Febrile neutropenia and periodontitis: lessons from a case periodontal treatment in the intervals between chemotherapy cycles for leukemia reduced febrile neutropenia

Abstract

Goals of Work:Oral and systemic infections arising from the oral cavity are significant problems in clinical management of patients undergoing leukemia treatment. However, there is significant disparity in the reported incidences of development of periodontal infections.Evidence is limited to those showing the systemic influence of periodontal infection in neutropenic patients. This study indicated an association between febrile neutropenia (FN) and periodontitis in a case in which periodontal treatment in the intervals between chemotherapy cycles reduced FN in subsequent courses of chemotherapy and hematopoietic transplantation (HCT). Patient and Methods:Periodontal treatment was performed in a 61-year-old man with advanced periodontitis, who received HCT following 3 cycles of chemotherapy. After recovery from neutropenia induced by initial chemotherapy, periodontal treatment was performed in each chemotherapy interval period. Following extraction of teeth with severe advanced periodontitis, all teeth were subjected to periodontal pocket curettage and root planing, which are common periodontal treatments to reduce periodontal pockets harboring anaerobic periodontal bacteria, before HCT. Main Results:Periodontal treatment successfully reduced periodontal pockets from 4.1±1.5 mm to 3.0±0.6 mm, which was almost within the healthy range (<3.0 mm), before HCT. The frequency of FN decreased significantly with increasing cycles of chemotherapy, and decreases in FN corresponded to progress of periodontal treatment. Blood cultures obtained a total of 12 times throughout leukemia treatment were all negative. 3 Conclusions:The observations reported here indicate the importance of periodontal treatment in clinical management of patients undergoing leukemia treatment to prevent FN, although all blood cultures were negative.

Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia

“…It is clear that reduction of tumor volume by grade B-to-C chemotherapy (known as induction or consolidation chemotherapy) can be safely followed by HSCT therapy, provided that adequate prophylactic dental treatments during the intervals between chemotherapy cycles. This hypothesis may be supported by one previous important case report by Soga et al [18]. In their report, the frequency of febrile neutropenia decreased with increasing cycles of chemotherapy, and decreases in febrile neutropenia corresponded to the progress of periodontal treatment.…”

Evaluation of Periodontal Parameters in Patients with Early Stage Chronic Lymphocytic Leukemia

“…Adekvatna oralna higijena umanjuje rizik od razvoja oralnog mukozitisa, febrilnih epizoda i bakterijemije (22). Parodontna terapija provedena u intervalima između kemoterapijskih ciklusa značajno smanjuje pojavu febrilne neutropenije tijekom kemoterapije i transplantacije koštane srži (23).…”

“…Good oral hygiene has been reported to reduce the risk of mucositis and decrease the risk of fever or bacteremia (22). Periodontal treatment in the intervals between chemotherapy cycles reduces febrile neutropenia in subsequent courses of chemotherapy and hematopoietic transplantation (23).…”

Oral Mucositis Induced By Anticancer Therapies

“…Poor dental health, particularly periodontal disease, has been identified as an environmental factor that may increase the severity of OM (discussed in more detail below) [ 24 •, 38 ]. Reducing oral bacterial load and periodontal inflammation was associated with a lower prevalence of OM in HSCT recipients [ 39 – 41 ]. There has been increased interest recently in the role of the oral microbiome in OM risk [ 42 , 43 •, 44 ••], with studies suggesting that shifts in the composition of the oral microbiome during chemotherapy influence OM severity [ 45 ].…”