Oral Manifestations: A Warning-Sign in Children with Hematological Disease Acute Lymphocytic Leukemia

Abstract

Acute lymphocytic leukemia (ALL) is the most frequent form of all childhood leukemias, mostly affecting children between 2 and 4 years old. Oral symptoms, such as mouth ulcers, mucositis, xerostomia, Herpes or Candidiasis, gingival enlargement and bleeding, petechiae, erythema, mucosal pallor and atrophic glossitis, are very common symptoms of ALL and can be early signs of the disease. Secondary and tertiary complications, a direct effect of chemo and radiotherapy, are associated with more severe bleeding, higher susceptibility to infections, ulcerations, inflammation of the mucous membranes, osteoradionecrosis, xerostomia, taste alterations, trismus, carious lesions and dental abnormalities. Immunotherapy, though less toxic, causes oral dysesthesia and pain. Overall, the effects in the oral cavity are transient but there are long-term consequences like caries, periodontal disease and tooth loss that impair endodontic and orthodontic treatments. Also, dental abnormalities resulting from disturbed odontogenesis are known to affect a child’s quality of life. The medical dentist should identify these complications and perform appropriate oral care in tandem with other health professionals. Thus, poor oral hygiene can lead to systemic ALL complications. The aim of this review is to describe the oral complications in children with ALL who are undergoing chemo, radio or immunotherapy.

Reduced Salivary Flow Rate and Increased Caries Susceptibility in Italian Children in Remission from Hematological Malignancy

“…Due to high prevalence of hyposalivation and the poor cariological profile of CSSs, regular oral examinations and screening of salivary gland dysfunction during long-term follow-ups are highly recommended in order to provide individualized oral supportive care and dietary interventions aimed to improve oral health. The use of artificial saliva based on carboxymethylcellulose or stimulation of salivary secretion via simple dietary measures such as chewing sugar-free gums or using pilocarpine can promote salivary functioning [11,54]. It is essential to educate the healthcare provider/s and child/children about the significance of oral health care to minimize discomfort and maximize the chances for a long-term successful outcome.…”

“…Chemotherapy (CT) is the primary therapeutic approach used in pediatric hematological tumors [7] and has adverse effects on oral health status [8][9][10][11]. As such, high prevalence of oral dryness, mucosal ulceration, and dental decay has been reported in these children, mostly secondary to changes in saliva functioning and properties.…”

“…Changes in free radicals and antioxidant levels may play an important role in the onset of oxidative stress-related oral pathologies [12]. Decreased salivary flow in pediatric cancer patients increases their risk of being affected by infectious odontogenic processes and gingival and mucosal inflammation, as whole saliva is a fundamental biofluid for maintaining oral homeostasis [9][10][11]. Its complex protective role is related to mechanical cleansing functions and lubrication of mucosal surfaces, buffering capacity, maintenance of tooth integrity, facilitation of cell healing, and antibacterial activity [14].…”

Different Levels of Therapeutic Strategies to Recover the Microbiome to Prevent/Delay Acute Lymphoblastic Leukemia (ALL) or Arrest Its Progression in Children

“…To date, however, the deep relationship between these factors and ALL onset, as well as the exact mechanisms and pathways involved in such complex ALL pathophysiology, are still not clear [14]. However, in the last few years, research has been focused on microbiomes since, in adult ALL cases, the microbiome has been demonstrated to be significantly associated with both onset and progression as well as modulation of the response and side effects of chemotherapy drugs, infection during treatment, and therapeutic efficacy [15][16][17]. Such particular attention is increasing given the growing evidence on the capacity of parents' microbiomes and particularly of the gut microbiome (GM) to impact the formation, growth, and functions of a newborn's hematopoietic system (HS) through fetal developmental programming as well as the newborn's susceptibility to developing onco-hematological neoplasms [13].…”

Different Levels of Therapeutic Strategies to Recover the Microbiome to Prevent/Delay Acute Lymphoblastic Leukemia (ALL) or Arrest Its Progression in Children

“…To date, however, the deep relationship between these factors and ALL investigations, and the exact mechanisms involved in ALL pathophysiology are still not clear [14]. Nevertheless, in the last years the interest has been focused on microbiome, since in adult ALL cases the role of microbiome has emerged in both development and progression, as well as in the response and side effects of chemotherapy drugs, infection during treatment, and therapeutic efficacy [15][16][17]. In addition, current evidence also reports the capacity of parents's microbiome, and precisely of gut microbiome, to impact the newborn's hematopoietic system (i.e., onset and function) via fetal developmental programming and its susceptibility after the birth to develop oncohematological neoplasms [13].…”