Oral Health, Caries Risk Profiles, and Oral Microbiome of Pediatric Patients with Leukemia Submitted to Chemotherapy

Abstract

Background. Chemotherapy is the primary treatment modality used for patients with acute lymphoblastic leukemia (ALL), but inevitably causes microbiota-related oral complications. This study is aimed at investigating the effects of chemotherapy on oral health status, caries risk, and oral microbiome in pediatric patients with ALL. Methods. Thirty-nine children with ALL receiving chemotherapy were enrolled, and a gender-, age-, dentition stage, and socioeconomic class matched healthy counterpart were recruited. Demographic information and overall health condition were obtained through the questionnaire and medical records. Oral examination was performed to assess caries and salivary status, plaque index, and other oral manifestations. Cariogram was used to assess the overall caries risk. Supragingival samples of thirteen ALL subjects and their counterparts were randomly selected to perform a 16S ribosomal RNA gene 454 pyrosequencing. Raw sequence data were screened, trimmed, and filtered using Seqcln and MOTHUR. Results. The prevalence of dental caries, gingivitis, oral mucositis, xerostomia, and candidiasis in ALL groups was higher than that of the control group ( p < 0.05 ). Children with ALL demonstrated higher caries risk compared to healthy controls (HC) based upon Cariogram ( p < 0.05 ). The oral microbial structure of ALL patients receiving chemotherapy is different from that of healthy controls. Oral microbiota of ALL groups showed less alpha diversity and significant differences in the composition of the oral microbiome compared to healthy controls. Conclusions. ALL patients receiving chemotherapy demonstrated compromised oral health, high caries risk, alteration of caries-related factors, and dysbiosis of oral microbiota. These findings may be of clinical importance in developing better strategies for personalized preventive management of oral diseases for pediatric children with ALL.

Changes in oral microbiota after the initiation of chemotherapy in patients with hematopoietic tumors

“…The overall diversity of the oral microbiota decreased after chemotherapy, and the bacterial composition changed after the start of chemotherapy. A decrease in the diversity of the oral microbiota due to chemotherapy for hematopoietic malignancies has been reported in children with leukemia [20] and in patients undergoing autologous hematopoietic stem cell transplantation [21], which is consistent with the results of our study. Furthermore, recent reports have shown that changes in the diversity of not only the gut microbiota [22], but also the oral microbiota, during chemotherapy for leukemia are associated with the risk of infection during treatment [23,24].…”

Microbiome Analysis of Carious Lesions in Pre-School Children with Early Childhood Caries and Congenital Heart Disease

“…The harmful systemic effects that result could thus be responsible for further systemically problematic concomitant conditions in children. Therefore, prevention of dysbiosis of the oral microbiome could be a promising measure to reduce the risk of infectious complications in sick children, especially in children with congenital heart disease [ 24 , 59 ]. Dental disease has been associated with increased risk of infection, suggesting that bacteria from the oral cavity may contribute to the development of inflammation.…”

“…A disturbed oral microbiome can have significant effects beyond the oral cavity, especially with regard to the increased risk of infection described above, which imply that patients are not healthy or lack good oral health [ 23 ]. Although the exact mechanism of the interaction between infectious diseases and microbiota has not been clarified, the prevention of dysbiosis of the oral microbiota might be a good measure for decreasing the risk of associated infectious complications in diseased children, as shown in a study of children under immunosuppression [ 24 ]. This association would necessarily affect children with congenital heart disease.…”

Evaluation Of Oral Health-Related Quality Of Life In Children With Hematological Malignances

“…The DMFT/dmft has been used to determine oral health in children and adults with type 1 diabetes mellitus 30 , HIV-positive adults, and children receiving antineoplastic treatment 31 , as well as in studies of fetal alcohol syndrome 32 , ALL and asthma 33 , orthodontic anomalies 34 , prosthodontic problems 35 , patients with a short dental arch 35 , patients with high sugar intake 36 , and tooth brushing habits 37 . Dubey et al reported that DMFT/dmft scores were higher in children with ALL than in those with type 1 diabetes mellitus or asthma 33 .…”