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.