CDA Essentials 2016 • Volume 3 • Issue 8

30 | Volume 3 Issue 7 S upporting Y our P ractice For children with leukemia, the oral cavity can be a source of bleeding and infection as a consequence of the disease itself or the chemotherapy prescribed to treat it. Good oral health can help mitigate that risk as well as improve oral comfort during therapy. In an article published in the journal Materia Socio Medica , Kholoud et al. recommend treating all teeth likely to produce complications 10–14 days prior to chemotherapy. 1 Oncology teams are unlikely to wait to start chemotherapy until after the mouth is optimized. Improved outcomes have been demonstrated for patients receiving expedited chemotherapy to treat leukemia. It is more likely that oral care would be coordinated to occur between cycles of chemotherapy so that the dentist can provide comprehensive and definitive care at a time while minimizing risk to the child. Dental interventions are commonly timed to coincide with the completion or initiation of a chemotherapy cycle, when the child’s platelet and white blood cell counts are most favourable to reduce the risk of sepsis and uncontrolled bleeding. Oral mucositis is the most significant source of oral morbidity during leukemia therapy and is exacerbated by poor oral hygiene. Due to the neutropenia and thrombocytopenia experienced by some children undergoing chemotherapy, regular brushing and flossing may not be consistently achievable. Moreover, the alcohol in chlorhexidine rinse may worsen the pain of mucositis. Hygiene may instead be managed with sodium bicarbonate- based mouth rinses. Mouth rinses containing topical anesthetics can also help reduce pain, and cryotherapy (sucking on ice chips) may reduce the incidence of mucositis as well as provide some pain relief. There is weak evidence for the efficacy of palifermin (recombinant keratinocyte growth factor) and low-level laser therapy for reduction of mucositis in adults, but efficacy has yet to be demonstrated in children. The general considerations put forward by Kholoud et al. for providing care to children with leukemia are sound: healthy mouths reduce the risks of leukemia . Contemporary practice, however, may diverge from some of the specific recommendations provided in the article. a Michael Casas DDS, DPaed,MSc, FRCD(C) Dr. Casas is director of clinics, department of dentistry, at the Hospital for Sick Children and associate professor at the University of Toronto faculty of dentistry DENTAL CONSIDERATIONS in Managing Pediatric Patients with Leukemia CDA thanks Materia SocioMedica for allowing us to republish a synopsis of its article, on the following page. Oral mucositis is the most significant source of oral morbidity during leukemia therapy and is exacerbated by poor oral hygiene. This interviewhasbeeneditedandcondensed. Theviewsexpressedarethoseoftheauthorand donotnecessarilyreflecttheopinionsorofficial policiesoftheCanadianDentalAssociation.