Diagnosis, prophylaxis and treatment of oral complications in children with acute lymphoblastic leukemia. A narrative review

Abstract

Acute lymphoblastic leukemia (ALL) is a malignant condition defined by the proliferation of immature hematopoietic bone marrow cells, which replace the normal bone marrow elements. Furthermore, immature cells will accumulate in various areas of the body. Chemotherapeutic drugs are cytotoxic and have unwanted effects on normal cells. This toxicity is acute, or it may be chronic. Approximately 60% of survivors of ALL will suffer from one or more health problems or adverse side effects of this treatment. Oral complications are a frequent consequence of oncology therapy in pediatric patients. Xerostomia, carious lesions, gingivitis, tumors of the oral cavity, bone deformities of the jaw, temporomandibular joint disorders, trismus, and infections due to abundant microbial flora are common in these children. The risk of dental anomalies (dental or root agenesis, root malformations, enamel defects, dental hypoplasia) is higher in those who started treatment before permanent teeth erupt. All children are at risk of developing oral lesions due to poor hygiene, but children who have survived cancer are at even higher risk. The survival rate of children diagnosed with ALL has significantly increased thanks to remarkable advances in chemotherapy. Therefore, it is important that these patients are constantly monitored by the dentist to treat complications arising from the treatments in a timely manner. In children diagnosed with ALL, oral health is of great importance as the oral environment changes as a side effect of hematological disorders and their treatments. Treatment of carious lesions, periodontal problems and lesions of the oral mucosa must be done before starting chemotherapy by cleaning the oral cavity to eliminate any possible risk of infection. The participation of the dentist is important in improving the preventive protocols and oral examination of the pathological processes that occur in children with ALL. Interdisciplinary collaboration between physicians is essential during the treatment of pediatric cancer patients.