Periodontal infection in cancer patients treated with high-dose chemotherapy

Abstract

The infected and inflamed periodontium can act as a focus for systemic infection in neutropenic cancer patients. The incidence of these oral infections is unknown, but probably underestimated. Periodontal infections can easily be overlooked, primarily because symptoms of gingival inflammation may be minimal and the infection may be located in deeper parts of the periodontium. Assessment of a patient's periodontal condition before the onset of profound neutropenia is critical to the diagnosis and the management of these potentially life-threatening infections. This review article is aimed at informing supportive care providers of recent insights into the pathogenesis of periodontal diseases and the role of subgingival microorganisms, with the emphasis on these infections in cancer patients treated with high-dose chemotherapy. Furthermore, a multidisciplinary approach to the management of periodontal infections and the need for future research is discussed.

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

“…Generally, periodontitis is diagnosed by measuring pocket depths and loss of attachment using a periodontal probe supplemented by radiographs [10]. The radiographic and gingival appearances in this case are shown in Fig.…”

“…However, the relative contributions of gingivitis and periodontitis to systemic infection in neutropenic cancer patients are largely unknown [10]. The incidence of so-called acute periodontal infections in previous studies showed significant disparity [10].…”

“…A considerable amount of ulcerated pocket epithelium (up to 35 cm 2 ) may be present in severe, untreated periodontitis. Patients with periodontitis harbor periodontal pathogens, many of which are gram-negative facultatively anaerobic bacteria [10]. There is evidence that pre-existing periodontal infections may induce fever and that microorganisms may spread systemically [2,5,7,9].…”

“…The risk of developing systemic infections may be associated with the severity of periodontal disease (i.e., the total surface area of the ulcerated pocket epithelium) and 5 the composition of the subgingival microflora [10]. Nevertheless, the harmful influences of gingivitis and periodontitis on systemic infection in neutropenic cancer patients are largely unknown [10].…”

“…Nevertheless, the harmful influences of gingivitis and periodontitis on systemic infection in neutropenic cancer patients are largely unknown [10]. Cross-sectional studies of patients receiving immunosuppressive drugs failed to show differences in the prevalence or severity of periodontitis between transplantation patients and healthy controls [12,13].…”