Oral Assessment of the Patients With Hematological Malignancies, 161 Cases during 2 Years

Oral assessment of the patients with hematological malignancies, 161 cases during 2 years

Yasuyuki Shimada ¹, Yohei Kawasaki ², Izumi Sato ³, Yumiko Nakagawa ⁴, Shiori Miyasako ¹, Michita Tayama ¹, Hitoshi Kurokawa ¹, Hiroshi Yamada ², and Yutaka Maruoka ¹

¹ Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine Hospital, Tokyo, Japan

² Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan

³ Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

⁴ AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan

Statements of the problem; The oral cavity has been identified as a potential site of complications in patients who need chemotherapy for hematological malignancy. However, there are few literatures that investigated the optimal oral management before chemotherapy and the details of oral complications after chemotherapy by a large-scale cohort study. This retrospective study was designed to carefully define and evaluate oral health conditions before and after chemotherapy and complications related to tooth extraction in a population of the patients with hematological malignancy.

Materials and methods; The study population included 161 patients with hematological malignancies such as multiple myeloma, malignant lymphoma, acute myeloid / lymphoid leukemia, and myelodysplastic syndrome seen in the Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine Hospital, Tokyo, Japan, during the 2-year study period from January 2011 through December 2012. Patients who had already received chemotherapy were excluded. Of these patients, 80 visited our institution before chemotherapy was initiated. Oral health care and dental treatments including tooth extraction were performed for these patients. Charts and panoramic radiographs were reviewed retrospectively to evaluate oral health conditions before and after chemotherapy. Attention was directed to a time frame about one month after the chemotherapy were performed

Results; The patients included 45 males (56%) and 35 females (44%) whose age at first visit ranged from 26 to 90 years, with a median of 64 years. Of the 80 patients, 8 (10%) suffered oral complications after chemotherapy, the most common of these being the progression of marginal periodontitis (n = 3; 38%), which is unrelated to the tooth extraction site. Two of the 28 tooth extraction cases (7.1%) had poor prognosis such as dry socket and bacterial infection. Two cases that we decided not to do tooth extraction owing to tight schedule of chemotherapy and physical conditions had acute inflammation of the affected sites after chemotherapy. On the other hand, 72 (90%) patients did not suffer any oral complications after chemotherapy and were able to go on chemotherapy without stress in their oral cavity.

Conclusion; This study suggests that the removal of infection focus in oral cavity as much as possible before chemotherapy is crucial for the patients with hematologic malignancy without reducing their quality of life.

References;

1)       Raut A, Huryn JM, et al: Sequelae and complications related to dental extractions in patients with hematologic malignancies and the impact on medical outcome. Oral Surg Oral Med Oral Pathol Oral Radio Endod 92: 49-55, 2001.

2)       Guven GS, Uzun O, et al: Infectious complicationsinpatientswithhematologicalmalignanciesconsultedbytheInfectiousDiseasesteam:aretrospective cohort study (1997-2001). Support Care Cancer 14: 52-55, 2006.