Humoral immunity of the oral cavity during remission-induction therapy in patients with acute myeloid leukaemia

Oral sources of septicaemia in patients with malignancies

This article reviews papers dealing with oral infections of adult septicaemia patients, searched from MEDLINE, Current Contents and Core Biomedical Collection databases from January 1966 to November 1996. Case reports were excluded. The systematic review of literature revealed that our knowledge of the topic is mostly based on very small patient material. There are no multicentre studies on the effects of various oral health treatment modes on the prevention of septicaemia of oral origin. The number of controlled and comparative studies on the efficacy of the different treatment protocols of oral infections is also small. Current recommendations in this respect are mainly empirical and not evidence based. Clinical practice guidelines are therefore urgently needed. Nevertheless, close co-operation between oncological and oral health units is emphasised because many studies have shown that the oral cavity is indeed an important source of bacteraemia. Life-threatening infections may follow if maintenance of oral health is neglected during anticancer therapy and if potential oral infection foci are left untreated before immunosuppressive therapy.

Salivary immunoglobulins in cancer patients with chemotherapy-related oral mucosa damage

In 40 patients with neoplastic disorders treated with chemotherapy containing anthracyclines or 5-fluorouracil, objective changes of the oral mucosa were registered in 22 patients (55%). Serum IgG and IgA levels and the mean serum IgG/IgA ratio were normal. On the contrary, the mean IgG/IgA salivary ratio was 1.27 (normally below 1.0) due to an increased salivary concentration of IgG (mean 0.095 g/l), but also due to a decreased IgA concentration (mean 0.075 g/l); the IgG/IgA ratio in saliva was higher in patients with objective changes of the oral mucosa (1.53). Values of the periodontal indices were compatible with the diagnosis of a manifest periodontal disease, which tended to be more severe than in control groups. A positive correlation between the gingival index and concentration of IgG in saliva, a non-linear correlation between the gingival index and salivary IgA and a positive linear correlation between serum IgA concentration and intensity of periodontal attachment level recession, indicate local and systemic immune responses to periodontal tissue alterations and dental plaque components. The IgA related local humoral immune response is, however, operating at a lower concentration level than in healthy individuals.