periodontal disease and oral microbial successions during myelosuppressive cancer chemotherapy*

Abstract

Factors contributing to the succession of opportunistic pathogens at oral sites, including the periodontium, during myelosuppressive chemotherapy are poorly understood. This study examined the relation of periodontal disease to qualitative and proportional shifts in the oral microflora of 21 acute nonlymphocytic leukemia patients (7 male and 14 female, mean age (range) = 51.0 (25-81 years) observed during standardized myelosuppressive regimens. Supra- and subgingival microbial plaque specimens were individually collected from 2 contralateral oral sites (distobuccal of teeth 1-6 and 3-6) in each participant at hospital admission (day 1) and during point of maximal myelosuppression (day 14). Periodontal disease indices obtained at day 1 included site-specific measures of attachment loss and clinical assessment of disease status. Using a residualized change score analysis, periodontal disease status and attachment loss were positively correlated with increases in the proportional recovery of Staphylococcus sp. from supragingival sites and total yeast from supra- and subgingival sites. When age-related covariation in the microbial shifts was controlled in the analysis, periodontal disease status and attachment loss demonstrated no significant correlation with increases in total yeast at supragingival sites. These findings suggest that host factors such as periodontal disease may contribute to patterns of oral microbial successions during cancer chemotherapy.

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

“…For example, 28% of all clinically defined infections in 22 leukemia patients that developed neutropenic fever during remission induction therapy were reported to be periodontitis [7]. However, in subsequent investigations, acute periodontal infections either did not develop at all [8,11] or only very infrequently [13].…”

Host-Microbiome Cross-talk in Oral Mucositis

“…However, given its richness and diversity and its role in local inflammatory diseases, the potential of oral microflora to affect the course of mucositis seemed likely. Adding to this thinking was the finding over 50 y ago of shifts in the oral flora in response to chemotherapy (Peterson et al 1987;Reynolds et al 1989;Peterson 1990;Spijkervet et al 1991;Ruescher et al 1998;Stokman et al 2003;Napenas et al 2010;de Mendonca et al 2012;Laheij et al 2012). Consequently, numerous antimicrobial strategies have been studied as interventions for mucositis.…”

Periodontal infection in cancer patients treated with high-dose chemotherapy

“…A high incidence of acute periodontal infections was also reported in patients with other malignancies [35]. In subsequent investigations, however, acute periodontal infections either did not develop at all [36,39], or only very infrequently [50]. Nearly all patients in these studies had pre-existing chronic periodontal infections, ranging from mild gingivitis to severe periodontitis.…”

“…Nevertheless, at present the relative contribution of gingivitis and periodontitis to systemic infection in neutropenic cancer patients is largely unknown. Figures on the incidence of so-called acute periodontal infections reported in studies performed in the 1980s show significant disparity [30,32,34,35,36,39]. Initially, 28% of all clinically defined infections in 22 leukemia patients who developed neutropenic fever during remission-induction therapy were reported to be periodontal [30].…”