CDA Essentials 2016 • Volume 3 • Issue 7 - page 30

30
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Volume3 Issue7
S
upporting
Y
our
P
ractice
For childrenwith leukemia, the oral cavity canbe a source of bleedingand infectionas
a consequence of the disease itself or the chemotherapy prescribed to treat it.Good oral
health canhelpmitigate that riskaswell as improve oral comfort during therapy.
Inanarticlepublished in the journal
MateriaSocioMedica
, Kholoudet al. recommend treating
all teeth likely toproducecomplications 10–14daysprior tochemotherapy.
1
Oncology teams
areunlikely towait to start chemotherapyuntil after themouth isoptimized. Improved
outcomeshavebeendemonstrated for patients receivingexpeditedchemotherapy to treat
leukemia. It ismore likely that oral carewouldbecoordinated tooccur betweencyclesof
chemotherapy so that thedentist canprovidecomprehensiveanddefinitivecareat a time
whileminimizing risk to thechild. Dental interventions arecommonly timed tocoincidewith
thecompletionor initiationof achemotherapycycle,when thechild’splatelet andwhite
bloodcell counts aremost favourable to reduce the riskof sepsis anduncontrolledbleeding.
Oralmucositis is themost significant sourceof oralmorbidityduring leukemia therapy
and is exacerbatedbypoor oral hygiene. Due to theneutropeniaand thrombocytopenia
experiencedby somechildrenundergoingchemotherapy, regular brushingandflossing
maynot beconsistentlyachievable.Moreover, thealcohol inchlorhexidine rinsemay
worsen thepainofmucositis. Hygienemay insteadbemanagedwith sodiumbicarbonate-
basedmouth rinses.Mouth rinses containing topical anesthetics canalsohelp reducepain,
andcryotherapy (suckingon icechips)may reduce the incidenceofmucositis aswell as
provide somepain relief. There isweakevidence for theefficacyof palifermin (recombinant
keratinocytegrowth factor) and low-level laser therapy for reductionofmucositis inadults,
but efficacyhas yet tobedemonstrated inchildren.
Thegeneral considerationsput forwardbyKholoudet al. for providingcare tochildren
with leukemiaare sound:
healthymouths reduce the risksof leukemia
. Contemporary
practice, however,maydiverge from someof the specific recommendationsprovided in
thearticle.
a
MichaelCasas
DDS,DPaed,MSc,
FRCD(C)
Dr.Casas is director of
clinics, department of
dentistry, at theHospital
forSickChildrenand
associate professorat the
University ofToronto
faculty of dentistry
DENTALCONSIDERATIONS
inManaging Pediatric Patients
with Leukemia
CDA thanks
Materia
SocioMedica
for
allowingus to
republishasynopsis
of itsarticle,on the
followingpage.
Oralmucositis is themost significant source of
oralmorbidityduring leukemia therapyand
is exacerbatedby poor oral hygiene.
This interviewhasbeeneditedandcondensed.
Theviewsexpressedarethoseoftheauthorand
donotnecessarilyreflecttheopinionsorofficial
policiesoftheCanadianDentalAssociation.
1...,20,21,22,23,24,25,26,27,28,29 31,32,33,34,35,36,37,38,39,40,...48
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