title: Incidence of oral complications and application of a preventive protocol in children with acute leukemia.
abstract: This prospective, controlled study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL). During a 13-month period, 96 children from one to 16 years of age with a diagnosis of ALL were evaluated. When the study was initiated, 60 patients already undergoing chemotherapy received palliative treatment for complications (Group I). Thirty-six children (Group II) with newly diagnosed ALL received a daily preventive protocol consisting of: (1) elimination of bacterial plaque; (2) application of a mouthwash with a non-alcoholic solution of chlorhexidine 0.12% and (3) topical application of iodopovidone, followed by "swish and swallow" with nystatin 500,000 units. Children in both groups were examined every 7 to 14 days by our pediatric dentistry team. We found a significant improvement in oral hygiene (p = 0.001) and a significant decrease in the incidence of mucositis grade 2 (p = 0.0013) and oral candidiasis (p = 0.009) in the Group II children. These findings show that the systematic application of a preventive protocol significantly reduces the incidence of oral complications. The results of this study identify a need to include a pediatric dentist in a multidisciplinary team which provides oral care for cancer patients.
authors.affiliation: Pediatric Dentistry Department, University of Maryland Dental School, Baltimore, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Levy-Polack
authors.forename: P
authors.initials: P
authors.lastname: Sebelli
authors.forename: N L
authors.initials: NL
authors.lastname: Polack
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects; D001118:Argentina / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill / Q000379:methods*; D005260:Female; D005891:Gingivitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009059:Mouth Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009061:Mouth Mucosa / Q000473:pathology; D009761:Nystatin / Q000627:therapeutic use; D009910:Oral Hygiene / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D013280:Stomatitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D000970:Antineoplastic Agents; D009761:Nystatin; D002710:Chlorhexidine