Intensive Oral Hygiene Interventions during Therapy of Acute Leukemia May Result in Detrimental Outcomes: A...

There are no standard guidelines on oro-dental care during induction therapy of acute leukemia (AL). This study aimed to assess the effect of intensive oral hygiene practice on oral mucositis, infection, and disease outcomes compared to standard clinical practice.

Newly diagnosed patients with AL were randomized to receive either standard oral hygiene protocol (group A, n  = 92) or comprehensive oral hygiene protocol (group B, n  = 91). In group A, the oral hygiene indexes were measured by the dentist at baseline and at the end of treatment. In group B, weekly monitoring of oral hygiene indexes by the dentist and interventions in the form of oral cavity inspection, probing for gum health, and use of a soft toothbrush and education on oral hygiene practices were carried out.

The frequency of mucositis was higher in group B (60%) than in group A (40%; p  = 0.09). There was no difference in the median Simplified Oral Hygiene Index (OHI-S; 0.5 vs. 0.6) and Silness and Loe plaque index (0.4 vs. 0.25) between the groups. The local (11 vs. 1%; p  = 0.005) and systemic infection rate (82.2 vs. 65.2%; p  = 0.009) were higher in group B than in group A.

This study failed to show the superiority of a comprehensive oral hygiene protocol compared to standard protocol in reducing oral mucositis in patients receiving induction therapy for AL. We hypothesize that frequent intervention in the oral cavity may lead to the dissemination of infection.