Feasibility of tooth brushing during prolonged neutropenia in adults receiving intensive induction for acute leukemia: a randomized trial.

BACKGROUND

Due to potential bleeding and/or infectious complications, tooth brushing is contraindicated in some centers in patients with acute leukemia with prolonged neutropenia due to intensive induction therapy while there is limited data to support or not this strategy. The goal of this study is to confirm the safety of tooth brushing in these patients to improve patient comfort.

METHODS

We randomized patients with acute leukemia undergoing intensive induction therapy to a mouthwash only strategy (control group) or a tooth brushing strategy (experimental arm) in a single center to verify the safety of tooth brushing in these patients. The oral assessment guide (OAG) was used as the primary endpoint to assess oral health during induction therapy. Other endpoints used to assess the safety tooth brushing included global and buccal bleeding complications, infectious complications, daily tolerance of oral hygiene protocols, and proportion of patients that discontinued the allocated oral hygiene procedure.

RESULTS

Between July 2019 and February 2023, we randomized 76 patients between the two strategies. The mean OAG scores were not different between the two groups (mean [standard deviation], 13.7 [2.9] vs. 13.1 [4.3] in the tooth brushing group, P = 0.47). While pain during the allocated hygiene protocol was similar in the two groups, tolerance was lower in the control group (6 [5-8] vs. 5 [3-6] in the tooth brushing group, P = 0.03). On the other hand, patients in the control group were less likely to discontinue the allocated oral hygiene protocol (6 vs. 32% in the tooth brushing group, P = 0.01). Other parameters, including oral mucositis, bleeding, and infections were not different between the two groups.

CONCLUSIONS

While there was a higher discontinuation rate in the experimental group, this was partially due to local buccal mucosae injury with similar rates of adverse events between the two groups. This study suggests the safety of tooth brushing in patients with acute leukemia undergoing intensive induction therapy.