{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T23:18:14Z","timestamp":1791069494392,"version":"4.1.0"},"reference-count":51,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T00:00:00Z","timestamp":1592524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.<\/jats:p>","DOI":"10.3390\/cancers12061634","type":"journal-article","created":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T10:43:58Z","timestamp":1592563438000},"page":"1634","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia"],"prefix":"10.3390","volume":"12","author":[{"given":"Francisco","family":"Cammarata-Scalisi","sequence":"first","affiliation":[{"name":"Pediatrics Service, Regional Hospital of Antofagasta, Antofagasta 12440, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Girardi","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Cell and Gene Therapy, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Strocchio","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Cell and Gene Therapy, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Merli","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Cell and Gene Therapy, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelyse Garret","family":"Bernardin","sequence":"additional","affiliation":[{"name":"Unit of Dentistry, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Galeotti","sequence":"additional","affiliation":[{"name":"Unit of Dentistry, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Magliarditi","sequence":"additional","affiliation":[{"name":"Unit of Dentistry, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5663-8674","authenticated-orcid":false,"given":"Alessandro","family":"Inserra","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Callea","sequence":"additional","affiliation":[{"name":"Unit of Dentistry, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/scd.12283","article-title":"Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia","volume":"38","author":"Fernandes","year":"2018","journal-title":"Spec. Care Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5037\/jomr.2012.3305","article-title":"Generalised Leukaemic Gingival Enlargement: A Case Report","volume":"3","author":"Reenesh","year":"2012","journal-title":"J. Oral Maxillofac. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"230","DOI":"10.2174\/1874210601812010230","article-title":"Long-Term Effects of Acute Myeloid Leukemia Treatment on the Oral System in a Pediatric Patient","volume":"12","author":"Lupi","year":"2018","journal-title":"Open Dent. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.4103\/jomfp.JOMFP_205_17","article-title":"Leukemic gingival enlargement: A case report and review of literature","volume":"22","author":"Chowdhri","year":"2018","journal-title":"J. Oral Maxillofac. Surg. Med. Pathol. JOMFP"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"573","DOI":"10.4103\/1119-3077.151803","article-title":"Diagnosis of acute myeloid leukemia in a dental hospital; report of a case with severe gingival hypertrophy","volume":"18","author":"Adisen","year":"2015","journal-title":"Niger. J. Clin. Pr."},{"key":"ref_6","first-page":"418","article-title":"Oral manifestations as first clinical sign of acute myeloid leukemia: Report of a case","volume":"34","author":"Brethauer","year":"2012","journal-title":"Pediatr. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s10147-019-01506-x","article-title":"Impact of oral voriconazole during chemotherapy for acute myeloid leukemia and myelodysplastic syndrome: A Japanese nationwide retrospective cohort study","volume":"24","author":"Tsutsumi","year":"2019","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_8","first-page":"395","article-title":"Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India","volume":"8","author":"Shankarapillai","year":"2010","journal-title":"Oral Health Prev. Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/ped.12865","article-title":"Acute myeloid leukemia in children: Current status and future directions","volume":"58","author":"Taga","year":"2016","journal-title":"Pediatr. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.mehy.2018.06.015","article-title":"Oral manifestations in stem cell transplantation for acute myeloid leukemia","volume":"121","author":"Mester","year":"2018","journal-title":"Med. Hypotheses"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"250","DOI":"10.20344\/amp.60","article-title":"Bilateral facial palsy and acute myeloid leukemia: An unusual association","volume":"25","author":"Pereira","year":"2012","journal-title":"Acta Med. Port."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"219","DOI":"10.5003\/2151-4194.2.2.219","article-title":"Acute Myeloid Leukemia","volume":"2","author":"Walter","year":"2011","journal-title":"Emerg. Cancer Ther."},{"key":"ref_13","first-page":"730","article-title":"Genetic predisposition to pediatric myeloid malignancies","volume":"57","author":"Muramatsu","year":"2016","journal-title":"Rinsho Ketsueki"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.hoc.2018.04.002","article-title":"Myelodysplastic Syndrome, Acute Myeloid Leukemia, and Cancer Surveillance in Fanconi Anemia","volume":"32","author":"Savage","year":"2018","journal-title":"Hematol. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.3109\/10428194.2015.1115030","article-title":"Acute myeloid leukemia in a 3 years old child with cleidocranial dysplasia","volume":"57","author":"Callea","year":"2015","journal-title":"Leuk. Lymphoma"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.3109\/10428194.2013.855310","article-title":"Up-regulation of RUNX2 in acute myeloid leukemia in a patient with an inherent RUNX2 haploinsufficiency and cleidocranial dysplasia","volume":"55","author":"Schnerch","year":"2014","journal-title":"Leuk. Lymphoma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1080\/10428194.2016.1274980","article-title":"Blood malignancies presenting with mutations at equivalent residues in RUNX1\u20132 suggest a common leukemogenic pathway","volume":"58","author":"Callea","year":"2017","journal-title":"Leuk. Lymphoma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1002\/ajmg.a.31360","article-title":"The genetic basis of tooth development and dental defects","volume":"140","author":"Thesleff","year":"2006","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2949","DOI":"10.1200\/JCO.2015.62.8289","article-title":"Collaborative Efforts Driving Progress in Pediatric Acute Myeloid Leukemia","volume":"33","author":"Zwaan","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5045\/br.2018.53.1.1","article-title":"Current treatment for pediatric acute myeloid leukemia","volume":"53","author":"Im","year":"2018","journal-title":"Blood Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"248","DOI":"10.4103\/0972-124X.113090","article-title":"Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature","volume":"17","author":"Gowda","year":"2013","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"687","DOI":"10.4103\/0972-124X.164761","article-title":"Gingival enlargement in myelodysplastic syndrome","volume":"19","author":"George","year":"2015","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4103\/jisp.jisp_136_18","article-title":"Regular oral screening and vigilance: Can it be a potential lifesaver?","volume":"22","author":"Gulati","year":"2018","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.14219\/jada.archive.1967.0349","article-title":"Oral manifestations of leukemia: A postdiagnostic study","volume":"75","author":"Lynch","year":"1967","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/0030-4220(83)90373-0","article-title":"Malignant gingival and skin \u201cinfiltrates\u201d in adult leukemia","volume":"55","author":"Dreizen","year":"1983","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s10006-019-00812-y","article-title":"A case of myeloid sarcoma of the mandibular gingiva as extramedullary relapse of acute myeloid leukemia","volume":"24","author":"Ishikawa","year":"2019","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_28","first-page":"38","article-title":"Poor Oral Health Linked with Increased Risk of Infectious Complications in Adults with Leukemia","volume":"64","author":"Allareddy","year":"2015","journal-title":"J. Mass. Dent. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/j.1600-051X.1989.tb01638.x","article-title":"Periodontal disease and oral microbial successions during myelosuppressive cancer chemotherapy*","volume":"16","author":"Reynolds","year":"1989","journal-title":"J. Clin. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00520-005-0867-7","article-title":"Mucositis prevention by improved dental care in acute leukemia patients","volume":"14","author":"Djuric","year":"2005","journal-title":"Support. Care Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e977","DOI":"10.4317\/medoral.17955","article-title":"Decayed, missing and filled teeth index and dental anomalies in long-term survivors leukaemic children: A prospective controlled study","volume":"17","author":"Lauritano","year":"2012","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"167","DOI":"10.17796\/jcpd.29.2.hq7307703428nt3v","article-title":"Dental abnormalities of a long-term survivor of a childhood hematological malignancy: Literature review and report of a case","volume":"29","author":"Zarina","year":"2005","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1902\/jop.2002.73.6.664","article-title":"Oral Manifestations of Acute Myelomonocytic Leukemia: A Case Report and Review of the Classification of Leukemias","volume":"73","author":"Wu","year":"2002","journal-title":"J. Periodontol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0039-1698323","article-title":"Gingival Hyperplasia as an Early Diagnostic Oral Manifestation in Acute Monocytic Leukemia: A Case Report","volume":"1","author":"Demirer","year":"2007","journal-title":"Eur. J. Dent."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/j.1600-0714.1989.tb00734.x","article-title":"Effect of plaque removal on patients with acute leukemia","volume":"18","author":"Ellegaard","year":"1989","journal-title":"J. Oral Pathol. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/0030-4220(85)90311-1","article-title":"Oral complications of acute leukemia: Prophylactic impact of a chlorhexidine mouth rinse regimen","volume":"60","author":"McGaw","year":"1985","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"371","DOI":"10.2147\/CEOR.S162964","article-title":"Health-care utilization and outcomes of patients at high risk of invasive fungal infection","volume":"10","author":"Fu","year":"2018","journal-title":"Clin. Outcomes Res."},{"key":"ref_38","first-page":"84","article-title":"Periodontal status and post-transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen","volume":"11","author":"Ozcan","year":"2012","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_39","first-page":"66","article-title":"Transient oral cavity and skin complications after mucositis preventing therapy (palifermin) in a patient after allogeneic PBSCT. Case history","volume":"51","author":"Kozak","year":"2006","journal-title":"Adv. Med. Sci."},{"key":"ref_40","first-page":"1811","article-title":"The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: A single-blind clinical trial","volume":"23","author":"Rahmani","year":"2018","journal-title":"Clin. Oral Investig."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1089\/pho.2017.4297","article-title":"Photobiomodulation Therapy Alleviates Tissue Fibroses Associated with Chronic Graft-Versus-Host Disease: Two Case Reports and Putative Anti-Fibrotic Roles of TGF-\u03b2","volume":"36","author":"Epstein","year":"2018","journal-title":"Photomed. Laser Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00784-017-2127-x","article-title":"Oral health status in adult patients with newly diagnosed acute leukemia","volume":"22","author":"Busjan","year":"2017","journal-title":"Clin. Oral Investig."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1080\/17474086.2019.1627869","article-title":"Healthcare expenses for treatment of acute myeloid leukemia","volume":"12","author":"Bewersdorf","year":"2019","journal-title":"Expert Rev. Hematol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.htct.2018.02.006","article-title":"The frequency of oral conditions detected in hematology inpatients","volume":"40","author":"Gomes","year":"2018","journal-title":"Hematol. Transfus. Cell Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3109\/00016358509064146","article-title":"Immediate and delayed effects of repeated doxorubicin injections on rat incisor mesenchymal cells","volume":"43","author":"Dahl","year":"1985","journal-title":"Acta Odontol. Scand."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1046\/j.1525-1500.1999.99028.x","article-title":"Daunorubicin-Induced Pathology in the Developing Hamster Molar Tooth Germ in vitro","volume":"23","author":"Bervoets","year":"1999","journal-title":"Cancer Detect. Prev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"658","DOI":"10.4143\/crt.2015.193","article-title":"Dental Anomalies as Late Adverse Effect among Young Children Treated for Cancer","volume":"48","author":"Proc","year":"2016","journal-title":"Cancer Res. Treat."},{"key":"ref_48","first-page":"181","article-title":"Agenesis and microdontia of permanent teeth as late adverse effects after stem cell transplantation in young children","volume":"103","author":"Alaluusua","year":"2004","journal-title":"Cancer"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1182\/blood-2017-04-779769","article-title":"Outcome of children with acute leukemia given HLA-haploidentical HSCT after \u03b1\u03b2 T-cell and B-cell depletion","volume":"130","author":"Locatelli","year":"2017","journal-title":"Blood"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/j.1365-263X.2011.01199.x","article-title":"Microdontia and hypodontia of premolars and permanent molars in childhood cancer survivors after chemotherapy","volume":"22","author":"Pedersen","year":"2011","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/ipd.12146","article-title":"How do children view other children who have visible enamel defects?","volume":"25","author":"Craig","year":"2014","journal-title":"Int. J. Paediatr. 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