Screening for Dental Infections Achieves 6-Fold Reduction in Dental Emergencies During Induction Chemotherapy for Acute Myeloid Leukemia.

PURPOSE: Patients with newly diagnosed acute myeloid leukemia (AML) are at risk of infection, including odontogenic infections, during induction chemotherapy. It is unknown whether clinical dental screening to diagnose and treat odontogenic disease in these patients can reduce the incidence of dental emergencies. METHODS: Between November 1, 2014, and December 31, 2016, we screened 147 patients with newly diagnosed AML before their admission for induction chemotherapy (n1 = 147, "screened" group). The patients not screened acted as controls (n2 = 190, "unscreened" group), as did patients diagnosed with AML in the 26 months before the initiation of the screening program (n3 = 304, "prescreening" group). The number of patients in each group who presented for emergency dental assessment during admission for induction chemotherapy was determined by 2 independent reviewers. RESULTS: Among the 147 patients in the screened group, only 1 patient presented with an infectious odontogenic emergency (0.68% [95% CI, -0.64% to 1.98%]). In the unscreened group, 8 developed an infectious odontogenic emergency during induction chemotherapy (4.21% [95% CI, 1.37% to 7.15%]), a statistically significant difference (P = .046, a = 0.05). A similar rate of infectious dental emergencies was observed in the prescreening group (4.28% [95% CI, 2.0% to 7.2%]). CONCLUSION: Clinical dental screening before induction chemotherapy in patients with AML resulted in a 6-fold reduction in infectious dental emergencies during the induction period.

Prevalence of oral lesions in and dental needs of patients with newly diagnosed acute leukemia.

BACKGROUND: Dentists are generally taught that in a significant number of patients with newly diagnosed acute leukemia (NDAL), the diagnosis may be suspected based on oral signs. In this study, the authors determined the frequency of oral signs of leukemia and tabulated the clinical dental needs and hematologic aspects of these patients. METHODS: Four calibrated dentists performed clinical examinations in 263 consecutive patients with NDAL. A standardized data form was used to direct and record presence or absence of oral signs of leukemia, clinically apparent dental disease, and circulating blood counts. RESULTS: Oral signs of leukemia were detected on oral examination in 30.8% (95% confidence interval [CI], 25.2% to 36.4%) of patients with NDAL on examination. Only 5.7% (95% CI, 2.9% to 8.5%) of patients had gingival enlargement (GE). Although 33.7% (95% CI, 26.6% to 40.9%) of regular dental treatment seekers and 55.3% (95% CI, 45.3% to 65.4%) of nonregular dental treatment seekers had clinically detectable dental disease, only 18.6% (95% CI, 13.9% to 23.3%) had circulating blood counts that precluded all but urgent oral health care. CONCLUSION: Although 30.8% of patients examined had some oral sign of leukemia, most adults with NDAL do not have GE at the initial examination. Even patients receiving regular oral health care may have unmet dental needs at the initial assessment that could safely be addressed before treatment. PRACTICAL IMPLICATIONS: Dentists should not necessarily expect to be able to detect overt oral signs of leukemia, such as GE, in patients with NDAL on oral examination. Once patients receive the diagnosis, dentists may be able to safely eliminate dental disease in most patients in an appropriate setting. Dentists are encouraged to undertake a thorough review of systems.

A Phase III placebo-controlled trial of oral pilocarpine in patients undergoing radiotherapy for head-and-neck cancer.

PURPOSE: To test the hypothesis that the use of oral pilocarpine during and after radiotherapy (RT) for head-and-neck cancer would reduce the symptoms of post-RT xerostomia. METHODS AND MATERIALS: One hundred thirty patients were randomized in a double-blind method to receive either pilocarpine (5-mg tablets) or placebo three times daily starting on Day 1 of RT and continuing for 1 month after treatment. The eligibility criteria included a planned dose of >50 Gy as radical or postoperative RT for head-and-neck cancer, with at least 50% of both parotid glands included in the treatment fields. The primary outcome measure was the severity of xerostomia as assessed by a patient-completed linear analog scale 3 months after RT. Secondary outcome measures included quality of life during therapy (as assessed by the McMaster University Head-and-Neck Questionnaire) and severity of mucositis during RT (as assessed using Radiation Therapy Oncology Group scales). RESULTS: No difference was observed between the pilocarpine-treated patients and the placebo group in the severity of xerostomia score as assessed by linear analog scale at baseline and 1, 3, and 6 months after treatment (repeated measures analysis, p = 0.92). No difference was apparent in the severity of mucositis during RT; 56.3% of patients receiving pilocarpine had Grade III/IV mucositis compared with 50.8% treated with placebo. No difference in quality of life was noted between the treatment groups during or after RT. The questionnaire score at 3 months after RT was 5.0 (SD 1.0). in the pilocarpine group and 4.9 (SD 0.9) in the placebo group. CONCLUSION: We were unable to detect a beneficial effect of pilocarpine on RT-induced xerostomia when administered during RT for head-and-neck cancer.