Evaluation of oral health and oral health-related quality of life among childhood leukemia survivors: a pilot study in the LEA cohort.

BACKGROUND

Oral abnormalities resulting from childhood leukemia treatment may significantly impact long-term health outcomes.

OBJECTIVES

This prospective study aims to evaluate oral health, to assess oral health-related quality of life (OHRQoL) among leukemia survivors, its impact on general Health Related Quality of Life (HRQoL) and to identify risk factors for oral health impairments.

METHODS

Dental examination was proposed to patients included in the LEA cohort (long-term follow-up of childhood/adolescent leukemia survivors) in two pediatric hematology centers. For cavities, Decayed/Missing/Filled/Teeth (DMFT/dmft) index was determined. Quantitative and qualitative saliva analyses were performed. Orthopantomograms were independently reviewed. OHRQoL was assessed using age-adapted questionnaires. Patient characteristics, treatment history, socio-economic status and HRQoL were extracted from LEA database. Statistical analyses were performed using SPSS software. Pearson's Chi2/Fisher's exact test/Student's t-test/Spearman correlation test/Adjusted multivariate logistic regression model were used when appropriate.

RESULTS

Eighty-nine patients were included with a mean follow-up from diagnosis of 12.5 ± 0.8 years. Females represented 48% of the cohort, acute lymphoblastic leukemia 76%. A history of leukemia relapse concerned 27% of patients; 45% of the cohort underwent hematopoietic stem cell transplantation (HSCT). Eighty-five patients had ≥1 oral abnormalities (excluding cavities); 53 required treatment intervention. Mean DMFT/dmft index was 2.3 ± 0.4; lower parents' education level was linked with higher index (p = 0.029). Younger age at diagnosis (<6 years old) was associated with enamel defects (p = 0.001). History of relapse was associated with teeth number, morphology and eruption abnormalities (p < 0.05). HSCT was associated with morphology abnormalities (p < 0.05). Among transplanted patients, no significant impact of total body irradiation on oral abnormalities was found as compared to busulfan-based conditioning regimen. In children, altered OHRQoL tend to have a negative impact on body image and physical well-being.

CONCLUSION

The high prevalence of oral abnormalities in pediatric leukemia survivors necessitates proactive dental monitoring and early interdisciplinary collaboration between pediatrician and dentists.