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Oral and Dental Considerations in Pediatric Leukemic Patient

DOI: 10.1155/2014/895721

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Abstract:

Throughout the world, there have been drastic decline in mortality rate in pediatric leukemic population due to early diagnosis and improvements in oncology treatment. The pediatric dentist plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child’s health and quality of life during, and follow up of the cancer treatment. This manuscript discusses recommendations and promotes dental care of the pediatric leukemic patients. 1. Introduction Leukemia constitutes approximately 30% of all childhood cancers and acute lymphoblastic leukaemia (ALL) is the most common type of malignancy encountered in children [1, 2]. ALL accounts for about 75% of childhood leukemias with its peak incidence at 4 years of age [3]. Acute lymphoblastic leukemia (ALL) is a malignant disorder resulting from the clonal proliferation of lymphoid precursors with arrested maturation [4]. The disease can originate in lymphoid cells of different lineages, thus giving rise to B-cell or T-cell leukemias or sometimes to mixed lineage leukemia. Acute lymphoblastic leukemia was one of the first malignancies to respond to chemotherapy [5]. Among various leukemia categories, it was the first leukemia that could be cured in a majority of children [6]. Since then, much progress has been made, not only in terms of treatment but also in prevention of oral problems due to cancer treatment in children. The most common signs and symptoms of ALL are anorexia, irritability, lethargy, anemia, bleeding, petechiae, fever, lymphadenopathy, hepatosplenomegaly, and bone pain and arthralgias caused either by leukemic infiltration of the perichondral bone or joint or by leukemic expansion of the bone marrow cavity leading to disability in walking in children [3]. The most common head, neck, and intraoral manifestations of ALL at the time of diagnosis are lymphadenopathy, sore throat, laryngeal pain, gingival bleeding, and oral ulceration [7]; see Table 1. Table 1: World Health Organization (WHO) recommendations for grading of acute and subacute toxic effects [ 10]. 2. Methods The current paper revision included a new systematic literature search of the PubMed electronic data base using the following parameters: terms: “pediatric cancer,” “pediatric oncology,” “hematopoietic cell transplantation,” “bone marrow transplantation,” “mucositis,” “stomatitis,” “chemotherapy,” “radiotherapy,” “acute effects,” “long-term effects,” “dental care,” “oral health,” and “pediatric dentistry.” 3. The Oncology Treatment of Acute Lymphoblastic Leukemia Is

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