising the risk of infections

The mouth harbours a lot of bugs even in good health and so keeping your mouth clean whilst you are neutropenic is an important measure to help minimise your risk from infections.

When you are immunosuppressed you can develop a sore mouth and sometime ulceration of your gut passages. These can then become a gateway for bacteria into the bloodstream and contribute to systemic infections or even infections in the heart (endocarditis).

Cleaning your teeth

Brushing your teeth regularly with a soft bristle toothbrush can help minimise the risk of gum disease and infections in the mouth.

It is important to use a soft bristle toothbrush o prevent accidental damage caused by aggressive tooth-brushing or from a harder
bristled toothbrush. Your treatment team may also prescribe you an anti-microbial mouthwash to use in the form of chlorhexidine such as Corsodyl which is also available as a toothpaste.

Make sure the mouthwash is alcohol free to avoid any further irritation or sensitivity of the gums.

When you have a higher susceptibility to infections it is recommended that you brush your teeth twice a day and use an anti-microbial
mouthwash four times a day.

The side-effects of anti-microbial mouthwash

One of the undesired side-effects of chlorhexidine mouthwashes is discolouration of the tongue or teeth. Whilst this can be unpleasant, the manufacturer claims that once you discontinue using the mouthwash, any staining should fade away over time.

Minimising staining

Once your neutrophil count and platelet count are at a more normal level, you will be able to go to a dental hygienist for a professional
clean. In the interim, you can minimise staining with the following measures:

1. Dilute the mouthwash with water to reduce its concentration

2. Drinking tea or coffee straight after is one of the main contributing factors to its staining properties. Try and wait at least an hour
after you have used the mouthwash before you drink coffee/tea.

Visiting your dentist

Visiting your dentist regularly is also important. You may sometimes need to have an oral x-ray to help look for any signs of a deep root infection. These are often not found through physical examination alone. If any abnormalities or problematic teeth are identified it may be recommended that they are repaired by a dental filling, root canal treatment, or sometimes extraction. This can help prevent them being a potential source of infection in the future.

Additional precautions

Please remember to discuss any potential dental procedures with your haematologist first. You may need to take some additional precautions, such as a short course of antibiotics after any extractions. If your platelet count is < 50 10^9/L then you
will need a platelet transfusion prior to the procedure to help minimise any bleeding complications.

We recommend these procedures be carried out by specialist dentists that are linked to a hospital. If you have any concerns about your oral hygiene, please speak to your haematology team who can refer you to a specialist dental clinic.

Ciclosporin

Many patients will be prescribed Ciclosporin as part of their treatment for Aplastic Anaemia – this is a powerful immunosuppressant drug
which can often cause swollen and thickened gums as a side effect.

I have treated many people over my 30 years in Dental Practice who have experienced issues where medications such as Ciclosporin have caused unpleasant oral side effects with their gums. It’s useful to know that adopting simple measures from the start of treatment such as switching to soft or baby toothbrushes, brushing more frequently but gently, and using chlorhexidine antimicrobial mouthwashes such as Corsodyl really do work. It is a good idea to visit your dentist or hygienist for further preventative advice and helpful techniques on an ongoing basis. The good news is that the side effects are temporary in nature and will disappear when you no longer need to take Ciclosporin.

- Fiona

You can find our general information about Ciclosporin as a treatment for aplastic anaemia here.

You can order this information as a free booklet, or download a printable PDF here.