Oral Health, Caries Risk Profiles, and Oral Microbiome of Pediatric Patients with Leukemia Submitted to Chemotherapy

Leukemia/lymphoma oral infiltration and its impact on disease outcomes: A Brazilian study

OBJECTIVE

Oral malignant infiltrations (OMI) are relevant for the diagnosis and prognosis of leukemia/lymphoma. This study analysed the oral health status and OMI of individuals with leukemia/lymphoma.

MATERIALS AND METHODS

A retrospective analysis (2010-2021) of data from individuals seen at a specialized hospital-based dental service in Brazil.

RESULTS

A total of 781 cases of leukemia/lymphoma were surveyed. Acute lymphoblastic leukemia (30.1%), acute myeloid leukemia (AML; 26.0%), and non-Hodgkin lymphoma (22.2%) were the most common diagnoses. The first (21.3%) and second (19.3%) decades of life were the most affected. Overall, dental caries (36.7%) and periodontal changes (34.6%) were the most frequent oral conditions. OMI occurred in 25 (3.2%) individuals. Lesions mainly involved the gingiva (80%) and patients diagnosed with AML (64%). Death (p < 0.001) and worse periodontal condition (p = 0.036) were more frequent among adults with OMI than among those without OMI. Death (p = 0.002) was more frequent among paediatric individuals with OMI than among those without OMI. When controlling for underlying disease, no association was observed between OMI and these outcomes.

CONCLUSION

Oral status of individuals with leukemia, particularly those with acute leukemia or lymphoma, should be closely monitored since one or multiple conditions may occur, including OMI, which may influence disease outcomes.

[Impact of acute lymphoblastic leukemia on the microbiome and oral lesions: scoping review]

Objective

To describe the existing knowledge about the alterations of the MBO oral microbiome and the presence of OL Oral Lesions in patients with Acute Lymphoblastic Leukemia ALL.

Materials and Methods

An electronic search was carried out in the PubMed, SciELO, and academic Google databases, and descriptive, analytical, observational articles on MBO, OL, and ALL were included, following the PRISMA criteria. 642 were evaluated, duplicate articles, case reports, and those where only changes were reported during or after chemotherapy treatment were eliminated.

Results

10 articles were evaluated, published between 1997 and 2021, 4 articles agreed that the MBO of patients with ALL is in dysbiosis showing a significant increase in firmicutes 0.1%, bacillus 0.05%, and opportunistic bacteria such as Moraxella spp, Klebsiella spp 5.66%, Pseudomonas spp 3.77%, Enterobacter spp 1.88%, Acinetobacter spp 1.88% and E. coli 1.08%, the most frequent OL reported in 5 articles were spontaneous gingival bleeding 3.5%, gingivitis 25% and ulcers 9.4%.

Conclusions

The oral cavity of patients with ALL is in dysbiosis and associated OL is identified. It is necessary to establish preventive strategies with a niche-ecological approach to restore the MBO, to reduce the risk of opportunistic infections and other OL during chemotherapy treatment.

Effectiveness of Application of Oral Regimen, Practicing Oral Health, Health Education, Observation (APHO) Nursing Intervention in Preventing and Managing Oral Mucositis in Children Undergoing Chemotherapy: An Interventional Study in Central India

Background The incidence of childhood cancer is rising worldwide, with acute lymphoblastic leukemia being the most commonly diagnosed form. These young patients are immunocompromised and susceptible to infections. In addition, chemotherapy and radiation therapy often cause oral mucositis as a side effect. Given these challenges, nurses play a crucial role in delivering special care to these vulnerable children. Material and methods A study design utilizing a one-group pretest-posttest approach was implemented on 45 children, aged one to 12 years, who were undergoing chemotherapy and experiencing oral mucositis. Demographic information, including age, gender, diagnosis, chemotherapy cycle, and length of therapy, was collected. A customized intervention, which involved the application of an oral regimen, oral health practices, health education for caregivers, and observation, was administered by nursing staff using the APHO (Application of an Oral Regimen, Practicing Oral Health, Health Education to Caregivers, and Observation) protocol for a period of seven days. Both pre-intervention and post-intervention assessments were conducted to determine the effectiveness of the APHO nursing intervention. The assessment tool used to assess the effectiveness of APHO intervention was using a standardized scale given by the World Health Organization grading scale for oral mucositis. Result An analysis was conducted utilizing both descriptive and inferential statistics. Before the intervention, those children in grade 2 were in grade 1 after the intervention, and the children in grade 1 before the intervention were in grade 0 after the intervention. The health education provided to the caregivers was significantly effective. Notably, there was a significant decrease in the oral mucositis grade of the children by one level in all instances, indicating that the APHO nursing intervention was remarkably effective. Thus, promoting the use of APHO nursing intervention can lead to positive outcomes in children afflicted with oral mucositis. Conclusion APHO nursing intervention has shown remarkable effectiveness among children with mucositis. As a result, promoting continuous APHO intervention in children with mucositis can help enhance in prevention and management.

Structural Changes in Resin-Based Composites in Saliva of Patients with Leukemia before Starting Chemotherapeutic Regimen

Background: The aim of this in vitro study was to assess the morphological characteristics and stability of dental composites immersed in saliva collected from patients with leukemia. Material and Methods: A total number of five patients without systemic disease and 20 patients with leukemia (acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML)) were included for saliva sampling. Composite disks were immersed in the leukemia, control, and artificial environments for 7 days. At the end of the experiment, atomic force microscopy (AFM), color stability (ΔE), and saliva elements analysis were performed. Statistical significance was considered for a p-value under 0.05. Results: The most changed surface resulted for ALL with a roughness that was almost double that of the untreated sample and was significantly increased compared to the healthy saliva. The effect of CLL was not as intense as observed for acute leukemia, but was significantly over the control. ALL seemed to modify structural components of the saliva, which were able to deteriorate the surface of the composite. ALL saliva promoted a significant dissolution of the initial feature of the samples and promoted nano-particle clusterization. All dental composites showed clinically acceptable color change values (ΔE < 3.3) in all four-leukemia salivas; CLL and CML showed large color differences for all composites. The total concentrations of P, Na, and K showed wide ranges of variations, while the coefficient of variation in Fe, Cu, and Mg showed narrow variations between the salvias’ investigated. The salivary concentration of zinc decreased considerably in the CLL and CML environments compared to the ALL and AML environments. Fe and Cu were significantly increased in the CML environment. Conclusions: Control and artificial salivas have a mild erosive effect on the surface of dental composites. The acute stage of the disease seems to deteriorate the surface roughness rather than its morphology, however, in the chronic stage, it is the surface morphology that mostly deteriorates.

Evaluation of Changes to the Oral Microbiome Based on 16S rRNA Sequencing among Children Treated for Cancer

Simple Summary

Childhood cancer survivors suffer from many oral complications during and after primary therapy. Our study focuses on changes in the oral microbiome of cancer survivors. Using 16S rRNA sequencing, we observed global and distinct changes in oral microbiome associated with a patient’s age and therapy duration, but not antibiotic therapy or cancer type. Observed changes in the oral microbiome could differentiate patients at higher risk of long-term oral complications.

Abstract

A child’s mouth is the gateway to many species of bacteria. Changes in the oral microbiome may affect the health of the entire body. The aim of the study was to evaluate the changes in the oral microbiome of childhood cancer survivors. Saliva samples before and after anti-cancer treatment were collected from 20 patients aged 6–18 years, diagnosed de novo with cancer in 2018–2019 (7 girls and 13 boys, 7.5–19 years old at the second time point). Bacterial DNA was extracted, and the microbial community profiles were assessed by 16S rRNA sequencing. The relative abundances of Cellulosilyticum and Tannerella genera were found to significantly change throughout therapy (p = 0.043 and p = 0.036, respectively). However, no differences in the alpha-diversity were observed (p = 0.817). The unsupervised classification revealed two clusters of patients: the first with significant changes in Campylobacter and Fusobacterium abundance, and the other with change in Neisseria. These two groups of patients differed in median age (10.25 vs. 16.16 years; p = 0.004) and the length of anti-cancer therapy (19 vs. 4 months; p = 0.003), but not cancer type or antibiotic treatment.

Influence of the treatment with the antineoplastic agents 5-fluorouracil and cisplatin on the severity of experimental periodontitis in rats

PURPOSE

The determination on how antineoplastic agents interfere on the progression of periodontitis is critical for improvement and even development of novel therapeutic approaches for periodontal management. This study evaluated the influence of chemotherapy with 5-fluorouracil (5-FU) or cisplatin (CIS) on healthy periodontal tissues and on the progression of experimental periodontitis (EP).

METHODS

One hundred forty-four male rats were divided into six groups (n = 24). Each group was treated with physiological saline solution (PSS) 0.9%, 5-FU, or CIS. Experimental periodontitis (EP) was induced by ligature placement. Animals were euthanized at 7, 15, and 30 days after treatment. Data were statistically analyzed (p ≤ 0.05).

RESULTS

The groups with EP and treated with 5-FU or CIS showed lower percentage of bone volume in the furcation region and higher percentage of alveolar bone loss, higher number of TRAP-positive cells, and lower number of PCNA-positive cells when compared group with EP and treated with PSS (p ≤ 0.05). Groups with EP and treated with 5-FU or CIS showed high immunolabelling pattern of RANKL, TNF-α, and IL-1β, moderate of BAX, and low of HIF-1α. Histological analysis showed severe tissue breakdown in the groups with EP and treated with 5-FU or CIS.

CONCLUSIONS

Chemotherapy with antineoplastic agents 5-FU and CIS increased the intensity and duration of the inflammation and compromised tissue repair by reduction in cellular and vascular turnover. The more severe periodontal breakdown was caused by 5-FU.

The Microbiome in Childhood Acute Lymphoblastic Leukemia

For almost 30 years, the term "holobiont" has referred to an ecological unit where a host (e.g., human) and all species living in or around it are considered together. The concept highlights the complex interactions between the host and the other species, which, if disturbed may lead to disease and premature aging. Specifically, the impact of microbiome alterations on the etiology of acute lymphoblastic leukemia (ALL) in children is not fully understood, but has been the focus of much research in recent years. In ALL patients, significant reductions in microbiome diversity are already observable at disease onset. It remains unclear whether such alterations at diagnosis are etiologically linked with leukemogenesis or simply due to immunological alteration preceding ALL onset. Regardless, all chemotherapeutic treatment regimens severely affect the microbiome, accompanied by severe side effects, including mucositis, systemic inflammation, and infection. In particular, dominance of Enterococcaceae is predictive of infections during chemotherapy. Long-term dysbiosis, like depletion of Faecalibacterium, has been observed in ALL survivors. Modulation of the microbiome (e.g., by fecal microbiota transplant, probiotics, or prebiotics) is currently being researched for potential protective effects. Herein, we review the latest microbiome studies in pediatric ALL patients.

Microbiome Analysis of Carious Lesions in Pre-School Children with Early Childhood Caries and Congenital Heart Disease

Oral bacteria have been associated with several systemic diseases. Moreover, the abundance of bacteria associated with caries has been found to be higher in patients with congenital heart disease (CHD) than in healthy control groups (HCGs). Therefore, this study aimed to evaluate the dental microbiota in children with CHD compared to a HCG. The aim was to describe and compare the carious microbiome regarding the composition, diversity, and taxonomic patterns in these two groups. Twenty children with CHD and a HCG aged between two and six years participated. All of them were affected by early childhood caries. Microbiome profiling indicated that Fusobacterium, Prevotella, Capnocytophaga, and Oribacterium were more abundant in the CHD group, whereas Lactobacillus and Rothia were predominant in the HCG. Furthermore, microbiome analysis revealed three distinct clusters for the CHD and HCG samples. In the first cluster, we found mainly the genera Lactobacillus and Coriobacteriaceae. The second cluster showed a higher relative abundance of the genus Actinomyces and a more diverse composition consisting of more genera with a smaller relative lot. The third cluster was characterized by two genera, Streptococcus and Veillonella. These data can help us to understand the oral microbial community structures involved in caries and endodontic infections of pre-school children in relation to the general health of these high-risk patients.