Evaluation of Oral Hygiene Status, Salivary Characteristics and Dental Caries Experience in Acute Lymphoblastic Leukemic (ALL) Children

Abstract

Leukemia constitutes approximately 30% of all childhood cancers and Acute Lymphoblastic Leukemia(ALL) is the most common type of malignancy. Oral dryness, ulceration, increased dental decay seen is due to altered salivary flow rate and buffering capacity in these children. Oxidative stress may play an important role in the malignancies resulting in onset of inflammatory oral pathologies. Saliva constitutes first line of defense against free radical-mediated oxidative stress. The present study attempted to relate the oral health status, salivary flow rate, salivary pH, gingival health status, dental caries experience and total salivary antioxidant levels in ALL children. A total of 120 children aged 4-10 years (90 leukemic children, study group and 30 normal healthy siblings, control group) were divided into 4 groups of 30 each. Oral health status, gingival status and dental caries experience was recorded followed by un-stimulated saliva collection. Total antioxidant capacity of un-stimulated saliva was evaluated. The results depicted deterioration in oral health status, gingival status and increased dental caries experience in leukemic children. Salivary flow rate, salivary pH and total salivary antioxidant levels were lowered in leukemic children when compared with control group.

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“…[38] Since a reduced SFR has been reported in children with ALL and that a diminished SFR favors accumulation of dental plaque on tooth surfaces, it may be hypothesized that children with ALL may be more susceptible to dental caries as compared to medically healthy children. [37] In this study, no significant difference is observed in DMFT of both groups, which supports the results of Maciel et al [39] / Kinirons et al [40] studies; it can be due to sanitarian educations and parents' awareness.…”

“…Conflicting results have been reported by Hegde et al [37] and Nasim et al [41] Although the negative effects of anticancer therapy on SFR are well-established; [37,[41][42][43] studies have reported that the oral mucosal inflammation induced by chemotherapy, may prevent some patients from performing daily oral hygiene maintenance regimes. [42,44] Hence, hematology patients need special dental considerations beside antineoplastic treatments.…”

“…Based on the Sepet et al [36] studies, pH was in normal interval in ALL children, whereas in Pajari et al [23] and Hegde et al [37] studies, pH depletion was observed among ALL children. This similarity can be due to the time of oral examination; examinations of both groups were done before noon that was at least 1 h after their last meal, that is a sufficient time interval for adjusting pH by saliva.…”

Original Research. The Evaluation of Caries Severity Index and Dental Hypoplasia in Children with Acute Lymphoblastic Leukemia. Results from a Romanian Medical Center

“…Our results showed high incidence for DMFT scores in both groups, which is in contradiction with the results of other studies reporting higher DMFT scores only for children with ALL or other malignancies or systemic disorders. [8][9][10][11] Venkatesh et al found maximum values in 76% of children with ALL compared to 66% in healthy controls, which was considered a consequence of chemotherapy. 8 Hedge et al and Dens et al emphasized high levels of caries intensity in children with ALL, and furthermore, Azher et al also reported high scores of DMFT in children with ALL.…”

“…8 Hedge et al and Dens et al emphasized high levels of caries intensity in children with ALL, and furthermore, Azher et al also reported high scores of DMFT in children with ALL. [9][10][11] Xerostomia is another frequent side effect of oncological therapy that might increase the severity of dental caries. 12 High caries levels have persisted in Romania over the last decades, and we have not achieved the WHO target of an average score lower than 3 at the age of 12 years.…”