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Acute Oral infection (viral, bacterial and fungal) Intensive high-dose chemotherapy regimens Head and neck radiation Odontogenic infections may present with pain/fever but without cardinal signs of erythema and purulence Intraoral HSV recrudescence may affect keratinized and non-keratinized mucosal sites Oral mucositis Intensive high-dose chemotherapy regimens Head and neck radiation mTOR inhibitor therapy Starts 7 to 10 days after chemotherapy, resolves within three weeks Peaks after third week of radiation, resolves weeks after completion of therapy mTOR inhibitor stomatitis appears aphthous-like, develops within first week of therapy Salivary dysfunction Head and neck radiation Oral burning common Increased risk of candidiasis Oral hemorrhage Thrombocytopenia secondary to chemotherapy Appears in the oral cavity as areas of active bleeding, petechiae, or ecchymosis

Late Chronic GVHD Patients who received allogeneic hematopoietic cell transplantation Typically appears after day +100 Reticulation, erythema and/or ulcerations, primarily affecting the tongue and buccal mucosa Superficial mucoceles of the palate Jaw osteonecrosis Anti-resorptive therapy Head and neck radiation Characterized by exposed necrotic bone in the oral cavity Symptoms usually due to secondary soft tissue infection Taste dysfunction Head and neck radiation Chemotherapy Chronic GVHD Typically recovers after several months Trismus Head and neck surgery Head and neck radiation Chronic GVHD Develops gradually over time Maintaining oral hygiene and providing dental care can be challenging Requires long-term physical therapy Impairment of craniofacial development in children Chemotherapy or head and neck radiation at a young age Dental abnormalities include delayed eruption of teeth, microdontia, and tooth agenesis Bone abnormalities include deficient head and neck skeletal growth Salivary dysfunction Head and neck radiation Chronic GVHD Oral burning common Increased risk of candidiasis and dental caries Prescription and non-prescription management Oral squamous cell carcinoma History of head and neck cancer Recipients of allogeneic hematopoietic cell transplantation Field cancerization changes increase risk of new primary lesions Well-defined, abnormal mucosal lesions, require biopsy for diagnosis HSV: herpes simplex virus; mTOR: mammalian target of rapamycin; GVHD: graft versus host disease.