Oral manifestations in pediatric patients with leukemia A systematic review and meta-analysis

Background. Leukemia is the most common malignancy in pediatric patients, and it has extramedullary involvement. Oral manifestations have been reported in the literature, but to the authors' knowledge, no systematic review has presented the general prevalence of these manifestations. This review aimed to determine the prevalence of oral manifestations in pediatric patients with leukemia. Types of Studies Reviewed. The authors conducted a search of PubMed-MEDLINE, Embase, Latin American and Caribbean Health Sciences Literature, Web of Science, and Scopus. Additional searches were carried out in the gray literature and via hand searching of reference lists of included studies. The inclusion criteria were observational studies that investigated the prevalence and occurrence of oral lesions in pediatric patients with leukemia. Two independent reviewers collected data from the selected articles in a prepiloted Excel (Microsoft) spreadsheet. Results. From 67 included studies, 79 oral manifestations were reported. The most frequent alteration in children with acute lymphoblastic leukemia during the treatment were caries (81%), with moderate certainty of evidence. The prevalence of gingivitis was 73%, oral mucositis was 50%, and lymphadenopathy was 45%, with very low certainty of evidence. After the therapy, the prevalence of dental anomalies was 61%, and the most common were enamel hypoplasia (40%), dental agenesis (22%), and microdontia (22%), presenting very low certainty of evidence. The high heterogeneity among studies contributed significantly to reduce the certainty of the evidence. Practical Implications. The findings of this study show that pediatric patients with leukemia have oral manifestations predominantly during and after treatment. Health care professionals must be aware of oral manifestations and refer the patients to dentists during the oncological treatment. Thus, the dentist must support pediatric patients with leukemia to help ensure a better quality of life.