Risk Factor Of Chemotherapy For Caries And Gingivitis In Children

Objectives: To evaluate chemotherapy as a risk factor for caries lesions and gingivitis in children with acute lymphoblastic leukemia (ALL) treated with the ALL IC-BFM 2009 chemotherapy protocol compared to a group of unexposed children treated in Valdivia, southern of Chile between 2010 and 2016.
Methods: Retrospective cohort study. Clinical records of 23 pediatric patients were analyzed according to the selection criteria [mean 6.67 (SD 2.86) years old] with a diagnosis of ALL exposed to chemotherapy according to the ALL IC-BFM 2009 international protocol in the Regional Hospital in Valdivia and 46 unexposed patients [7.11 (SD 1.59) years old] in the pediatric dental clinic at the Universidad Austral de Chile assessed every 3 months for 24 months. Data on sex, age, subjects' caries status (number of decayed, missing or filled permanent teeth [DMF-T]), number of teeth with new caries and the presence of gingivitis were recorded (Mann-Whitney U test and logistic regression analysis, p ≤ 0.05).
Results: The DMF-T of the children after chemotherapy [mean 1.58 (SD 2.87)] increased significantly compared to the unexposed children [mean 0.31 (SD 0.64); p < 0.01. A significantly greater frequency of gingivitis (69.57%; p < 0.002) and average of new caries lesions was observed in children treated with chemotherapy than in the unexposed children (p < 0.01). The ALL IC-BFM 2009 chemotherapy protocol presented a relative risk of 2.15 (95% CI = 1.22 - 2.66; p = 0.01) for new caries lesions and 2.29 (95% CI = 1.76 - 3.82; p = 0.002) for the presence of gingivitis.
Conclusions: The ALL IC-BFM 2009 chemotherapy in patients with ALL is a risk factor for new caries lesions and gingivitis. It is suggested that prevention and education measures with respect to a non-cariogenic diet, hygiene and use of fluorides be increased in patients undergoing chemotherapy treatment.