Oral health status in adult patients with newly diagnosed acute leukemia

Evaluation of oral manifestations and head and neck lymphadenopathy in newly diagnosed acute leukemia patients

OBJECTIVES

To determine the frequency of head and neck lymphadenopathy (LAP) and intraoral findings (non-dental/dental) in patients with newly diagnosed acute leukemia (AL).

SUBJECTS AND METHODS

Twenty-eight (52.8%) females and 25 (47.2%) males in a total of 53 patients with newly diagnosed AL with a mean age of 46 years were included in the study. Personal information, the type of AL (AML [acute myelogenous leukemia]/ALL [acute lymphocytic leukemia]), and hematological findings (anemia, neutropenia, and thrombocytopenia) were obtained from medical records. One of two calibrated oral diagnosis and maxillofacial radiology specialists performed extraoral (head and neck LAPs) and intraoral (non-dental and dental) clinical examinations. The Chi-square (χ2) test was used to evaluate categorical variables.

RESULTS

LAP was observed in 22.6% and intraoral findings in 30.2% of the patients. LAP was most commonly observed in the neck and none in the parotid glands. The most intraoral findings were gingival/mucosal bleeding and oral petechiae/ecchymosis. While there was no statistical difference between AML and ALL patients in terms of LAP (p > .05), intraoral findings were observed more in patients with AML (p < .05). Only two (3.8%) patients had dental findings. With a slight difference, intraoral findings were more with thrombocytopenia and LAP with neutropenia.

CONCLUSION

In AL, especially non-dental intraoral findings are common. The fact that dentists working in the oral cavity are often the first specialists to encounter the oral manifestations of AL imposes an important role in early diagnosis and treatment.

Utility of a xanthene-based dye for determination of nilotinib using two spectroscopic approaches. Applications to bulk powder, capsules, and spiked human plasma

Novel, selective, facile, and precise spectroscopic approaches were validated to determine nilotinib hydrochloride, a tyrosine kinase inhibitor used to treat patients with chronic myeloid leukemia. These approaches depend on the reaction of the tertiary amine group of nilotinib with erythrosine B in the Britton-Robinson buffer at pH 4. Method I, depends on measuring the absorbance of the formed complex at 551 nm. The absorbance concentration plot showed linearity over the concentration range of 1.0 to 9.0 μg/ml. Method II, involved the measurement of the quenching of the native fluorescence of erythrosine B by adding nilotinib in an acidic medium. The fluorescence quenching of erythrosine B was measured at 549 nm after excitation at 528 nm. This approach showed excellent linearity in the concentration range of 0.04 to 0.7 μg/ml. The limit of detection values for Method I and Method II were 0.225 and 0.008 μg/ml, respectively, while the limit of quantitation values for Method I and Method II were 0.68 and 0.026 μg/ml, respectively. To get the optimal conditions, factors that may affect the formation of the ion-pairing complex were thoroughly examined. The two approaches were carefully validated following the International Conference of Harmonization (ICH Q2R1) guidelines. Statistical assessment of the results achieved using the suggested and previously published comparison approaches showed no significant difference. The approaches were successful in determining nilotinib in a pharmaceutical dosage form as well as spiked human plasma samples. The eco-friendly properties of the methods were evaluated by three different tools.

Oral health in patients scheduled for hematopoietic stem cell transplantation in the Orastem study

Despite advances in transplant medicine, prevalence of complications after hematopoietic stem cell transplantation (HSCT) remains high. The impact of pre-HSCT oral health factors on the incidence and severity of complications post-HSCT is poorly understood. The aim of this prospective, observational study was to analyze oral health in patients planned for HSCT. Patients ≥18 years requiring HSCT were included from five sites between 2011-2018. General health, oral findings and patient-reported symptoms were registered in 272 patients. Oral symptoms around disease onset were reported by 43 patients (15.9%) and 153 patients (58.8%) reported oral complications during previous chemotherapy. One third of patients experienced oral symptoms at the oral examination before conditioning regimen and HSCT. In total, 124 (46.1%) patients had dental caries, 63 (29.0%) had ≥one tooth with deep periodontal pockets, 147 (75.0%) had ≥one tooth with bleeding on probing. Apical periodontitis was observed in almost 1/4 and partially impacted teeth in 17 (6.3%) patients. Oral mucosal lesions were observed in 84 patients (30.9%). A total of 45 (17.4%) of 259 patients had at least one acute issue to be managed prior to HSCT. In conclusion, oral symptoms and manifestations of oral disease were prevalent in patients planned for HSCT. The extent of oral and acute dental diseases calls for general oral screening of patients pre-HSCT.

Synchronized spectrofluorimetric determination of ponatinib and curcumin as an effective therapeutic combination in laboratory prepared mixtures and human plasma samples

Curcumin is a natural product that is frequently utilized in cancer prevention and treatment. The significant benefit of vegetable-derived nutraceuticals in combination with widespread cytostatic medication such as ponatinib is to reduce toxicity and side effects. In this paper, we focus the study on analytical quantification of ponatinib and curcumin through highly sensitive synchronous spectrofluorometric method. Applying this method at Δλ = 160 nm, each of ponatinib and curcumin could be measured at 303 and 412 nm without interference from each others. The diverse experimental factors impacting the performance of the method were studied and optimized. The method exhibited a reasonable linearity in the ranges of 5.0-60.0 and 10.0-200.0 ng/mL for ponatinib and curcumin, respectively with detection limits of 1.48 and 1.22 ng/mL and quantitation limits of 4.49 and 3.68 ng/mL, respectively. The anticipated method was employed for the assessment and evaluation of the studied drugs in the spiked human plasma samples. The mean % recoveries in plasma samples (n = 6) for each of ponatinib and curcumin were 99.84 ± 1.86 and 100.06 ± 2.72, accordingly. The developed method was validated in conformity with the requirements of International Council of Harmonization (ICH).

Assessment of oral health and care in head and neck oncology patients in King Faisal Specialist Hospital and Research Center-Jeddah

Objectives

To assess oral hygiene indices, dental status, and oral health practices among head and neck cancer patients at King Faisal Specialist Hospital and Research Center (KFSHRC)-Jeddah.

Materials and Methods

The charts of 117 patients with head and neck cancer were reviewed to identify the decayed/missing/filled teeth (DMFT) index, calculus index (CI), gingival index (MGI), and oral hygiene index. The type of cancer, other systemic diseases, and sex data were extracted from the records and analyzed using SPSS statistical software for descriptive statistics, Student’s t-test, analysis of variance (ANOVA), and Spearman correlation statistical analyses.

Results

The total mean DMFT index was 14.33. The significant caries index (SiC) for the studied sample was 25.87. Men had a mean DMFT of 14.11 (SD 9.8). The mean DMFT index for women was 14.63 (SD 9.7). The DMFT score for patients with systemic disease was 17.47 (SD 9.9). Patients with no other diseases had a mean DMFT score of 12.82 (SD 9.3). The DMFT index was not significantly different between men and women (p = 0.925). One-way ANOVA (F = 1.729) revealed no significant difference (p = 0.110) between DMFT scores according to the location of the cancer. DMFT with systemic disease showed no significant difference (p = 0.6) in comparison to patients without systemic disease.

The Spearman rho statistic revealed no correlation between the DMFT score and CI (p = 0.383).

Conclusions

The total DMFT score was 14.33. The total SiC was 25.87. The DMFT scores of men and women were not significantly different. Cancer location and presence or absence of systemic diseases did not affect the DMFT score. The DMFT score and CI were not correlated, but a correlation was found between the DMFT score and MGI and the oral hygiene index.

Oral manifestations of leukemia as part of early diagnosis

Introduction

The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics.

Objective

To identify oral manifestations as the first clinical signs of leukemia.

Methods

This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis.

Results

A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%).

Conclusion

The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Changes of Dentition State in Leukemic Patients during Chemotherapy

A number of systemic diseases including hematological disorders have manifestations in the oral cavity region. These manifestations may often represent early signs of the underlying hematopoietic disease and occur frequently in leukemia. Despite the fact that leukemia has long been known to be associated with oral health deterioration, the available literature on this topic consists mostly of case reports, without data to conclude these. The aim of the study was to assess dentition state in leukemic patients during one cycle of chemotherapy and its correlation with blood parameters. The study included 102 adults treated because of leukemia at the Clinic of Haemato-Oncology and Bone Marrow Transplantation at the university hospital in Lublin, Poland. The sample group consisted of 51 women and 51 men aged 22 to 72 (54.07 ± 10.33) with following diagnoses: Acute myelogenous leukemia (AML)-55 patients (53.92%), Chronic lymphocytic leukemia (CLL)-17 patients (16.67%), Acute lymphoblastic leukemia (ALL)-16 patients (15.69%), Chronic myelogenous leukemia (CML)-10 patients (9.80%), Acute promyelocytic leukemia (APL) -3 patients (2.94%), Chronic hairy cell leukemia (HCL)-1 patient (0.98%). DMFT index was used to assess dentition state. After the cycle of chemotherapy, their dentition state changed in terms of decayed, missing and filled teeth and correlated with hematological parameters. Adult patients with leukemia have high dental treatment needs, and high number of missing teeth; thus, a comprehensive and fast dental treatment is necessary to avoid systemic complications and ensure better quality of life.

Oral health status of patients with leukemia: a systematic review with meta-analysis

OBJECTIVE

The aim of this study was to systematically review the literature regarding the prevalence of periodontal diseases and dental caries in patients with leukemia.

METHODS

An electronic search for observational studies on oral health outcomes in patients with leukemia was performed on Medline/PUBMED, Embase, Web of Science, and Science Direct databases up to April 2020. Dental caries and periodontal diseases were assessed using the following standardized parameters, respectively: mean number of decayed, missing and filled teeth (DMFT), and presence of marginal inflammation (gingivitis) or clinical attachment loss (periodontitis). Two independent reviewers conducted all phases of review. Included studies reporting similar outcomes were subjected to random-effects meta-analysis.

RESULTS

From 1,246 retrieved references, 39 were included. Most studies were cross-sectional investigations involving young patients with acute lymphoblastic leukemia. Nine studies presented high risk of bias and were not included on quantitative analyses. All studies in the meta-analysis (n = 14) were conducted with children/teenagers with acute leukemia. Pooled gingivitis prevalence in patients before and during leukemia treatment was 85% (95%CI 75, 97%; 4 studies) and 82% (95%CI 71, 94%; 6 studies), respectively. Pooled DMFT means were 2.28 (95%CI 1.31, 3.25; 7 studies) and 3.65 (95%CI 1.45, 5.86; 5 studies) respectively for patients during and after leukemia treatment. Studies regarding periodontitis prevalence were too few to run a meta-analysis.

CONCLUSIONS

Based on cross-sectional data, young people with acute leukemia have high prevalence of gingivitis and caries experience. These findings indicate that the effect of leukemia on oral health still needs to be better investigated.

Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.

Dental and Periodontal Treatment Need after Dental Clearance Is Not Associated with the Outcome of Induction Therapy in Patients with Acute Leukemia: Results of a Retrospective Pilot Study

This retrospective pilot study aimed to detect whether remaining dental/periodontal treatment need and periodontal inflammation after dental clearance would be associated with the initial therapy outcome of adult patients with acute leukemia undergoing induction chemotherapy. Different parameters were assessed from the patients' records: initial blood parameters, blood parameters during initial chemotherapy, leukemia/therapy related complaints, duration of fever, microbiological findings (blood and urine), as well as patients' survival. Dental treatment need was defined as the presence of at least one carious tooth; periodontal treatment need was determined by the presence of probing depth ≥3.5 mm in at least two sextants. To reflect periodontal inflammation, the periodontal inflamed surface area (PISA) was applied. Thirty-nine patients were included. A dental treatment need of 75% and periodontal treatment need of 76% as well as an average PISA of 153.18 ± 158.09 were found. Only two associations were detected: periodontal treatment need was associated with thrombocyte count after 7 days (p=0.03), and PISA was associated with erythrocyte count three days after induction of therapy (p=0.01). It can be concluded that remaining dental and periodontal treatment need as well as periodontal inflammation after dental clearance is not associated with the outcome of induction therapy in adult patients with acute leukemia.

Oral disorders in patients with newly diagnosed haematological diseases

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.

Dissociations of oral foci of infections with infectious complications and survival after haematopoietic stem cell transplantation

Introduction

Haematopoietic stem cell transplantation (HSCT) recipients are at increased risk for severe infections. This study examined the associations of common oral infections with survival and infectious complications in HSCT recipients.

Materials and methods

All autologous and allogeneic HSCT recipients transplanted in the University Hospital of Basel, Switzerland, between 2008 and 2016 and referred to oral infection control pre-HSCT were included in this retrospective case-control study. All patients had a clinical and a panoramic radiological dental examination taken immediately prior to HSCT. Presence of acute or chronic oral foci of infections, decayed, missing or filled tooth index (DMFT) and radiological attachment loss (RAL) were examined. Survival and infections of the subjects were followed up for 6 months post-HSCT.

Results

Altogether 341 allogeneic and 125 autologous HSCT recipients were included in the study. Within 6 months post-HSCT, 47 (14%) of the allogeneic and 4 (3%) of the autologous recipients died. Oral foci of infections (acute or chronic), DMFT or periodontitis pre-HSCT were not associated with survival 6 months post-HSCT. Oral foci of infections were also not associated with hospital treated infectious diseases or blood culture positive bacteremia during the 6 month follow-up period. Untreated oral foci of infections were not associated with survival or severe infectious complications within 6 months post-HSCT.

Conclusion

The results of this study suggest that radical dental interventions to chronic oral infections could be postponed until post-HSCT.

Gingival hyperplasia as an early manifestation of acute myeloid leukemia. A retrospective review

Background

We study the prevalence of acute myeloid leukemia (AML) among patients with severe gingival enlargement.

Material and Methods

We retrospective reviewed the clinical records of patients with severe gingival enlargement, between 2011 and 2018. The Saxer and Mühlemann index were used to measure inflammation and gingival bleeding. The degree of dental mobility was measured by the Nyman and Lindhe technique.

Results

A correlation analysis was carried out to test whether there were any associations among the different variables. In the sample of 117 patients the mean gingival bleeding index was ≥3 and the degree of dental mobility ≥2.3. 1.7% of patients, with severe gingival hyperplasia were diagnosed with AML. We found a significant association between gingival bleeding and aging (p<0.001) and a trend (0.54) between bleeding and suffering from AML.

Conclusions

Severe gingival enlargement, abundant gingival bleeding, and dental mobility could be early manifestations of a blood dyscrasia. Key words:Acute myeloblastic leukemia, gingival hyperplasia, bleeding, tooth motility, oral health.

Common oral diseases in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pre-HSCT

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.

Oral manifestations in stem cell transplantation for acute myeloid leukemia

Acute myeloid leukemia is a highly aggressive malignancy with a high morbidity rate, for which an accurate and rapid diagnostic is essential. Acute myeloid leukemia manifestations frequently include oral abnormalities. Still, there is a limited number of studies reporting the incidence of oral manifestations in acute leukemia, the prevalence of periodontal status and periodontal parameters in these patients. Our aim was to emphasize the importance of early recognition by the dental practitioners of oral cavity manifestations as signs of acute myeloid leukemia, so that prompt referral to the hematologists is being done, and appropriate treatment is offered.