Canterbury DHB

Context

Management of oral chronic GVHD

In This Section

Diagnosis

Assessment and Grading

Management

Further Reading

Diagnosis

It is important to differentiate cGVHD from other conditions which may mimic it, including infections and other ulcerative conditions.

The diagnostic features of chronic GVHD are:

Distinctive but not diagnostic features:

Assessment and Grading

Oral cGVHD has three distinct profiles:

Screening questions

Examination

The mouth should be assessed for the four cardinal features of GHVD:

Grading of severity

The NIH global score for oral GVHD is a simplified 0-3 scale for screenng and routine calendar assessment:

For more comprehensive assessment of oral GVHD and response to treatment, use the more detailed NIH scoring system (0-15).

Mucosal change

No evidence of cGvHD

Mild

Moderate

Severe

Erythema

None

0

Mild or moderate erythema (< 25%)

1

Moderate (> 25%) or severe (< 25%) erythema

2

Severe erythema (≥ 25%)

3

Lichenoid

None

0

Hyperkeratobic changes (< 25%)

0

Hyperkeratobic changes (< 25-50%)

2

Hyperkeratobic changes (> 50%)

3

Ulcers

None

0

None

1

Ulcers involving (≤ 20%)

3

Severe ulcerations (> 20%)

6

Mucoceles*

None

0

1-5 mucoceles

1

6-10 scattered mucoceles

2

Over 10 mucoceles

3

 

*Mucoceles scored for lower labial and soft palate only

 

Total score for all mucosal changes

 

When assessing the area of the mouth involved, a rule of thumb is:

Management

  1. Swab erythematous lesions for fungal disease.
  2. Mouth ulcers:
  3. Educate on home oral hygiene:
  4. Dry mouth:
  5. Topical steroids:
  6. Topical cyclosporin, oral liquid preparation 100 mg/ml - Dilute 1 ml in 20 mls water in a glass container, rinse for 3-4 minutes and spit.
  7. Consider proton pump inhibitor, e.g. omeprazole 20 mg BD to control GORD.
  8. Annual general dental review.
  9. Annual review for secondary cancer screening – Refer to dental department.

Further Reading

Sjogen’s Syndrome Society website

About this Canterbury DHB document (253743):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 253743