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Al Beesh FA, Martini N, Suleiman S, Aljoujou A. Oral manifestations associated with neutropenia in Syrian patients diagnosed with hematological malignancies and undergoing chemotherapy: A cross-sectional study. Medicine (Baltimore) 2024; 103:e36780. [PMID: 38215147 PMCID: PMC10783351 DOI: 10.1097/md.0000000000036780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024] Open
Abstract
Neutropenia can be caused by a variety of congenital and acquired factors, with Chemotherapy-induced myelosuppression being the most common cause. Neutropenia significantly affects oral health, leading to the manifestation of oral lesions such as ulcers, fungal and viral infections, and mucositis. This study aims to investigate oral lesions in patients with hematological malignancies who developed neutropenia after chemotherapy. This cross-sectional study included 50 patients with hematological malignancies. The participants were divided into 2 groups: the first group consisted of 25 patients with hematological malignancies who developed chemotherapy-induced neutropenia and the second group consisted of 25 patients with hematological malignancies who did not develop chemotherapy-induced neutropenia. Patients were assigned to one of the groups based on the absolute neutrophil count (ANC). Full oral clinical examination was performed to determine the presence of oral lesions. In the Chemotherapy-Induced Neutropenia group, the most common lesion was ulceration, observed in 12 patients (48%). Fungal infections were the second most common, present in 5 patients (20%), followed by viral infections in 4 patients (15%), and mucositis, which occurred in a single patient (4%). A statistically significant association was found between neutropenia and the presence of oral ulcers (P value = .015). In contrast, in the Chemotherapy group, oral changes were less frequent. Fungal infections were the most common, occurring in 4 patients (15%), followed by oral mucositis in 3 patients (12%). Ulceration and viral infections were the least common, each observed in 1 patient (4%). The frequency of various forms of oral ulcers increases with the severity of neutropenia. However, there was no significant increase in other oral lesions in patients with neutropenia.
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Affiliation(s)
- Fatima AlZahraa Al Beesh
- University of Damascus, Faculty of Dentistry, Department of Oral Medicine, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- University of Damascus, Faculty of Medicine, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Siham Suleiman
- University of Damascus, Faculty of Medicine, Department of Hematology-Oncology, Damascus, Syrian Arab Republic
| | - Abeer Aljoujou
- University of Damascus, Faculty of Dentistry, Department of Oral Medicine, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
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Aggarwal A, M Pai K. Orofacial Manifestations of Leukemic Children on Treatment: A Descriptive Study. Int J Clin Pediatr Dent 2018; 11:193-198. [PMID: 30131640 PMCID: PMC6102430 DOI: 10.5005/jp-journals-10005-1510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Aim To study the prevalence of orofacial manifestations in leukemic children undergoing treatment and to correlate these manifestations with various stages of chemotherapy. Materials and methods A prospective noninvasive study comprising 43 acute lymphocytic leukemic pediatric patients at various stages of therapy. They were examined on day of their each blood examination, and lesions were recorded on a self-designed pro forma. A total of 133 observations were recorded by a single observer. The treatment was divided into the phase of induction, consolidation, maintenance, and relapse. Results The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 10.1. There were 24 males and 19 females in this study, aged between 3 and 13 years. The common oral lesions seen were dental caries, lymphadenopathy (86.04%), pallor (65.11%), ulcers (13.95%), mucositis (16.27%), gingival enlargement, hemorrhages (20.93%), candidiasis, herpes simplex virus (HSV) infection, xerostomia (44.18%), paresthesia, and tooth mobility. Herpes simplex virus infection was seen only during induction and consolidation phases. Ulcers were seen during all phases of therapy. Clinical significance Orofacial manifestations may be seen as the first sign of leukemia and a dentist may play a significant role in the diagnosis of the disease per se. This study highlights not only about commonly occurring lesions but also their variation during various phases of therapy. To the best of our knowledge, no study has such an extensive reporting of orofacial manifestations of acute lymphocytic leukemia (ALL) patients under treatment. How to cite this article: Aggarwal A, Pai KM. Orofacial Manifestations of Leukemic Children on Treatment: A Descriptive Study. Int J Clin Pediatr Dent 2018;11(3):193-198.
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Affiliation(s)
- Aparna Aggarwal
- Reader, Department of Oral Medicine and Radiology, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar Rajasthan, India
| | - Keerthilatha M Pai
- Professor and Dean, Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka, India
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Morais EFD, Lira JADS, Macedo RADP, Santos KSD, Elias CTV, Morais MDLSDA. Oral manifestations resulting from chemotherapy in children with acute lymphoblastic leukemia. Braz J Otorhinolaryngol 2014; 80:78-85. [PMID: 24626896 PMCID: PMC9443976 DOI: 10.5935/1808-8694.20140015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/22/2013] [Indexed: 11/20/2022] Open
Abstract
Introdução A leucemia linfocítica aguda é um dos tipos de câncer mais comuns em crianças e é caracterizada pela produção excessiva e desordenada de leucócitos imaturos na medula óssea. Objetivo Identificar as manifestações orais mais frequentes em crianças portadoras de leucemia linfocítica aguda sob o tratamento quimioterápico. Metodologia A pesquisa foi realizada nas bases de dados eletrônicas PubMed/Medline, Science Direct, Scielo e Scopus. Procurou-se por artigos apresentados na íntegra, escritos em português, inglês e espanhol, publicados entre janeiro de 1992 e abril de 2013. Resultados Dos estudos selecionados primariamente, apenas oito atenderam aos critérios de inclusão. A população avaliada foi um grupo de crianças portadoras de leucemia linfócitica aguda. Todos os estudos realizaram exames intraorais para o diagnóstico das lesões bucais. De acordo com os resultados, as lesões mais frequentes foram mucosite, candidíase, periodontite e gengivite. A condição de saúde bucal dos portadores de leucemia linfócitica aguda variou de acordo com a higiene bucal do paciente. Conclusão Pacientes com LLA podem apresentar alguma lesão na cavidade oral durante ou após o início da quimioterapia. O cirurgião dentista necessita reconhecer as manifestações orais e intervir na saúde bucal do paciente com LLA, contribuindo e auxiliando no seu tratamento. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.
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Padmini C, Bai KY. Oral and dental considerations in pediatric leukemic patient. ISRN HEMATOLOGY 2014; 2014:895721. [PMID: 24724033 PMCID: PMC3960739 DOI: 10.1155/2014/895721] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 01/17/2014] [Indexed: 11/24/2022]
Abstract
Throughout the world, there have been drastic decline in mortality rate in pediatric leukemic population due to early diagnosis and improvements in oncology treatment. The pediatric dentist plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life during, and follow up of the cancer treatment. This manuscript discusses recommendations and promotes dental care of the pediatric leukemic patients.
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Affiliation(s)
- Chiyadu Padmini
- Department of Pedodontics and Preventive Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad, Andhra Pradesh, India ; NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - K Yellamma Bai
- NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India ; Department of Pedodontics and Preventive Dentistry, Mally Reddy Women's Dental College, Hyderabad, Andhra Pradesh, India
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Napeñas JJ, Miles L, Guajardo-Streckfus C, Streckfus CF. Salivary flow rates among women diagnosed with benign and malignant tumors. SPECIAL CARE IN DENTISTRY 2013; 33:102-10. [PMID: 23600980 DOI: 10.1111/scd.12017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to compare salivary flow rates (SWS) among patients diagnosed with benign and varying malignant solid tumors with the comparison group, prior to the initiation of any treatment. An evaluation of the results found that mean baseline SWS flow rates were higher for healthy patients (1.55 ml/min) when compared to patients diagnosed with benign tumors (1.13 ml/min), breast cancer (1.09 ml/min), and reproductive carcinomas (0.94 ml/min). The overall model (F = 7.76; p < .001) and the Dunnett's post hoc analyses were statistically significant at the p < .001 level. Additionally, medications, race, and season of the year had significant effects on mean SWS flow rates. The results suggest that salivary secretion is lower among both benign and malignant tumor subjects prior to the initiation of treatment. Salivary evaluations of subjects prior to treatment may be useful in identifying individuals at risk for oral complications during chemotherapy.
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Affiliation(s)
- Joel J Napeñas
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
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Tomlinson D, Gibson F, Treister N, Baggott C, Judd P, Hendershot E, Maloney AM, Doyle J, Feldman B, Sung L. Designing an oral mucositis assessment instrument for use in children: generating items using a nominal group technique. Support Care Cancer 2008; 17:555-62. [PMID: 18982362 DOI: 10.1007/s00520-008-0523-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 10/01/2008] [Indexed: 11/30/2022]
Abstract
GOALS OF WORK There was a need to develop a mucositis instrument that would be specific for use with children. This paper describes the step of generating items in the process of developing a new instrument for the assessment of oral mucositis in children. MATERIALS AND METHODS Nine health care professionals with expertise in pediatric cancer, mucositis assessment, and oral assessment in children were invited to participate in a nominal group technique to generate items that should be included in an instrument. RESULTS Thirty items were generated initially. Voting processes established that six of these items were thought to be necessary for inclusion: (1) presence of ulcers, (2) pain assessment, (3) amount of pain medication received, (4) effect on eating, (5) drooling-pooling of saliva, and (6) effect on drinking. Using these six items, an initial draft of an instrument was developed that could be used to assess oral mucositis in children, namely, the Children's International Mucositis Evaluation Scale. CONCLUSION The six items generated by this process provided the basis for a simple, feasible, and reliable instrument. With increased clinical research investigating interventions to reduce and prevent oral mucositis, such an instrument will be critical to the effective conduct of this research in children. Further testing of this instrument is necessary.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sciences, Hospital for Sick Children, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada.
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Tomlinson D, Judd P, Hendershot E, Maloney AM, Sung L. Establishing Literature-Based Items for an Oral Mucositis Assessment Tool in Children. J Pediatr Oncol Nurs 2008; 25:139-47. [DOI: 10.1177/1043454208317235] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although there are numerous instruments for oral mucositis (OM) assessment in adults, there is a lack of validated instruments for use in children. The objectives of this systematic review were to describe literature-based items that should be considered for a pediatric mucositis scale and other issues that should be considered when assessing mucositis in children. Literature search of PubMed and bibliography searches identified articles relevant to the assessment of mucositis and mucositis assessment studies in children. The elements established from the literature were grouped under objective, subjective, and functional items. Other issues that require consideration include the conditions for the assessment of the oral cavity and the etiology of OM. The resultant list included 23 items that have been used in mucositis assessment scales. This list of items may be used as an initial step in developing a new pediatric OM scale that particularly focuses on the unique issues in children.
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Affiliation(s)
| | - Peter Judd
- Paediatric Dentistry division, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eleanor Hendershot
- Haematology/Oncology Department, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Maloney
- Haematology/Oncology Department, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- CHES, Hospital for Sick Children, Toronto, Ontario, Canada
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Cubukcu CE, Sevinir B. Debridement could be a solution to promote healing of established oral mucositis in children. Eur Arch Paediatr Dent 2007; 8:105-12. [PMID: 17555693 DOI: 10.1007/bf03262578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The aim of the study was to present a novel approach to promote healing of established oral mucositis and to alleviate symptom clusters in a group of children who were on induction chemotherapy. STUDY DESIGN A clinical prospective study. METHODS Children (40) diagnosed with Grade 3 or 4 oral mucositis were randomly assigned into two groups: In Group I (n=20), accumulated debris on ulcerations was removed (debridement); In Group II (n=20), subjects had no debridement. The condition of oral lesions, speech, lips, teeth, saliva, gingiva, and swallowing ability were examined 3 x week during the study. All subjects received the same oral care regimen. They were well balanced in respect of age, the type of antineoplastic treatment, and the number. RESULTS Debridement promoted resolution and decreased the severity of oral mucositis significantly. Thus, the subjects had less oral discomfort, pain, and nutritional difficulties. STATISTICS The data were entered in the SPSS 13.0 program, and the tests used were Kolmogorov-Smirnov, Shapiro-Wilk, Mann-Whitney, and Spearman's correlation coefficient with a 5% significance level. CONCLUSION Well-controlled, prospective clinical studies related to the management of established oral mucositis will lead to the development of potential interventions and improved patient care.
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Affiliation(s)
- C E Cubukcu
- Dept Paediatric Dental Care, Uludağ University, Medical Faculty, Bursa, Turkey.
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Minicucci EM, Lopes LF, Crocci AJ. Dental abnormalities in children after chemotherapy treatment for acute lymphoid leukemia. Leuk Res 2003; 27:45-50. [PMID: 12479851 DOI: 10.1016/s0145-2126(02)00080-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The frequency of dental abnormalities, such as delayed dental development, microdontia, hypoplasia, agenesis, V-shaped root and shortened root was evaluated in 76 acute lymphoblastic leukemia (ALL) pediatric patients who had been off chemotherapy for 6 months. These children had been subjected to one of the three Brazilian Protocols or the BFM86 Protocol. The patients were divided into three groups: Group I (GI; high risk) treated with one of the three Brazilian Protocols who received high-dose chemotherapy, intensive maintenance and cranial radiotherapy; Group II (GII; low risk) who were also treated with one of the three Brazilian Protocols using low-intensive chemotherapy with no radiotherapy; and Group III (GIII) based on the BFM86 Protocol. Of 76 children, 13 showed no dental abnormalities (8 were at the age of tooth formation). The remaining 63 children (82.9%) showed at least one dental anomaly. The abnormalities were probably caused by the type, intensity, frequency of the treatment and age of the patients at ALL diagnosis and this might have important consequences for the children's dental development.
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Affiliation(s)
- Eliana Maria Minicucci
- Department of Pathology, School of Medicine of Botucatu, São Paulo State University, SP, São Paulo, Brazil.
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Bonnaure-Mallet M, Bunetel L, Tricot-Doleux S, Guérin J, Bergeron C, LeGall E. Oral complications during treatment of malignant diseases in childhood: effects of tooth brushing. Eur J Cancer 1998; 34:1588-91. [PMID: 9893633 DOI: 10.1016/s0959-8049(98)00169-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
During anticancer treatment, oral lesions considerably aggravate the child's clinical condition and increase the risk of infection. This prospective study evaluated the incidence, nature and chronology of oral complications arising during the first 6 weeks of chemotherapy. 131 children were included in this study, and their oral and dental health evaluated on enrolment. Each child was observed once a week, for 6 weeks. Fifty-two per cent (68/131) of the children presented with at least one oral lesion. Two oral healthcare regimens (with or without tooth brushing) were evaluated. Tooth brushing significantly reduced the number of children affected. Standardised multicentre studies should permit the definition of oral care regimens which would eliminate pain and reduce the risk of infection in children hospitalised for cancer.
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Affiliation(s)
- M Bonnaure-Mallet
- Equipe de Biologie Buccale (UPRES-EA 1256), Unité Fonctionnelle de Pédodontie, UFR d'Odontologie, Rennes, France
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Chang MW, Romero R, Scholl PR, Paller AS. Mucocutaneous manifestations of the hyper-IgM immunodeficiency syndrome. J Am Acad Dermatol 1998; 38:191-6. [PMID: 9486673 DOI: 10.1016/s0190-9622(98)70239-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The recurrent pyogenic infections of patients with hyper-IgM syndrome are controlled by intravenous gamma globulin administration, but patients may suffer from early-onset oral ulcerations and warts. OBJECTIVE We have characterized the mucocutaneous manifestations associated with this condition to allow physicians to more readily identify it. METHODS Three male patients with the mucocutaneous manifestations of the hyper-IgM syndrome are described. In one, histopathologic examination of the oral mucosal lesion was performed. RESULTS Recurrent large, painful oral ulcerations can occur that are not necessarily associated with neutropenia nor do they respond to granulocyte colony-stimulating factor administration. Histopathologic examination of an ulcer showed a heavy infiltrate of mixed inflammatory cells. Warts tend to be widespread and resistant to traditional therapy. CONCLUSION Physicians should consider this uncommon condition when examining a male patient with severe oral ulcers or recalcitrant widespread warts.
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Affiliation(s)
- M W Chang
- Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614-3394, USA
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Sixou JL, de Medeiros-Batista O, Bonnaure-Mallet M. Modifications of the microflora of the oral cavity arising during immunosuppressive chemotherapy. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:306-10. [PMID: 8944833 DOI: 10.1016/0964-1955(96)00006-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Infections are a major cause of mortality among immunosuppressed cancer patients. The oral cavity is a possible reservoir for those microorganisms, both commensal and acquired, whose virulence is exacerbated in the immunosuppressed patient. The mouth consists of multiple habitats offering ecological niches to a variety of organisms. The object of this article is to review the literature devoted to quantitative and qualitative variations in the flora of the oral cavity during immunosuppressive treatment of cancer patients. Examination of these different studies reveals modifications of the commensal flora, as well as an increase in Gram negative rods, in staphylococci and in yeasts. These data confirm the necessity for constant surveillance of the oral cavity during chemotherapy.
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Affiliation(s)
- J L Sixou
- Equipe de Biologie Buccale (EA 1256), Université de Rennes, France
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Bunetel L, Bonnaure-Mallet M. Oral pathoses caused by Candida albicans during chemotherapy: update on development mechanisms. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:161-5. [PMID: 8863305 DOI: 10.1016/s1079-2104(96)80219-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Oral candidiasis occurs at a high frequency among immunocompromised hosts. The development mechanisms of oral pathoses associated with Candida are complex and certainly multifactorial. In immunocompromised patients, they include the evolution of the buccal flora associated with the influence of antineoplastic treatments and immunosuppression. They also include adherence of Candida to epithelial cells of the oral cavity as a function of host cell-related and yeast-related factors. Interaction and cooperation between Candida and bacteria could be a third influence in the development of oral candidiasis. It seems important to determine these mechanisms more precisely so as to improve preventive and therapeutic measures.
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Affiliation(s)
- L Bunetel
- Equipe de Biologie Buccale, UFR d'Odontologie, Rennes, France
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O'Sullivan EA, Duggal MS, Bailey CC. Changes in the oral health of children during treatment for acute lymphoblastic leukaemia. Int J Paediatr Dent 1994; 4:31-4. [PMID: 7748846 DOI: 10.1111/j.1365-263x.1994.tb00098.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thirty children diagnosed as suffering from acute lymphoblastic leukaemia were followed up for between 6 months and 1 year during their treatment for the disease. Dental examinations were carried out at approximately monthly intervals for caries, gingival condition, plaque and calculus. The results showed a significant deterioration in gingival condition, but there were no significant changes in the amounts of plaque and calculus. No new carious lesions developed in any of the children's teeth during the study period.
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Affiliation(s)
- E A O'Sullivan
- Division of Child Dental Health, University of Leeds, England
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