Odontostomatologic management of hemato-oncologic pediatric patients

Aim: dentists both as clinical practice and research increased progressively their interest in leukemia, because the oral complications are common during the outcome of the disease, dental management is complex, and the mouth is a potential source of morbidity. Dental Clinic of University of Milan-Bicocca has prepared, in collaboration with the Hematologic Pediatric Department, guidelines for dental treatment of children affected by leukemia. Dentists, who take care of leukemic children, have several roles: diagnostic, preventive, therapeutic and supportive role. Diagnostic role: head and neck signs resulting from leukemic infiltrates include cervical lymphadenopathy, oral bleeding, gingival infiltrates, oral infections, and oral ulcers. Thrombocytopenia and anemia manifest in pallor of the mucosa, petechiae, and ecchymoses, as well as gingival bleeding. Spontaneous gingival bleeding is common when the platelet count falls below 20.000/mm3. Preventive role: dental treatment to eliminate potential sources of oral infection, such as teeth with caries, pulpitis, moderate to severe periodontal disease, is accompanied by a significant reduction in the rate of septicemia. The early diagnosis of oral infection is mandatory because oral disease is considered a true source of potentially life-threatening infection from gram-positive and gram-negative bacilli. The oral flora is the most likely sources of septicemia in 50% of cases. Therapeutic role: it is dentists' duty to develop screening evaluation and remove sources of infection before chemotherapy has started, following subsequent guidelines: complete oral examination, removal of orthodontic brackets, conservative therapy, professional hygiene, resolution of inflammation, extraction of compromised teeth, even if platelet transfusion and intravenous combinated antibiotics may be required before. The use of absorbable gelatin or collagen sponges, topical thrombin, or the placement of microfibrillar collagen held in place by packing or splints are helpful. Supportive role: as survival rate of children with cancer increased significantly during the past decades, late effects of antineoplastic therapy become important to be forwarded. Children with acute lymphoblastic leukemia received brain radiation and chemotherapy to prevent a relapse. Craniofacial deformities and dental anomalies are quite common in children who receive this therapy, expecially before age 5. The most common abnormalities reported in children were deficient mandibular development, dental agenesis, arrested root development, microdontia, and enamel dysplasia. Conclusions: Leukemic children need special care. Appropriate oral hygiene and health should be manteined and restored before development of irreversible dental damage: only a close cooperation among pediatric hematoncologists, pediatric dental surgeons, and dental hygienists could guarantee these. In the last 5 years we have treated 317 leukemic children and have made 5292 dental care. Our experience suggests that even if detrimental impact of antineoplastic therapy on oral cavity is unavoidable, it could be diminished with an adequate and correct preventive or curative therapy contributing to a better quality of life of children treated for leukemia.