Acute lymphoblastic leukemia is the most common type of childhood leukemia, and most children with acute lymphoblastic leukemia show impaired oral health, high risk of dental caries, altered caries related factors and oral flora disorders, with significantly higher periodontitis status and oral mucous inflammation. Dental morphological disorders are more common in children with ALL than in healthy children. In children with ALL, malocclusion due to small dental clusters may also trigger TMJ disorders. In recent years, the treatment and prognosis of children with acute lymphoblastic leukemia have been significantly improved, but the disease and its therapeutic measures can lead to a variety of oral complications, which affects further treatment and is not conducive to disease control. Maintaining oral health, improving related symptoms of patients and reducing the occurrence of complications has received much attention. In order to improve the quality of life of children, this paper reviews the oral health status and oral health management of children with acute lymphoblastic leukemia, providing clinical reference.

Lan Lan, Yuwei Han, Yishan Liu. Oral health and oral health management in children with acute lymphoblastic leukemia. International Journal of Frontiers in Medicine (2023), Vol. 5, Issue 8: 115-120. https://doi.org/10.25236/IJFM.2023.050816.

[1] Duan Y F. Research progress on the relationship between STAT5 and acute lymphoblastic leukemia in children [J]. Chinese Journal of Pediatrics, 2002, 24(8): 942-947. 

[2] Tang Yawen, Zhang Lin, Yang Xue et al. Oral health management of children with acute lymphoblastic leukemia [J]. Oral Disease Prevention and Treatment, 2019, 29(8): 572-576. (In Chinese)

[3] Riley P, Glenny AM, Worthington HV, et al. Interventions for preventing oralmucositis in patients with cancer receiving treatment: cytokines and growth factors [J]. Cochrane Database Syst Rev, 2017, 11(11): Cd011990. 

[4] Wang Y, Zeng X, Yang X, Que J, Du Q, Zhang Q, Zou J. Oral Health, Caries Risk Profiles, and Oral Microbiome of Pediatric Patients with Leukemia Submitted to Chemotherapy. Biomed Res Int. 2021 Jan 16; 2021: 6637503. doi: 10. 1155/2021/6637503. PMID: 33532491; PMCID: PMC7834790. 

[5] Sun Wenmin, Ming Xiuyun, Zhang Xiuyun, et al. Multi-factor nursing intervention of oral lesions after chemotherapy for leukemia [J]. PLA Journal of Nursing, 2006, 23(7): 14-16. (In Chinese)

[6] Garrett WS, Lord GM, Punit S, et al. (2007) Communicable ulcerative colitisinduced by T-bet deficiency in the innate immune system. Cell 131: 33-45. 

[7] Barrett AP (1986). Leukemic cell infiltration of the gingivae. J Periodontol 57: 579-581. 

[8] Hou GL, Huang JS, Tsai CC (1997). Analysis of oral manifestations of leukemia: a retrospective study. Oral Dis 3: 31-38. 

[9] Meyer U, Kleinheinz J, Handschel J, et al. (2000) Oral findings in three different groups of immunocompromised patients. J Oral Pathol Med 29: 153-158. 

[10] Javed F, Utreja A, Bello Correa FO, et al. (2012) Oral health status in children with acute lymphoblastic leukemia. Crit Rev Oncol Hematol 83: 303-309. 

[11] E. C. de Oliveira Lula, C. E. de Oliveira Lula, C. M. Alves, F. F. Lopes, and A. L. Pereira, “Chemotherapy-induced oral complications in leukemic patients, ” International Journal of Pediatric Otorhinolaryngology, vol. 71, no. 11, pp. 1681–1685, 2007. 

[12] N. Oosterom, P. H. Griffioen, M. A. H. den Hoed et al, “Global methylation in relation to methotrexate-induced oral mucositis in children with acute lymphoblastic leukemia, ” PLoS One, vol. 13, no. 7, article e0199574, 2018. 

[13] Mazaheri R, Jabbarifar E, Ghasemi E, et al. Oral health status, salivary pH status, and Streptococcus mutans counts in dental plaques and saliva of children with acute lymphoblastic leukemia. Dent Res J (Isfahan). 2017 May-Jun; 14(3): 188-194. 

[14] Ribeiro ILA, Limeira RRT, Dias de Castro R, et al. Oral mucositis in pediatric patients in treatment for acute lymphoblastic leukemia [J]. Int J Environ Res Public Health, 2017, 14(12). 

[15] Sroussi HY, Epstein JB, Bensadoun RJ, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis [J]. Cancer Med, 2017, 6(12): 2918-2931. 

[16] Vuciccevicc Boras V, Vidoviccc Juras D, Aurer I, et al. Gingival ulcerations in a patient with acute myeloid leukemia: a case report and literature review [J]. Acta Clin Croat, 2019, 58(3): 556 - 560. 

[17] Pereira IF, Firmino RT, Meira HC, et al. Radiation - induced oral mucositis in brazilian patients: prevalence and associated factors [J]. In Vivo, 2019, 33(2): 605-609. 

[18] Figliolia SL, Oliveira DT, Pereira MC, et al. Oral mucositis in acute lymphoblastic leukaemia: analysis of 169 paediatric patients [J]. Oral Dis, 2008, 14(8): 761-766. 

[19] Riley P, Glenny AM, Worthington HV, et al. Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors [J]. CochraneDatabaseSystRev, 2017, 11(11): Cd011990. 

[20] Kapoor G, Goswami M, Sharma S, et al. Assessment of oral health status of children with Leukemia: a cross-sectional study [J]. Spec Care Dentist, 2019, 39(6): 564-571. 

[21] Krasuska-Sławińska E, Broz·yna A, Dembowska-Bagińska B, et al. Factors influencing caries incidence in permanent teeth in children/adolescents under and after anti-neoplastic treatment [J]. Contemp Oncol (Pozn), 2016, 20(1): 45 - 51. 

[22] Goho C. Chemoradiationtherapy: effect on dental development. Pediatr Dent 1993; 15: 6-12. 

[23] V ahlsing HL, Kim SK, Feringa ER. Cyclophosphamide-induced abnormalities in the incisors of the rat. J Dent Res 1977; 56: 809-16. 

[24] Stene T. Effect of vincristine on odontoblasts in rat incisor. Scand J Dent Res 1978; 86: 346–56. 

[25] Maciel JC, de Castro Jr CG, Brunetto AL, et al. Oral health and dental anomalies in patients treated for leukemia in childhood and adolescence. Pediatr Blood Cancer 2009; 53: 361–5. 

[26] Dahllöf G, Rozell B, Forsberg CM, et al. Histologic changes in dental morphology induced by high dose chemotherapy and total body irradiation. Oral Surg Oral Med Oral Pathol 1994; 77: 56–60. 

[27] Kaste SC, Hopkins KP, Jenkins 3rd JJ. Abnormal odontogenesis in children treated with radiation and chemotherapy: imaging findings. AJR Am J Roentgenol 1994; 162: 1407–11. 

[28] Sonis AL, Tarbell N, Valachovic RW, et al. Dentofacial development in long-term survivors of acute lymphoblastic leukemia. A comparison of three treatment modalities. Cancer 1990; 66: 2645–52. 

[29] Kaste SC, Hopkins KP, Jones D, et al. Dental abnormalities in children treated for acute lymphoblastic leukemia[J]. Leukemia, 1997, 11(6): 792-796. 

[30] Çetiner D, Çetiner S, Uraz A, et al. Oral and dental alterations and growth disruption following chemotherapy in long - term survivors of childhood malignancies[J]. Support Care Cancer, 2019, 27(5): 

[31] Anirudhan D, Bakhshi S, Xess I, et al. Ls A. Etiology and outcome of oral mucosal lesions in children on chemotherapy for acute lymphoblastic leukemia. Indian Pediatr 2008; 45: 47–52. 

[32] Subramaniam P, Girish Babu KL, Nagarathna J. Oral manifestations in acute lymphoblastic leukemic children under chemotherapy. J Clin Pediatr Dent 2008; 32: 319–24. 

[33] Azher U, Shiggaon N. Oral health status of children with acute lymphoblastic leukemia undergoing chemotherapy[J]. Indian J Dent Res, 2013, 24(4): 523. 

[34] Kung AY, Zhang S, Zheng LW, et al. Oral health status of chinese paediatric and adolescent oncology patients with chemotherapy in Hong Kong: a pilot study[J]. Open Dent J, 2015, 9: 21-30. 

[35] K. P. Dholam, S. Gurav, J. Dugad, and S. Banavli, “Correlation of oral health of children with acute leukemia during the induction phase, ” Indian journal of medical and paediatric oncology : official journal of Indian Society of Medical & Paediatric Oncology, vol. 35, no. 1, pp. 36–39, 2014. 

[36] C. H. Hong, J. J. Napeñas, B. D. Hodgson et al, “A systematic review of dental disease in patients undergoing cancer therapy, ” Support Care Cancer, vol. 18, no. 8, pp. 1007–1021, 2010. 

[37] Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in Temporomandibular disorders: a review [J]. J Can Dent Assoc, 2017, 83: h7. 

[38] Dahllöf G, Krekmanova L, Kopp S, et al. Craniomandibular dysfunction in children treated with total - body irradiation and bone marrow transplantation[J]. Acta Odontol Scand, 1994, 52(2): 99 105. 

[39] Wu VW, Lam YN. Radiation - induced temporo - mandibular joint disorder in post - radiotherapy nasopharyngeal carcinoma patients: assessment and treatment[J]. J Med Radiat Sci, 2016, 63(2): 124132. doi: 10. 1002/jmrs. 145. 

[40] Stein C, Santos NML, Hilgert J. B. , et al. Effectiveness of oral health education on oral hygiene and dental caries in schoolchil⁃dren: systematic review and meta⁃analysis[J]. Community Dent Oral Epidemiol, 2018, 46(1): 30⁃37. 

[41] Djuric M, Hillier -Kolarov V, Belic A, et al. Mucositis prevention by improved dental care in acute leukemia patients[J]. Support Care Cancer, 2006, 14(2): 137-146. 

[42] Furlong W , Rae C , Feeny D ,et al.Health‐related quality of life among children with acute lymphoblastic leukemia[J]. Pediatric Blood & Cancer, 2012, 59(4):717-724.DOI:10.1002/pbc.24096.

[43] Gaetti-Jardim E Jr, Jardim ECG, Schweitzer CM, et al. Supragingi-val and subgingival microbiota from patients with poor oral hy-giene submitted to radiotherapy for head and neck cancer treat-ment[J]. Arch Oral Biol, 2018, 90: 45-52.

[44] Bahrololoomi Z, Sadat-Hashemi A, Hassan-Akhavan-Karbassi M, et al. Evaluating the additive effect of Persica and chlorhexidine mouthwashes on oral health status of children receiving chemotherapy for their hematomalignancy: A randomized clinical trial[J]. J Clin Exp Dent, 2020, 12(6): e574-e580. 

[45] Kawashita Y, Soutome S, Umeda M, et al Oral management strategies for radiotherapy of head and neck cancer[J]. Jpn Dent Sci Rev, 2020, 56(1): 62-67. 

[46] Lalla RV, Treister N, Sollecito T, et al. Oral complications at 6months after radiation therapy for head and neck cancer[J]. OralDis, 2017, 23(8): 1134-1143.