[A PhD completed 9. The value of oral foci screening in oncology patients]. / Hora est 9. De waarde van tandheelkundig focusonderzoek bij oncologiepatiënten.

In both patients who undergo radiotherapy because of a tumour in the head and neck region and patients who are treated with high doses of chemotherapy because of haematological disorders, prior to treatment an oral foci screening is carried out. The aim of this focus investigation is to identify oral abnormalities, the so-called oral foci. Such foci can lead to oral problems during or post-treatment. A careful oral foci screening, conforming to protocol, appears to be very relevant for patients who have to undergo head and neck radiotherapy. Particular attention must be devoted to the evaluation of the perodontium, because the chance of disorders affecting the bone-healing that appear post-radiotherapy in the head and neck region is increased in patients with periodontitis. In patients with a haematological disorder, asymptomatic, chronic foci do not require treatment prior to or during the oncological treatment because such oral foci do not increase an extra risk of infectious complications, despite what was hitherto believed.

Effect of leaving chronic oral foci untreated on infectious complications during intensive chemotherapy.

BACKGROUND: Leukaemic patients receiving intensive chemotherapy and patients undergoing autologous stem-cell transplantation (ASCT) are routinely screened for oral foci of infection to reduce infectious complications that could occur during therapy. In this prospective study we assessed the effect of leaving chronic oral foci of infection untreated on the development of infectious complications in intensively treated haematological patients. METHODS: We included and prospectively evaluated all intensively treated leukaemic patients and patients undergoing ASCT who were referred to our medical centre between September 2012 and May 2014, and who matched the inclusion/exclusion criteria. Acute oral foci of infection were removed before chemotherapy or ASCT, whereas chronic oral foci were left untreated. RESULTS: In total 28 leukaemic and 35 ASCT patients were included. Acute oral foci of infection were found in 2 leukaemic (7%) and 2 ASCT patients (6%), and chronic oral foci of infection in 24 leukaemic (86%) and 22 ASCT patients (63%). Positive blood cultures with microorganisms potentially originating from the oral cavity occurred in 7 patients during treatment, but were uneventful on development of infectious complications. CONCLUSIONS: Our prospective study supports the hypothesis that chronic oral foci of infection can be left untreated as this does not increase infectious complications during intensive chemotherapy.