4. DISCUSSION
Leukemias constitute the vast majority of childhood HM, and the most
common of these is ALL 9. In this study, the majority
of the children with HM were ALL patients, which agrees with previous
studies. Oral health can adversely affect the QoL of adults and
children, and their families. 10The SOHI has been used
to obtain information about the oral care habits and QoL of individuals
varying in age, ethnicity, and sociocultural and health
status11. In this study, the SOHI was higher in the HM
group than the control group, despite similar sociocultural and economic
conditions; the difference may have been related to treatment
complications, such as mucositis, saliva volume and swallowing
difficulties, along with poorer self-care in children with
HM12, 13 .OHRQoL is an important public health issue
with physical and psychological implications. OHRQoL differs among
communities and ethnic groups, depending on the level of awareness of
its importance and access to treatment14.
OHRQoL research has shown utility in studies of diverse populations,
including oral cancer patients 15, sleep apnea
patients 16, toddlers with early childhood caries17, and children with craniofacial
anomalies18 .
Various scales, such as the ECOHIS19 and Child
Perceptions Questionnaire20 , have been used to
determine OHRQoL in children of various ages from different countries
and communities. In particular, the ECOHIS questionnaire has been widely
used to assess the impact of several oral problems on QoL; it has been
frequently been applied in studies of preschool children, and is
suitable and reliable for assessing preschool and elementary school
students21 .The original ECOHIS assessed the impact of
oral health problems, and the treatments used to address them, on the
QoL of preschool children and their families21 .
The ECOHIS was originally developed in English to determine OHRQoL in
preschool children, but has since been translated into different
languages and validated for use in various cultural settings5. The ECOHIS-T has acceptable validity and
reliability22 .
The ECOHIS has been used for aesthetic and functional evaluations of
oral tissues, malocclusion 23, dental trauma, cerebral
palsy24 , autism spectrum disorder25, bruxism26 , children with cleft lip and palate, and
HIV-positive and negative children27 . It has also
been used to assess the effects of maternal depression and anxiety on
pediatric OHRQoL 28, and to evaluate oral health in
patients with head and neck cancers. Rodrigues et al.16 detected a negative correlation between OHRQoL
evaluated by the ECOHIS and bruxism, while Alencar et
al.26 reported that this correlation was mediated by
anxiety. In a study conducted by Du et al. 25, a
significant difference was observed in the ECOHIS scores of children
with and without cerebral palsy and autism spectrum disorder. Birunghi
et al. 27 detected a significant difference in the
ECOHIS score between children with and without HIV. Costa et al.28 showed that the OHRQoL of mothers with maternal
depression and anxiety was lower compared to healthy mothers. In the
present study, no significant difference was found in total OHRQoL
scores between healthy children and those with HM.The incidence of pain
was closer to that reported in other validation studies, which ranged
from 15 to 24%13. The rate of pain in the control and
HM groups ranged from 20.1 to 44.8% and was significantly higher in the
HM group than the control group. While the incidence of pain in the
control group was comparable with the literature, the higher incidence
in our HM children compared to previous studies may be associated with
differences in the oral complications of treatments or pain perception
of the patients, or with the effect of disease on oral
tissues13 .
Du et al.25 conducted a study on healthy children with
cerebral palsy and reported significant differences on all questions,
including ones about self-image and social interactions on the CIS of
the ECOHIS. In the present study, hesitancy to smile, and issues with
self-perception and social interaction, were observed significantly more
frequently in the HM than control group.
Khari et al. 29 reported that ECOHIS scores were
negatively correlated with parental education level. Similarly, in the
present study, education level and the ECOHIS and DMFT/dmft scores were
negatively correlated.
The DMFT/dmft has been used to determine oral health in children and
adults with type 1 diabetes mellitus 30, HIV-positive
adults, and children receiving antineoplastic treatment31, as well as in studies of fetal alcohol
syndrome32 , ALL and asthma33 ,
orthodontic anomalies 34, prosthodontic problems35, patients with a short dental
arch35 , patients with high sugar intake36, and tooth brushing habits37 .
Dubey et al. reported that DMFT/dmft scores were higher in children with
ALL than in those with type 1 diabetes mellitus or asthma33.
Olczak-Kowalczyk et al. showed that the DMFT/dmft scores during the
post-treatment period are higher than those in children aged 5–18 years
during and after antineoplastic CT38 . In the current
study, the DMFT/dmft scores were similar between the healthy and HM
groups. This result may be associated with late complications of
antineoplastic treatments and a decrease in patient self-care skills.
When there is a normal occlusal relationship, the primary dentition are
parallel to the permanent dentition. The occlusal relationships of teeth
vary during the primary dentition period and are important for early
diagnosis and treatment of malocclusion39. Dentition
and dental occlusion status are important oral health parameters for
both milk and permanent teeth. In the current study, the HM group had
significantly more advanced dentition compared to the control group, and
a higher incidence of Class 1 dental occlusion. Although this is
advantageous for maintaining good oral health, in this study the
difference may have been due to the age difference between the control
and HM groups.
This study had some limitations. First, it was cross-sectional and
certain parameters in the HM group could not be evaluated both before
and after treatment. Second, a limited number of patients were included,
and they were all from the same center. Third, the types and doses of CT
contrast agents were unknown, as were the RT dose schedules.