Interplay of salivary function, oral health, and psychological well-being in hematopoietic stem cell transplantation : a longitudinal cohort study

Abstract

Clinical relevance Hematopoietic stem cell transplantation (HSCT) is a life-saving treatment for hematologic malignancies, but survivors often face significant long-term oral health challenges, which severely impact oral health-related quality of life (OHRQoL) and are further influenced by psychological stress. Objectives To investigate the relationship of salivary flow rate (SFR), alcohol use, smoking, oral hygiene, and graft-versus-host disease (GvHD) with OHRQoL and psychological stress over time from pre-HSCT to 365 days post-HSCT. Materials and methods In HSCT patients’ oral health and psychological well-being at baseline and at 100, 200, and 365 days post-HSCT were assessed, including oral hygiene, GvHD, and unstimulated SFR. OHRQoL and psychological stress were analyzed using OHIP-G 14 and HADS tools. Results The study included 70 HSCT patients (57% male, mean age 56 ± 13.75 years), with acute myeloid leukemia being the most common diagnosis (61%). SFR significantly declined post-HSCT, recovering partially by day 365. OHRQoL worsened at day 200 and improved by day 365, with functional limitation and physical pain being the most affected. GvHD peaked at day 200 (49%) and significantly impacted OHRQoL. Anxiety and depression levels decreased significantly over time, showing significant associations with OHRQoL, oral hygiene, and tobacco consumption. Conclusion Decreased SFR and worsening of overall oral health significantly affected OHRQoL, especially in terms of pain and functional limitations. Anxiety and depression were consistently associated with OHRQoL, but not directly with salivary flow. GvHD severity was a key factor influencing both oral health and psychological outcomes.