the treatment regimen includes multi - agent chemotherapy ( three phases : induction therapy , intensification therapy , maintenance therapy ) and central nervous system directed radiotherapy .
immune suppression caused due to disease , and its therapy makes these children more prone to infections with severe stomatologic complications .
the most common complications are mucositis , xerostomia , bleeding , dysgeusia and infections leading to pain , discomfort and interfere with the course and prognosis of the neoplasm .
the study was planned to study the oral manifestations in pediatric population with acute leukemias during the induction phase only . 
 to study the oral manifestation of acute leukemia during induction chemotherapy.to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) . 
  to study the oral manifestation of acute leukemia during induction chemotherapy . to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) .

 to study the oral manifestation of acute leukemia during induction chemotherapy.to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) . 
  to study the oral manifestation of acute leukemia during induction chemotherapy . to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) .
this was a cross - sectional noninvasive study . thirty three patients both sexes age range ( 5 - 15 years ) in pediatric oncology unit with diagnosis of acute lymphoblastic leukemia and acute myeloblastic leukemia were the subjects for the study .
single clinician ( dental surgeon ) performed oral examination of children at the 1 week of induction and 4 week of induction of chemotherapy .
patients who have completed first induction phase or those who were on maintenance therapy were excluded from the study .
the parents / responsible guardians were informed and explained about the aim and character of the study .
patients were evaluated for , oral hygiene by using  oral hygiene index - simplified ( ohi - s )  [ table 1a , b ] , dental caries by using 
def index  and  decayed missing filled teeth ( dmft ) index ,  [ table 2 ] and gingival findings by using 
the patients were also scrutinized for any other findings or lesions in the oral cavity , i.e. , lesion including site and size of the lesion , candidiasis , any other infections as herpes simplex virus , varicella zoster virus , cytomegalovirus , acute necrotizing and ulcerative gingivitis .
gingival index of loe and silness debris index : debris is defined as soft , foreign matter consisting of bacterial plaque and food debris .
the criteria include : the same examination was again carried out in the 4 week of the induction phase .
all the scores and observations were recorded in a diagnostic chart along with the brief patient 's history and complete blood count on the day of observation .
these reports were collected and co - related with short term outcomes such as febrile / neutropenic episodes / morbidity / mortalities with the help of routine blood culture reports .
the changes in the oral health status were being observed during first week and fourth week and were analyzed with wilkoxon 's signed rank test .
the indices scores were converted in to percentage scale . for this pilot study , a
cut - off criteria has been set as 50% for oral hygiene , gingival and def / dmft index .
debris index : debris is defined as soft , foreign matter consisting of bacterial plaque and food debris .
the criteria include : the same examination was again carried out in the 4 week of the induction phase .
all the scores and observations were recorded in a diagnostic chart along with the brief patient 's history and complete blood count on the day of observation .
these reports were collected and co - related with short term outcomes such as febrile / neutropenic episodes / morbidity / mortalities with the help of routine blood culture reports .
the changes in the oral health status were being observed during first week and fourth week and were analyzed with wilkoxon 's signed rank test .
the indices scores were converted in to percentage scale . for this pilot study , a
cut - off criteria has been set as 50% for oral hygiene , gingival and def / dmft index .
a total of 23 male and 10 female patients with acute leukemia were studied prospectively .
we found that the dental status namely the gingival and periodontal tissues were affected in this period due to lack of good oral hygiene and overall poor health status following chemotherapy [ table 1 ] .
15 out of 30 ( 50% ) subjects showed increase in  ohi - s ,   loe and silness gingival index . 
a significant change was observed in these indices ( p = 0.002 ; 0.003 , respectively ) .
there were no extractions or dental filling done ; the decay factor was mainly noticed in this period .
dental finding pre- and post - induction phase table 5 shows hematological finding pre- and post - induction phase .
no significant difference was noted in hemoglobin , total leucocytic count , or absolute neutrophil count ( p = 0.4 ; 0.11 ; 0.53 respectively ) , but highly significant difference was seen in platelet count p < 0.05 .
hematological finding pre- and post - induction phase in this study , no interruptions in induction chemotherapy was reported due to dental infections .
three patients expired due to debilitating general health , but not due to induction therapy .
palatal aphthous ulcer was observed in a child and it was 1.5 cm diameter in size . in another subject angular cheilitis was noted .
all the remaining subjects presented no clinical signs of oral lesion . as a regular protocol the suspected foci of infection was cultured and it was found to be candida in angular cheilitis . in the second case of aphthous ulcer neutropenia was noticed as a cause .
leukemia is a disease resulting from the malignant transformation of stem cells whose proliferation starts in the bone marrow .
oral complaints precipitated by the side - effects of the antineoplastic agents are primarily those of discomfort , sensitivity of teeth and pain , ulceration , gingival hemorrhage , dryness and impaired taste sensation .
maintenance of oral hygiene is the basic preventive aid from all kinds of oral infections .
patients are advised against any vigorous mechanical dental cleansing aid ( tooth brush / floss / interdental cleaning aids ) to avoid triggering of any bleeding episodes .
an alkaline saline rinse of warm water flavored with salt and sodium bicarbonate is recommended for oral cleansing .
gingiva reacts differently to even slight amount of plaque if subject is on anti - neoplastic therapy for blood dyscrasias . in the present study
, it was observed that the ohi - s count was increased in 50% of individuals .
this change in ohi - s definitely affects other oral hard and soft - tissues .
inflammation in the gingiva is most common and probably earliest presentation of changes in oral tissues due to plaque .
the increased scores of gi in 50% of individuals clearly highlight the problems associated oral hygiene maintenance in these patients
. the gingival inflammation , if not treated leads to periodontal problems and may eventually lead to loss of teeth in adult patients .
dmft / def index was found to be increased in 10 patient 's , i.e. , 33% of study population . since no active dental treatment
is advocated ( advisable ) to any patient undergoing induction therapy , the difference in dmft was only in d , i.e. , decay component of the dmft .
although the induction therapy drugs are not directly responsible for the decay process , the change in oral environment due to excess plaque accumulation and/or change in quality and quantity of saliva due to drugs might have played important role in increased in caries process . in most of the patient 's erythematous oral mucosa ,
burning sensation of mouth was common , since mucositis was not primary objective of this study , the findings were not noted .
one subject demonstrated an aphthous ulcer on palatal mucosa but it responded well to the symptomatic therapy . in another subject , angular cheilitis was seen .
the angular cheilitis is generally a clinical sign of an inflammatory response to fungal infection .
there was no statistical significant difference was observed in terms of short term outcomes of leukemia therapy due to dental problem .
in this study , it was observed that the oral health status worsened following first induction chemotherapy in acute leukemic pediatric patients . there was a significant increase in level of ohi , gingival index and def / dmft .
lesions like aphthous ulcer and angular cheilitis were noticed in two of the subjects while other subjects did not have any oral complications .
these finding suggest that there is a need to institute optimum oral health , during and in between induction phases .
further study is study with larger sample size is needed to conclude the role of oral hygiene in the induction outcome of pediatric patients receiving treatment for acute leukemia .
 background : treatment of acute leukemia's- a common childhood malignancy , involves intensive and powerful multi - drug chemotherapeutic regime . 
 oral lesions are a common complication in these patients affecting oral health status.aim:this study was conducted to evaluate and assess the oral health status of newly diagnosed leukemic pediatric patients during induction phase and its correlation to outcome of induction therapy.material methods : oral examinations was done in 33 children between the age group of 5 - 15 years with acute lymphoblastic leukemia ( all ) and acute myloblastic leukemia ( aml ) , who were undergoing chemotherapy . 
 oral hygiene index- simplified , ( ohi - s ) decayed missing filled teeth index ( def / dmft ) , loe and sillness index for gingiva , and complete blood count at first and fourth week of induction phase were recorded for each patient . 
 the changes in the oral health status were analyzed with wilcoxon signed rank test.results:during an induction phase it was observed that level of ohi - s ( p = 0.002 ) , loe and sillness index ( p = 0.003 ) , def / dmft index ( p = 0.076 ) , platelet count ( p = 0.00 ) increased significantly and no significant difference was noted in hemoglobin ( p = 0.4 ) and total leucocytes count ( p = 0.11).conclusion : it was observed that , although oral health status had significantly worsened , the induction outcome was not affected . 
INTRODUCTION
Aims and objectives
MATERIALS AND METHODS
Simplified OHI calculation
RESULTS
DISCUSSION
CONCLUSION