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Gao X, Zhao S, Wang S, Sun Y, Gao C. Influence of periodontal status on patients undergoing hematopoietic stem cell transplantation: A retrospective analysis. Heliyon 2024; 10:e30998. [PMID: 38778978 PMCID: PMC11108988 DOI: 10.1016/j.heliyon.2024.e30998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/19/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This retrospective analysis aimed to evaluate the prevalence of periodontitis in patients undergoing hematopoietic stem cell transplantation, and investigate the effects of various periodontal statuses and risk factors on oral infection incidence. Study design Medical records of patients pre- and post-hematopoietic stem cell transplantation from June 2019 to October 2021were reviewed. The study examined the effort of different periodontal statuses on oral complications and infections in patients during transplantation. Results Of 549 transplant patients studied, 363 had periodontitis. Patients with or without periodontitis showed significant differences in mean age, male proportion, and mucositis incidence during transplantation (P < 0.05). Bacteremia rates were slightly higher in patients with periodontitis, but not significant. Male proportion, age, and hospitalization duration significantly increased with advancing periodontitis stages. Only two patients experienced periodontal complications, that were effectively managed and did not interfere in the grafting process. Conclusion Periodontitis is prevalent in patients with hematopoietic diseases. Despite its association with oral mucositis, the occurrence of periodontal infection remains low and controllable.
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Affiliation(s)
- Xuan Gao
- Peking University People's Hospital, Beijing, China
| | | | - Shuting Wang
- Peking University People's Hospital, Beijing, China
| | - Yang Sun
- Peking University People's Hospital, Beijing, China
| | - Chengzhi Gao
- Peking University People's Hospital, Beijing, China
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2
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Sabancı A, Kuku İ. Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:242-248. [PMID: 36344391 DOI: 10.1016/j.oooo.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT. STUDY DESIGN Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT. RESULTS Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05). CONCLUSIONS The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.
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Affiliation(s)
- Arife Sabancı
- Department of Periodontology, Inonu University, Malatya, Turkey.
| | - İrfan Kuku
- Department of Internal Medicine-Hematology, Inonu University, Malatya, Turkey
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3
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Hosainzadegan H, Parvan R, Hosainzadegan M. A retrospective study comparing oral health in cancer patients and healthy people. Eur J Transl Myol 2022; 32:10672. [PMID: 36039833 PMCID: PMC9830400 DOI: 10.4081/ejtm.2022.10672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to investigate the relationship between oral and dental health in cancer patients and control group, which was conducted in Tabriz Shahid Gazi hospital. A researchers-made and validated questionnaire including oral and dental health criteria, was filled by the cancer patients (201 cases) and healthy controls (199 cases). Then, the results of the study were analyzed by SPSS software, and reported as Odds ratios (95 % confidence intervals) in tow groups. The results indicate that comparison of filled tooth, tooth extraction, dental caries, and gingival problems including bleeding, gum surgery and inflammation in cancer and controls were significantly meaningful. However, the comparison between the two groups was not significant in terms of the type of the tooth (natural or denture) and the number of daily toothbrushes, but they were considered as risk factors due to statistical results. Environmental factors, and especially oral hygiene, can play an important role in the incidence of different cancers. Among these, the type of oral microorganisms, and their overgrowth and released antigens should be studied further in the emergence of different kinds of cancer in humans.
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Affiliation(s)
- Hasan Hosainzadegan
- Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran,Maragheh University of Medical Sciences, Maragheh, Iran. ORCID ID: 0000-0002-3775-0767
| | - Reza Parvan
- Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
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Sabancı A, Karasu B, Sabancı HI, Kuku İ, Kırmızıgul OA. Impact of periodontal status on the oral mucositis in patients receiving high-dose chemotherapy. Clin Oral Investig 2022; 26:6341-6346. [PMID: 35906338 DOI: 10.1007/s00784-022-04588-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Oral mucositis (OM) is a frequent complication of cancer treatments. Oral mucositis and periodontal disease have a common inflammatory pattern. The purpose of this study was to evaluate the OM and its association with periodontal status in patients with hematologic malignancies who undergo high-dose chemotherapy. MATERIALS AND METHODS Fifty-five patients who received high-dose chemotherapy were included in the study. Full-mouth periodontal clinical measurements including plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing depth (PD) values were recorded before the condition chemotherapy regime. OM monitoring was initiated 1 day after the chemotherapy and maintained for 20 days. RESULTS Twenty-two of patients (40%) were observed oral mucositis after high-dose chemotherapy. Patients with mucositis had significantly higher GI scores than those who did not have mucositis (p < 0.05). There was a significantly moderate positive correlation between the grade of mucositis and GI scores (p < 0.05). In patients with periodontitis, the incidence of grade 1-2 mucositis was significantly higher than in the healthy group (p < 0.05). In individuals with periodontitis and gingivitis, the healing duration of mucositis was significantly longer than the healthy group (p < 0.05). CONCLUSIONS The results of this study showed that the severity grades of oral mucositis may increase in patients with gingival inflammation. The results also suggest that periodontal diseases may have a significant impact on the duration of oral mucositis. CLINICAL RELEVANCE The current study contributes to our understanding of the importance of oral health status in reducing the occurrence, severity, and duration of OM in hematological cancer patients treated with high-dose chemotherapy.
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Affiliation(s)
- Arife Sabancı
- Department of Periodontology, Faculty of Dentistry, Inonu University, 44280, Malatya, Turkey.
| | - Basak Karasu
- Department of Periodontology, Karatekin University, Çankırı, Turkey
| | | | - İrfan Kuku
- Department of Internal Medicine - Hematology, Inonu University, Malatya, Turkey
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5
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Dang RR, Brar B, Pasco JM, Rebhun C, Sohn W, Salama A. Dental Practice Patterns for Oral Care in Medical Oncology Patients-a Survey-Based Assessment of Massachusetts Dentists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:555-560. [PMID: 32761443 DOI: 10.1007/s13187-020-01845-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Oral complications associated with cancer therapy lead to a significant deterioration of oral health and overall quality of life. The primary aim of this study was to assess dental practice patterns followed by dentists for oral care of medical oncology patients and to identify potential barriers to recommended care. A questionnaire-based survey was developed using the Qualtrics online platform. It was electronically distributed to all dentists within the Massachusetts Dental Society (MDS). Descriptive statistics were automatically computed by Qualtrics. A total of 363 responses (10.7%) were received. Dentists reported minimal correspondence from the oncology team during referrals. Most dentists communicate treatment recommendations to the oncology team with regard to extractions (74.6%), restorations (66.7%), periodontal health (68.8%), and other urgent needs (73.5%). Potential obstacles to providing care included insufficient time for dental care before start of therapy (61%), lack of patient education on oral complications associated with therapy (56%), and lack of dental insurance (31%). Only 50% of the dentists felt adequately trained to treat oncology patients, and 46% of dentists infrequently followed the recommendations set by the National Institute of Dental and Craniofacial research (NIDCR). The findings of this study indicate significant variability in the referral patterns and practice protocols for medically necessary oral care in oncology patients. The major barriers to following established guidelines for care may be attributed to the lack of correspondence between provider teams, inadequate training of professionals, and financial or insurance factors associated with increased cost of supportive care.
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Affiliation(s)
- Rushil R Dang
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA
| | - Branden Brar
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA
| | | | - Chad Rebhun
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA
| | - Woosung Sohn
- Population Oral Health, School of Dentistry, University of Sydney, Sydney, Australia
| | - Andrew Salama
- Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dentistry, 635 Albany St, Boston, MA, 02118, USA.
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6
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Hansen HJ, Estilo C, Owosho A, Solano AK, Randazzo J, Huryn J, Yom SK. Dental status and risk of odontogenic complication in patients undergoing hematopoietic stem cell transplant. Support Care Cancer 2021; 29:2231-2238. [PMID: 32901321 PMCID: PMC8432266 DOI: 10.1007/s00520-020-05733-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Dental evaluation and management prior to hematopoietic stem cell transplant (HSCT) plays a vital role in identifying and treating infections that may be life-threatening. The purpose of this study is to describe the dental management of patients undergoing pre-HSCT examination with the Dental Service at Memorial Sloan Kettering Cancer Center (MSKCC) and to report on odontogenic complications. METHODS Patients referred for evaluation as part of the standard preparation for HSCT were included. Following clinical and radiological examination, patients were assigned to one of three groups based on risk of odontogenic infection, and treatment was provided as indicated. Patients were followed, and their medical records were reviewed for odontogenic complications during the transplant admission. RESULTS Of the 375 patients evaluated, 350 patients underwent HSCT: allogeneic 143 (40.9%) and autologous 207 (59.1%). The distribution of primary cancer diagnosis was as follows: multiple myeloma 104 (29.7%), leukemias 95 (27.1%), Hodgkin's lymphoma 28 (8.0%), non-Hodgkin's Lymphoma 99 (28.3%), and other conditions 24 (6.9%). The median time from dental evaluation to transplant was 29 days. The median Decayed, Missing, Filled Teeth Index was 17. The median Community Periodontal Index was 1. Based on dental status, 145 patients (41.4%) were classified as low risk, 133 (38%) as moderate risk and 72 (20.6%) as high risk of odontogenic infection. One hundred fourteen patients (32.6%) required dental treatment prior to HSCT, and 100 of these (28.6%) completed treatment. Two (0.57%) patients had odontogenic complications. CONCLUSIONS With conservative pre-HSCT dental treatment based on an infection risk classification system, a low odontogenic complication rate was observed.
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Affiliation(s)
- Heidi J Hansen
- Department of Surgery, Division of Oral & Maxillofacial Surgery and Dentistry, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA.
| | - Cherry Estilo
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adepitan Owosho
- Missouri School of Dentistry and Oral Health, Kirksville, MO, USA
| | - Armand Karl Solano
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Randazzo
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Huryn
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - SaeHee K Yom
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wazzan T, Jagtap R, Mona M, Katz J. A Radiographic Assessment of Dental Morbidity in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplant: A Retrospective Study. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206820975981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To assess the dental and oral morbidity in multiple myeloma patients as expressed in dental radiographs before autologous stem cell transplant. Materials and Methods: A retrospective study involving 79 multiple myeloma patients was designed to collect data prior to their autologous stem cell transplant. Patients were seen at the oral medicine clinic at the University of Florida College of Dentistry during the years 2010–2013. Through available patient data and interpretation of radiographs, the following variables were recorded: age, gender, carious lesions, periodontal disease, and periapical radiolucency. In addition, the incidence of root fragment retention and the presence of punched-out osteolytic lesions were recorded. Cochran–Mantel–Haenszel (CMH) tests and logistic regression were performed for descriptive analysis and presentation of the data. Results: Seventy-nine multiple myeloma patients were recruited for this study. Ages ranged from 28 to 79 years (mean = 61, SD = 9.6), including 41 (51.9%) females and 38 (48.1%) males. The results demonstrated dental decay in 64.56% of patients, periodontal disease in 62.03%, apical rarefying osteitis in 13.92% of patients, and punched-out lesions in 24.05% of patients. Conclusion: Our study indicates high dental morbidity in multiple myeloma patients prior to autologous stem cell transplant. The elimination of foci of infection is highly recommended prior to autologous stem cell transplant for this high-risk population because of the potential risk of bacteremia/septicemia from oral bacteria associated with dental morbidity.
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Affiliation(s)
- Taggreed Wazzan
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Rohan Jagtap
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
- Department of Care Planning and Restorative Sciences, Division of Oral and Maxillofacial Radiology, University of Mississippi Medical Center School of Dentistry, Jackson, MS, USA
| | - Mahmoud Mona
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Joseph Katz
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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8
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Pauliina U, Jakob P, Joda T, Weiger R, Matti M, Tuomas W. Oral disorders in patients with newly diagnosed haematological diseases. Clin Oral Investig 2020; 24:3085-3091. [PMID: 31897707 DOI: 10.1007/s00784-019-03178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to examine saliva flow rates and prevalence of dental and periodontal diseases of patients with newly diagnosed severe haematological diseases and compare these findings with age-matched controls of normal population. METHODS A total of 149 patients diagnosed with haematological diseases aimed to be treated with haematological stem cell transplantation between 2008 and 2018 and 154 controls were included in the study. A dental examination was performed for patients within a maximum of 6 months after diagnosis. Differences were compared in terms of the stimulated salivary flow rate (SSFR); decayed, missing and filled teeth (DMFT) index; number of teeth; caries prevalence; presence of periodontitis and acute infections. RESULTS The mean SSFR of the patient group was significantly lower (1.1 ml/min ± 0.7 ml/min) than the mean SSFR of the controls (1.3 ml/min ± 0.5 ml/min; p = 0.004). The number of caries lesions was significantly higher in the patient group (mean ± SD, 1.1 ± 1.9) than in the control group (mean ± SD, 0.4 ± 1.2; p < 0.001). There were fewer teeth and a higher DMFT index in the patient group compared to the control group, but the differences were not significant. Acute symptomatic infections were observed in eight (5.4%) patients and in none of the controls (p < 0.01). CONCLUSIONS AND CLINICAL RELEVANCE Oral examinations in patients with newly diagnosed severe haematological disease demonstrated a higher prevalence of caries, acute infections and lower mean SSFR compared with the controls. These findings support the recommendations for early dental examination at the time of diagnosis.
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Affiliation(s)
- Uutela Pauliina
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Hebelstrasse 3, CH-4055, Basel, Switzerland.
| | - Passweg Jakob
- Department of Hematology, University Hospital, Basel, Switzerland
| | - Tim Joda
- Department of Reconstructive Dentistry, School of Dental Medicine, UZB University Center for Dental Medicine, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, UZB University Center for Dental Medicine, Basel, Switzerland
| | - Mauramo Matti
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pathology, Haartman Institute and HUSLab, Helsinki University Central Hospital, Helsinki, Finland
| | - Waltimo Tuomas
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Hebelstrasse 3, CH-4055, Basel, Switzerland
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9
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de Oliveira MCQ, Lebre Martins BNF, Santos-Silva AR, Rivera C, Vargas PA, Lopes MA, Vechiato-Filho AJ, Brandão TB, Prado-Ribeiro AC. Dental treatment needs in hospitalized cancer patients: a retrospective cohort study. Support Care Cancer 2019; 28:3451-3457. [DOI: 10.1007/s00520-019-05202-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
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10
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Zecha JAEM, Raber-Durlacher JE, Laheij AMGA, Westermann AM, Epstein JB, de Lange J, Smeele LE. The impact of the oral cavity in febrile neutropenia and infectious complications in patients treated with myelosuppressive chemotherapy. Support Care Cancer 2019; 27:3667-3679. [PMID: 31222393 PMCID: PMC6726710 DOI: 10.1007/s00520-019-04925-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022]
Abstract
Febrile neutropenia (FN) is an inflammatory response causing fever that may develop during cancer therapy-induced neutropenia. FN may herald life-threatening infectious complications and should therefore be considered a medical emergency. Patients presenting with FN are routinely subjected to careful history taking and physical examination including X-rays and microbiological evaluations. Nevertheless, an infection is documented clinically in only 20-30% of cases, whereas a causative microbial pathogen is not identified in over 70% of FN cases. The oral cavity is generally only visually inspected. Although it is recognized that ulcerative oral mucositis may be involved in the development of FN, the contribution of infections of the periodontium, the dentition, and salivary glands may be underestimated. These infections can be easily overlooked, as symptoms and signs of inflammation may be limited or absent during neutropenia. This narrative review is aimed to inform the clinician on the potential role of the oral cavity as a potential source in the development of FN. Areas for future research directed to advancing optimal management strategies are discussed.
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Affiliation(s)
- Judith A E M Zecha
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Judith E Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Anneke M Westermann
- Department of Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joel B Epstein
- Cedars-Sinai Health System, Los Angeles and City of Hope Cancer Center, Duarte, CA, USA
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Centre for Dentistry, (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Centre for Dentistry, (ACTA), University of Amsterdam, Amsterdam, The Netherlands.,Department of Head & Neck Oncology & Surgery, Netherlands Cancer Institute- Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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11
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Saito M, Hirano H, Miyakoshi S. [The oral examination and dental treatment before cord blood transplantation in aged patients and the development of oral mucositis after transplantation]. Nihon Ronen Igakkai Zasshi 2019; 55:395-401. [PMID: 30122706 DOI: 10.3143/geriatrics.55.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In this study, we performed intraoral examinations and dental treatment before umbilical cord blood transplantation for elderly people and investigated the development of oral mucositis after transplantation. The results of this study are reported herein. METHODS Study period: January 2009 to December 2016. SUBJECTS 106 patients who requested oral examinations at our department prior to cord blood transplantation. METHODS We examined the following information from charts and nursing records: (1) blood disease; (2) history of dental treatment and the details thereof; (3) the relationship between the average number of days from the initial dental visit until transplantation and the history of dental treatment and the details thereof; (4) the relationship between the occurrence of oral mucositis after transplantation and the details of treatment; and (5) the dates of the occurrence and disappearance of oral mucositis after transplantation, along with a comparison of the levels of granulocytes and platelets between the occurrence date and the disappearance date. RESULTS For patients who had undergone "periodontal therapy" and "tooth extraction," the average number of days from the initial dental visit to transplantation was longer than in patients not undergoing "periodontal therapy" and "tooth extraction." The levels of granulocytes and platelets at the onset of oral mucositis after transplant were lower than those at the disappearance of oral mucositis. In particular, the level of granulocytes was significantly decreased. CONCLUSION For transplant patients, a rapid intraoral examination is necessary, and it is important to start and end dental treatment at an early stage.
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Affiliation(s)
- Mika Saito
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Hirohiko Hirano
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital
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12
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Uutela P, Passweg J, Halter J, Weiger R, Waltimo T, Mauramo M. Common oral diseases in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pre-HSCT. Eur J Haematol 2019; 102:351-356. [PMID: 30632215 DOI: 10.1111/ejh.13209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the prevalence of common oral diseases between allogeneic haematopoietic stem cell transplantation (HSCT) recipients and healthy controls. MATERIALS AND METHODS A total of 143 adult allogeneic HSCT recipients who were treated for haematological malignancies between 2008 and 2016 were included in the study. The HSCT recipients were age and sex matched with healthy controls. A dental examination was performed on the HSCT recipients prior to HSCT. Differences in stimulated saliva flow rate (SSFR), decayed, missing and filled teeth (DMFT) index, number of teeth, number of caries lesions, and measures of current or previous periodontitis (radiological attachment loss >3 mm or probing pocket depth ≥4 mm) between HSCT recipients and controls were examined. RESULTS Stimulated saliva flow rate, DMFT index and the number of caries lesions were poorer in the HSCT recipients pre-HSCT compared to controls (all P-values <0.05). No statistically significant differences in the measures of current or previous periodontitis were observed. CONCLUSIONS Stimulated saliva flow rate was low and caries was common in HSCT recipients prior to HSCT. Efficient preventive strategies are important in order to maintain the oral health of these patients.
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Affiliation(s)
- Pauliina Uutela
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Jörg Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Tuomas Waltimo
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Matti Mauramo
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pathology, Haartman Institute and HUSLab, Helsinki University Central Hospital, Helsinki, Finland
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13
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Cheng Y, Qin SK, Chen YP, Dong LH, Sun XD, Yu SY, Wu SK. Local analgesic effect of a bioadhesive barrier-forming oral liquid in cancer patients with oral mucositis caused by chemotherapy and/or radiotherapy: a randomized multicenter, single-use, positive-controlled, open-label study. Onco Targets Ther 2018; 11:8555-8564. [PMID: 30584316 PMCID: PMC6280986 DOI: 10.2147/ott.s185915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective CAM2028 (Episil®; Camurus AB, Lund, Sweden) is a liquid for use in the oral cavity to treat various pains associated with mouth injuries. Upon contact with the swollen oral mucosa, the oral liquid forms a thin protective film that acts as a mechanical barrier to relieve pain. This study was the first in China to evaluate the local analgesic effect of oral liquid in cancer patients who developed oral mucositis following chemotherapy and/or radiotherapy. Methods A total of 60 patients were randomized in a 1:1 ratio to the CAM2028 group (the pump device was firmly pressed three times and the fluid was distributed to the painful area of the oral cavity) or KS (a mucoadhesive oral wound rinse, Kangsu™; Luye Pharmaceutical Co. Ltd, Nanjing, China) group (5 mL of the oral rinse was poured into and kept in the oral cavity for at least 1 minute). The primary endpoint was the area under the oral mucosal pain score-time curve (AUC) within 6 hours of treatment in the trial and control groups. Medical device adverse events were assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. Statistical analyses were performed using the chi-squared test (Fisher's exact test), independent-samples t-test, and analysis of covariance. Results Sixty patients were included in the per-protocol set population analysis. The average (mean ± SD) 6-hour AUC of the CAM2028 group and the KS group was 14.20±10.29 and 24.46±14.15, respectively. The difference between the groups was statistically significant (P=0.0022). The incidence of adverse events in the trial group and the control group was 16.67% and 30.0%, respectively, and there was no statistical difference. Conclusions CAM2028 displayed an efficacious local analgesic effect in cancer patients who developed oral mucositis following chemotherapy and/or radiotherapy. The results demonstrated its potential value in clinical applications.
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Affiliation(s)
- Yuan Cheng
- Department of Oncology, Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210002, China,
| | - Shu Kui Qin
- Department of Oncology, Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210002, China,
| | - Yan Ping Chen
- Department of Stomatology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Li Hua Dong
- Department of Radiotherapy, First Hospital of Jilin University, Changchun 130021, China
| | - Xiang Dong Sun
- Department of Radiotherapy, Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210002, China
| | - Shi Ying Yu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430012, China
| | - Shi Kai Wu
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 10071, China
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14
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Sampson MM, Nanjappa S, Greene JN. Mucositis and oral infections secondary to gram negative rods in patients with prolonged neutropenia. IDCases 2017; 9:101-103. [PMID: 28736716 PMCID: PMC5512178 DOI: 10.1016/j.idcr.2017.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/30/2022] Open
Abstract
Patients with prolonged neutropenia are at risk for a variety of complications and infections including the development of mucositis and oral ulcers. The changes in oral flora during chemotherapy and its effects on the development of infections of the oral cavity have been studied with inconsistent results. However, there is evidence that supports the colonization of gram negative rods in patients undergoing chemotherapy. In this report, we present two leukemic patients who developed oral ulcers secondary to multi-drug resistant Pseudomonas aeruginosa. It is important to suspect multi-drug resistant gram negative rods in patients with prolonged neutropenia who develop gum infections despite appropriate antibiotic coverage.
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Affiliation(s)
- Mindy M Sampson
- Department of Internal Medicine, University of South Florida, 17 Davis Blvd., Suite 308, 33606 Tampa, FL, United States
| | - Sowmya Nanjappa
- Department of Internal Medicine and Department of Oncologic Sciences, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, United States
| | - John N Greene
- Infectious Diseases and Hospital Epidemiologist, H. Lee Moffitt Cancer Center and Research Institute,12902, Magnolia Drive, FOB-3, United States
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15
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Nuernberg MAA, Rodrigues SC, Perdoncini NN, Funke VAM, Bonfim CMS, Nabhan SK, Torres-Pereira CC. Periodontal status of candidates for allogeneic hematopoietic stem cell transplantation. SPECIAL CARE IN DENTISTRY 2017; 37:187-193. [DOI: 10.1111/scd.12229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Samir Kanaan Nabhan
- Avenida Prefeito Lothário Meissner; 632, Jardim Botânico Curitiba Paraná Brazil, 80210-170
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16
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Hernández-Fernández A, Ortiz-Ruiz AJ, De Arriba-de la Fuente F, Vicente-García V, Iniesta-López-Matencio P, Oñate-Sánchez RE. Cambra system in patients awaiting hematopoietic progenitor cell transplant and high caries risk. J Clin Exp Dent 2017; 9:e654-e660. [PMID: 28512542 PMCID: PMC5429477 DOI: 10.4317/jced.53617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/01/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Recent times have witnessed a significant increase in the number of patients affected by problems related to oncological treatment Aims of this study is to evaluate dental affectation among patients awaiting hematopoietic progenitor cell transplant (HPCT), and they showed high caries risk, so it should establish a protocol prior to transplantation. MATERIAL AND METHODS The study included 72 patients due for HPCT. Clinical and radiological explorations were performed and oral photos taken. The amount of caries, missing teeth and fillings were registered for each patient. CAO, DMFS and Restoration Indices were calculated. RESULTS 83% of patients presented caries. 48 patients (67%) had lost at least one tooth. Only 32 patients (44%) had received some sort of conservative treatment. The average CAO index value obtained was 10.37. The DMFS index showed an average of 27.06 affected surfaces. Of the 72 patients studied, 40 (56%) showed a restoration index value of zero. CONCLUSIONS These patients presented a high number of carious teeth and a low restoration index. The presence of so many possible septic foci in an individual, who will later become susceptible to infection, highlights the importance of preventative treatment and bucco-dental restoration within this patient population. These patients with a high caries risk can be treated with CAMBRA system. Key words:Hematopoietic progenitor cell transplantation, high caries risk, state of oral health, haematological disease, CAMBRA system.
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17
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Hansen PB, Penkowa M. Bismuth adjuvant ameliorates adverse effects of high-dose chemotherapy in patients with multiple myeloma and malignant lymphoma undergoing autologous stem cell transplantation: a randomised, double-blind, prospective pilot study. Support Care Cancer 2016; 25:1279-1289. [PMID: 27966023 DOI: 10.1007/s00520-016-3522-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/05/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE High-dose chemotherapy prior to autologous stem cell transplantation (ASCT) leads to adverse effects including mucositis, neutropenia and bacteremia. To reduce the toxicity, we treated myeloma and lymphoma patients with peroral bismuth as an adjuvant to chemotherapy to convey cytoprotection in non-malignant cells. METHODS This trial was a prospective, randomised, double-blind, placebo-controlled pilot study of hematological inpatients (n = 50) receiving bismuth or placebo tablets, in order to identify any potential superiority of bismuth on toxicity from chemotherapy. RESULTS We show for the first time that bismuth significantly reduces grade 2 stomatitis, febrile neutropenia and infections caused by melphalan in multiple myeloma, where adverse effects also were significantly linked to gender. In lymphoma patients, bismuth significantly reduces diarrhoea relative to placebo. Also, lymphoma patients' adverse effects were linked to gender. For the first time, bismuth is demonstrated as a safe strategy against chemotherapy's toxicity without interfering with intentional anti-cancer efficiency. Also, we show how gender significantly influences various adverse effects and response to treatment in both multiple myeloma and malignant lymphomas. CONCLUSION These results may impact clinical prevention of chemotherapy's cytotoxicity in certain patient groups, and also, this study may direct further attention towards the impact of gender during the course and treatment outcome of malignant disorders.
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Affiliation(s)
- Per Boye Hansen
- Department of Hematology, Herlev Hospital, University of Copenhagen, 2720, Herlev, Denmark.
- Department of Hematology, University Hospital of Roskilde, DK-4000, Roskilde, Denmark.
| | - Milena Penkowa
- Section for Neuroprotection, Hjerneeksperten, 1718, Copenhagen, Denmark
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18
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Taichman LS, Van Poznak CH, Inglehart MR. Self-reported oral health and quality of life of postmenopausal breast cancer survivors on aromatase inhibitors and women without cancer diagnoses: a longitudinal analysis. Support Care Cancer 2016; 24:4815-24. [PMID: 27455851 DOI: 10.1007/s00520-016-3336-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/10/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Aromatase inhibitors (AIs) are a well-established component of adjuvant therapy in postmenopausal women with hormone receptor (HR) + early stage breast cancer (BCa). We explored in an 18-month cohort study whether subjective oral health (OH), subjective periodontal health (PH), and oral health-related quality of life (OHRQoL) of postmenopausal BCa survivors on AIs differ from those of women without cancer diagnoses, and whether saliva flow, OH, PH, and OHRQoL are related. METHODS Data were collected from 29 postmenopausal BCa survivors on AIs and 29 postmenopausal women without cancer diagnoses. Socio-demographic information, OH, PH, and OHRQoL were collected at baseline and 6, 12, and 18 months later. Unstimulated whole saliva volume per 15 min was determined by drooling. RESULTS The two groups did not differ in background characteristics at baseline. Women on AIs had poorer OH (p = .043), PH (p = .04), and OHRQoL (p = .017), and lower saliva flow rate (p < .001) than control respondents. BCa survivors had the poorest PH at the 18-month visit. Xerostomia was correlated with OH at baseline and with OH and PH at 18 months. However, objective saliva flow rate was not correlated with OH or OHRQoL at this visit. CONCLUSIONS This study is the first to investigate the effects of AIs on patients' subjective OH, subjective PH, and OHRQoL. The data suggest that women treated with AIs have worse OH, PH, and OHRQoL than women without cancer diagnoses. Interprofessional care is recommended so that women on AIs receive optimal supportive oral care to assure long-term OH and positive OHRQoL. TRIAL REGISTRATION ClinicalTrials.gov NCT01272570 https://clinicaltrials.gov/ct2/show/NCT01272570 .
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109-1078, USA.
| | - Catherine H Van Poznak
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan, Ann Arbor, MI, USA
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry & Department of Psychology, College of Literature, Science & Arts, University of Michigan, Ann Arbor, MI, USA
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19
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Effects of Hangeshashinto on Growth of Oral Microorganisms. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:512947. [PMID: 26170876 PMCID: PMC4485921 DOI: 10.1155/2015/512947] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/22/2022]
Abstract
Oral mucositis (OM) in cancer patients induced by chemotherapy or radiotherapy has a significant impact on quality of life, and causes considerable morbidity. Oral microorganisms are likely to intensify the inflammatory process and aggravate the formation of ulcers. Hangeshashinto (HST), a Japanese kampo medicine, has been reported to be effective when used as a gargle for the treatment of OM. To clarify the effects of HST on oral microorganisms, we assessed its antimicrobial activity against 27 microbial species, including 19 oral bacteria and one fungus. HST extract inhibited the growth of Gram-negative bacteria, including Fusobacterium nucleatum, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Prevotella melaninogenica, Tannerella forsythia, Treponema denticola, and Porphyromonas asaccharolytica, though inhibitory effects were less pronounced for Gram-positive bacteria and the fungal strain. We then investigated the effects of antibacterial activities on 15 purified ingredients of HST and determined that baicalein, berberine, coptisine, [6]-shogaol, and homogentisic acid actively inhibited the growth of these bacteria. These findings showed that HST inhibits the growth of specific Gram-negative periodontopathogenic bacteria, which are significant pathogens in OM, without disturbing the normal oral flora. Our data suggest that HST may be a useful treatment for OM in patients undergoing anticancer treatment.
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Abstract
PURPOSE OF REVIEW Oral mucositis is one of the most prevalent toxicities after hematopoietic stem cell transplantation. Mucositis is initiated by the chemotherapy or radiotherapy preceding the transplantation. It is commonly accepted that microorganisms play a role in the process of oral mucositis. Despite the upcoming techniques to determine the whole oral bacterial ecosystem, the exact role of the microflora in mucositis is not yet understood. This article provides an overview of the state-of-the-art research on the oral microflora and mucositis. RECENT FINDINGS A shift in microflora, in both the intestine and the oral cavity, can be found after chemotherapy or radiation therapy. The presence of oral ulcerative mucositis coincides with the presence of periodontitis-associated bacteria, in particular Porphyromonas gingivalis. Moreover, this bacterium can inhibit wound healing processes in an in-vitro model. SUMMARY We come to realize that some diseases are associated with a shift in the microflora. The role of the microflora in oral and intestinal mucositis is gaining more attention in recent literature. In the oral cavity, periodontitis-associated bacteria may influence the healing of ulcerations and the role they play in mucositis may be more subtle and complicated than was previously thought.
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21
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Epstein JB, Güneri P, Barasch A. Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time. Support Care Cancer 2014; 22:1981-8. [PMID: 24676676 DOI: 10.1007/s00520-014-2228-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The identification of experienced and knowledgeable dental specialists to provide appropriate oral care for cancer patients, as well as the integration of this care within general oncology management, may be a challenge. This paper discusses the general and additional requirements for dental care providers to support the cancer patient and provide prevention and/or treatment for oral complications of cancer therapy. METHODS We performed a literature review of specific issues regarding the oral cavity and adjacent structures in the cancer patient, including detection and early diagnosis of oral malignancy. We incorporated the systemic effects of cancer and its therapy that affect oral disease and treatment. We present a summary of how to seek expert dental care for cancer patients and for referral from the dental and medical community. RESULTS Due to the complexity conferred by the disease and its treatment, cancer patients require educated, experienced dentists for treatment and/or prevention of oral-related morbidity. Correct diagnosis and evidence-based prophylactic and therapeutic oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs. CONCLUSIONS The knowledge and expertise of dental professionals regarding prevention/treatment of complications and secondary malignant lesions in cancer patients are critical. Integration of oral care with the oncology care and in survivors requires effective communication between dental and medical providers beginning ideally at diagnosis. These clinicians may be identified at the cancer center, nearby hospital dental programs, and, less commonly, in the community.
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Affiliation(s)
- Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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