Salivary Microorganisms and Oral Status in Children Undergoing Oncology Treatment

Objectives: To evaluate the relationships between salivary levels of mutans streptococci (MS), Lactobacilli (LB), Candida Albicans (CA), and oral health of children undergoing oncology treatment (chemotherapy with or without radiotherapy) and compare it to healthy individuals. Materials and Methods: The study group comprised 35 children with childhood malignancies, aged 4-14 years (mean=8.2±2.8). Twenty-eight received chemotherapy (C) to treat Leukemias and lymphomas, while 7 received chemotherapy and radiation (C+R) for solid malignancies. The control group consisted of 17 healthy children aged 4-14 years (mean=8.6±2.5). Clinical examination included: caries status (number of carious/ extracted/ restored teeth) and plaque index (PI). In stimulated whole saliva, microbial levels of MS, LB and salivary buffer capacity were assessed, using CRT®-Vivadent kits. CA levels were measured, using Dentocult CA®-Orion kits. Results: Mean number of carious/ extracted/ restored teeth was 6.4±3.3 in the C group, 9.3±5.7 in the C+R group, compared to 7.3±3.3 in the control group. No significant difference in PI or in buffer capacity was found. MS, LB and CA levels were higher in C+R group (mean=2.6, 3.5, and 2.6 respectively), compared to C group (mean=2.1, 2.8, and 1.6 respectively) and to the control group (mean=2.27, 3.2, and 1 respectively). Conclusions: Children undergoing chemotherapy combine with radiotherapy are at higher risk for dental caries, compared to healthy individuals or children receiving chemotherapy alone. Elevation in CA, MS and LB colonization in immunosuppressed children can increase the risk for oral complications. It is highly recommended that an oral and dental examination and treatment be a part of the pretreatment protocols in children undergoing oncology therapy, with particularly concern to children receiving chemotherapy combine with radiotherapy.