How groundbreaking UAE research is revealing the critical connection between oral health and leukaemia treatment outcomes in children
In the bustling hospitals of the United Arab Emirates, a silent battle rages within the mouths of the nation's youngest cancer patients.
While leukaemia—a cancer of the blood-forming tissues—poses significant health challenges of its own, the treatments designed to save lives often wage a secondary war on oral health. For paediatric patients, this can mean painful ulcers, severe tooth decay, and infections that compound their suffering and potentially compromise their cancer treatment.
What if protecting these children's smiles could actually help fight their larger battle against cancer? Emerging evidence from the UAE suggests that oral health isn't just about comfort—it's a critical component of comprehensive cancer care. In this article, we'll explore groundbreaking research from the UAE that sheds light on this overlooked aspect of paediatric oncology and how dental professionals and oncologists are joining forces to protect these vulnerable patients.
To understand why oral health becomes so critical for leukaemia patients, we need to consider both the disease itself and its treatments. Leukaemia affects the production of blood cells, including the white blood cells essential for fighting infection. This alone leaves patients more vulnerable to infections anywhere in the body, including the mouth.
When chemotherapy begins, the problem intensifies. These powerful drugs target rapidly dividing cells—including cancer cells, but also the cells lining the mouth and salivary glands. The result can be oral mucositis (painful inflammation and ulcers in the mouth), reduced saliva production, and changes in the oral environment that allow harmful bacteria to thrive 9 .
Oral complications are far more than just discomforts—they can lead to treatment delays, dose reductions, increased hospitalization, higher healthcare costs, and potentially life-threatening systemic infections.
For children, whose teeth are still developing, chemotherapy can also cause long-term dental abnormalities that may persist for years after cancer treatment ends 9 .
In 2018, UAE researchers embarked on a crucial study to document the oral health challenges faced by leukaemic children in the country. Their retrospective investigation, titled "Oral health problems in leukaemic paediatric patients in the United Arab Emirates," became one of the first dedicated efforts to quantify this issue in the region 2 3 .
Researchers reviewed medical records of 120 leukaemic patients under 15 years old from three main hospitals providing cancer therapy in the UAE 3 6 .
Researchers meticulously documented all oral health problems recorded in the patients' files, noting the type and frequency of each issue.
Each oral health problem was correlated with the specific phase of chemotherapy the patient was undergoing at the time.
The team used statistical methods to identify patterns and relationships in the data, looking for when patients were most vulnerable to specific oral complications 3 .
This comprehensive approach allowed them to create the first detailed picture of how leukaemia and its treatment affect the oral health of UAE's paediatric population.
The findings from the UAE study painted a concerning picture of the oral health burden faced by young leukaemia patients.
The researchers discovered that oral health problems were not the exception but the norm among these patients:
| Oral Health Problem | Prevalence (%) |
|---|---|
| Any oral health problem | 60% |
| Oral mucositis and ulceration | 52.4% |
| Dental caries | 18.3% |
| Oral candidiasis | 14.2% |
| Other problems (gingivitis, gingival bleeding, herpetic gingivostomatitis, poor oral hygiene, facial palsy) | Remaining cases |
Table 1: Prevalence of various oral health problems among leukaemic paediatric patients in the UAE 3 6
As these numbers reveal, a striking 60% of young leukaemia patients experienced some form of oral health problem during their treatment. The most common issue by far was oral mucositis and ulceration, affecting more than half of all patients.
Perhaps the most intriguing finding was how oral complications varied across different phases of chemotherapy:
| Chemotherapy Phase | Frequency of Oral Health Problems |
|---|---|
| Phase IV (Maintenance) | Highest occurrence |
| Local treatment and follow-up | More common than those treated abroad |
Table 2: Distribution of oral health problems across treatment phases 3 6
Contrary to what one might expect, oral health problems peaked during the maintenance phase of chemotherapy (Phase IV), rather than during the initial intensive treatment stages.
The research also noted that patients who received treatment and follow-up locally experienced more oral health problems than those treated abroad, possibly reflecting differences in preventive dental care practices or protocols for managing oral complications in different healthcare systems 3 .
To conduct thorough investigations into oral health in leukaemic patients, researchers rely on several key tools and resources:
Provides comprehensive patient data across multiple hospitals
Analyzes patterns and correlations in patient data (e.g., IBM SPSS)
Allows access to sufficient patient numbers for meaningful analysis
Ensures patient privacy and research integrity
These tools enable researchers to extract meaningful patterns from complex medical data, ultimately leading to insights that can improve patient care. The UAE study's use of multi-center collaboration was particularly important, as it allowed researchers to gather sufficient data despite the relatively small number of paediatric leukaemia patients at any single institution.
The high prevalence of oral health problems documented in the UAE study translates to significant real-world consequences for young patients.
Oral mucositis—the most common problem identified—causes painful ulcers and inflammation that can make eating, drinking, and even speaking difficult. For children already grappling with the side effects of chemotherapy, this added discomfort can be devastating.
In severe cases, the pain may be so intense that patients require opioid medications or nutritional support 9 .
Dental caries (tooth decay) represented another major challenge, affected approximately 1 in 5 patients. This finding is particularly concerning given the already high rates of childhood dental caries in the general UAE population, where studies have found caries prevalence as high as 93.8% in 5-year-old children 7 .
When combined with the effects of leukaemia and its treatment, this existing vulnerability creates a perfect storm for dental disease.
The UAE researchers emphasized a crucial conclusion from their work: managing these oral complications requires close collaboration between oncology and dental teams 3 .
This partnership should begin before cancer treatment starts, with a comprehensive dental examination and any necessary treatment to eliminate potential sources of infection.
Continuing dental care throughout cancer treatment—especially during the maintenance phase when oral problems peak—can help prevent minor issues from becoming major complications.
This integrated approach not only preserves oral health but may also support better cancer treatment outcomes by preventing infections that could delay chemotherapy.
The study also documented cases of oral candidiasis (a fungal infection), gingivitis (gum inflammation), herpetic gingivostomatitis (viral infection), and even facial palsy, illustrating the diverse range of oral complications these young patients face 3 6 .
The UAE retrospective study represents an important step forward in understanding and addressing the oral health needs of leukaemic children. By documenting the specific challenges these patients face, the research provides a foundation for developing better preventive and management strategies.
Several UAE hospitals have already implemented programs to improve oral health awareness and care, such as the "Dubai Smiles Healthy" initiative and "Abu Dhabi Smiles" school-based program 1 5 .
Expanding these efforts to specifically address the needs of paediatric cancer patients could make a significant difference.
For parents of children undergoing leukaemia treatment, the study underscores the importance of:
As research in this field continues, the hope is that integrated dental-oncology care will become standard practice, ensuring that protecting smiles remains an integral part of healing bodies for all of the UAE's young cancer warriors.
The battle against leukaemia is fought on many fronts. Thanks to growing awareness and research, we now understand that the mouth—often overlooked—is one of the most critical battlefields of all.