The Potential Contribution of Dental Foci and Oral Mucositis to Febrile Neutropenia in Patients Treated With Myelosuppressive Chemotherapy for Solid Tumors and Lymphoma

Abstract

IntroductionFebrile neutropenia (FN) is a potential life-threatening complication of myelosuppressive chemotherapy, particularly when induced by infection. There is evidence that FN can originate from the oral cavity, but its contribution to FN is largely understudied in patients treated for solid tumors. The aim of this study was to assess the prevalence of FN in these patients and to evaluate its relation with dental foci and oral mucositis.Material and MethodsA prospective longitudinal observational study was conducted. Patients diagnosed with solid tumors and lymphoma scheduled to be treated with myelosuppressive chemotherapy with an intermediate risk of developing FN were included. A pre-chemotherapy dental examination was performed and patients were followed during and after chemotherapy regimen. During subsequent hospital visits for chemotherapy administration, the oral cavity was inspected and oral mucositis (OM) was scored using the CTC-AE version 3.0. When patients presented with fever, a comprehensive full body examination including laboratory/microbiological/imaging investigation was performed.ResultsEighty-eight patients were included. Pre-chemotherapy, 39 patients (44.3%) were diagnosed with a dental focus. During chemotherapy, 46 patients developed OM (53.4%), of which 15 patients had a maximum score of grade II (ulcerative mucositis). Ten patients developed FN during the follow-up period. Patients with FN more often suffered from ulcerative OM compared to patients without FN; both FN and mucositis risk was associated with the myelotoxicity of chemotherapy. However, no relation could be established between the presence of dental foci prior to chemotherapy and the development of FN (p > 0.05).ConclusionA significant relation was identified between ulcerative OM and FN, but no robust conclusions could be drawn with respect to a relationship between the presence of dental foci and FN.

Pre-Chemotherapy Dental Screening: Is There Additional Diagnostic Value for a Panoramic Radiograph?

“…This suggests that oral foci may play a role in causing FN and underscores the need for the dental evaluation of patients prior to the start of chemotherapy. However, the present study was part of a prospective observational study in which only one patient experienced an acute exacerbation of a chronic oral infection during the neutropenic phase, with 1.1% of the patients presenting with a dental focus prior to the start of the CT regimen [16]. The risk of developing oral infectious complications might be higher in patients treated with high-risk myelosuppressive CT or myeloablative CT regimens followed by stem cell transplantation (HCT) [41,42].…”

“…At first sight, our study seems to contradict this, as additional dental foci (i.g., peri-apical lesions) were identified with panoramic radiography. Nevertheless, the clinical significance of this finding remains to be assessed, as there is a growing body of evidence suggesting that asymptomatic periapical pathology is only rarely exacerbated in patients treated with myelosuppressive CT [16,25,30].…”

“…The study was part of a prospective longitudinal observational study aimed at assessing the role of oral foci in FN development in patients with solid cancers and lymphoma treated with myelosuppressive CT that took place between December 2015 and December 2020. The results have been published elsewhere [16].…”

Holistic Approach of a Leukemic Child Suffering from Oral Mucositis with Coinfections: A Case Report

“…3,4 Ulceration in oral mucositis' (OM) clinical stages can be a portal of entry for microorganisms so coinfections can occur such as necrotizing ulcerative stomatitis (NUS) and oral candidiasis. 5 The purpose of this case report is to describe the holistic approach to obtaining the successful treatment of OM with coinfections in a pediatric ALL patient. To date, treatment of OM still varies, depending on the symptoms, severity, and underlying condition of patients.…”

“…8,15 In addition, OM in the ulceration phase causes disturbances in food intake, oral drug use, and oral hygiene, which can increase the risk of infection. 5 Microbial risk factors also play a role including herpes simplex virus (HSV) type 1, Candida species, and non-specific bacterial infections. 8,9 The healing of OM, in this case, was delayed because of the presence of Candida infection and bacterial infection (NUS) as coinfections.…”