How Chronic GVHD affects the Mouth and Salivary Glands

Graft-versus-host disease can cause mouth dryness and sores, sensitivity to food and eating difficulties.

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Symptoms

Chronic GVHD often affects the mouth and salivary glands. Symptoms may include:

  • redness and lacy white patches in the mouth, on the tongue, on the  inner cheeks, or on the lips
  • painful sores anywhere in the mouth or on the lips
  • painless, small, fluid-filled lesions that come and go throughout the day
  • sensitivity to spicy, acidic, or crunchy foods, carbonated beverages, or mint-flavored toothpaste
  • a very dry mouth
  • changes in how some foods taste
  • difficulty eating and swallowing food
  • swelling, redness, pain, and/or bleeding gums
  • rough feeling in the mouth, like a scalded mouth

Treatment

Chronic GVHD in the mouth is usually treated with: 

  • a topical steroid gel or cream such as fluocinonide or clobetasol
  • an oral rinse containing dexamethasone, budesonide, or prednisolone
  • tacrolimus, either as a rinse or as a topical ointment
  • pilocarpine and cevimeline for dry mouth
  • steroid injection into mouth sores

Some over-the-counter products, such as Biotène® dry mouth toothpaste and mouthwash, Mouth Kote® or Biotène® oral moisturizing spray, and Xylimelts® or and Sparx® xylitol candies.

Medications such as lidocaine or magic mouthwash may be prescribed to control pain. A dietitian can help you plan meals that avoid foods that may cause discomfort.

A dietitian can help you plan meals that avoid foods that may cause pain.

Take Action!

  • Tell your doctor right away if you have symptoms of chronic GVHD in your mouth.
  • Since a lack of saliva can lead to tooth decay, practicing good brushing and flossing is important.
  • See a dentist twice a year for a thorough cleaning and check-up. Ask your dentist if you need a fluoride prescription or in-office fluoride varnish therapy to prevent cavities.
  • Patients with oral chronic GVHD have an increased risk of developing cancer in their mouth. You should be checked annually, preferably by a specialist who is familiar with both GVHD and oral cancer, to examine any unusual lesions.
  • You can find a doctor who specializes in oral GVHD in BMT InfoNet’s online GVHD Directory.
  • GVHD in your mouth can make eating difficult. Order the free brochure Eating Well, Living Well after Transplant at bmtinfonet.org/eat-well or phone 888-597-7674.

Watch the video about Oral GVHD. Click here to read the transcript and download the slides.

(To view this page in Spanish click here.)

Next page: Lungs and GVHD

Updated December 2024

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