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Changes in the oral streptococcal flora of children undergoing allogeneic bone marrow transplantation
V S Lucas1, D Beighton, G J Roberts
1The Great Ormond Street Hospital For Children/Institute of Child Health, Maxillofacial and Dental Department, London, U.K.
Insights
Allogeneic bone marrow transplant significantly alters oral streptococcal flora in children, increasing the
Area of Science:
- Microbiology
- Hematology
- Oral Medicine
Background:
- Allogeneic bone marrow transplantation (BMT) involves intensive immunosuppression.
- Oral health complications are common post-BMT.
- Changes in oral microbiota can impact patient outcomes.
Purpose of the Study:
- To investigate alterations in oral streptococcal flora following allogeneic bone marrow transplantation in children.
- To correlate changes in oral flora with oral health indices.
Main Methods:
- Saliva samples collected from 20 children at four time points: pre-conditioning, 7 days post-transplant, neutrophil recovery, and 119 days post-transplant.
- Dental caries, plaque, gingivitis, herpetic stomatitis, and mucositis were assessed.
- Oral streptococcal counts (aerobic and anaerobic) and the proportion of the 'Streptococcus oralis group' were analyzed.
Main Results:
- Significant decrease in total aerobic and anaerobic oral bacteria counts by 7 days post-transplant.
- Marked increase in the 'Streptococcus oralis group' proportion (from 12.1% to 48.4%) at 7 days post-transplant.
- Significant rise in plaque and gingivitis indices by 7 days post-transplant.
Conclusions:
- Allogeneic bone marrow transplantation profoundly impacts oral streptococcal composition in children.
- The 'Streptococcus oralis group' overgrowth may be linked to increased gingivitis and potential systemic dissemination.
- Oral health monitoring is crucial during post-BMT recovery.
Abstract:
The changes in the oral streptococcal flora of twenty children undergoing allogeneic bone marrow transplant are described. Saliva was collected from each child on four separate occasions: (i) before the conditioning regimen; (ii) 7 days post-transplantation; (iii) when the neutrophil count had risen above 0.5 x 10(9)/l; (iv) 119 days post-transplantation. Indices for dental caries, plaque, gingivitis, herpetic stomatitis and mucositis were also recorded. There was a significant decrease in the total aerobic (P<0.001) and anaerobic counts (P<0.0002) between baseline and 7 days post-transplantation. The proportion of the 'Streptococcus oralis group' (Streptococcus mitis and S. oralis) increased significantly from baseline 12.1% to 48.4% at 7 days post-transplantation (P<0.003). The plaque and gingivitis indices increased significantly from baseline to 7 days post-transplantation (P<0.001). Twenty percent of the children had either positive blood cultures or Hickman line cultures for the 'S. oralis group', and it is possible that the inflamed gingival tissues are a further site of entry for these streptococci. There were no differences in the total anaerobic counts or the proportion of the 'S. oralis group' between baseline and the end of the study in the transplant children, or between the transplant and control children.