Prevalence of Periodontal Disease in Children with

Leukemia and Thalassemia

Marhamah, Hardianti Maulidita
Department of Pedodontic, Faculty of Dentistry, University of Hasanuddin
Makassar, Indonesia

ABSTRACT
Background. Various periodontal disease can occur in children and adolescents.
Some can take place quickly and periodontal tissue damage. Several previous studies
indicate that systemic diseases associated with periodontal disease in children.
Objectives. This study aims to determine the prevalence of periodontal disease in
children with leukemia and thalassemia.
Methods. The design study is a cross-sectional approach. Periodontal pocket depth
measurements performed using the WHO standard of measurement. The samples in
this study were drawn from the entire population using accidental sampling method.
Sampled population was pediatric patients with leukemia and thalassemia. These
patients were undergoing treatment in hospital Wahidin Sudirohusodo Hospital
Makassar.
Results. During the study, children with leukemia as many as 18 patients and
children with thalassemia by 8 patients. Distribution of pediatric patients suffering
from leukemia by CPITN score; score of 2 as many as 10 patients (55.6%), a score of
1 as 6 patients (33.3%), and score of 0 as many as 2 patients (11.1%). CPITN score
in children with thalassemia; scores 2 in 1 patient (12.5%), a score of 1 as 6 patients
(75%), and score of 0 by 1 patient (12.5%).
Conclusion. From the study, it can be concluded that in children with leukemia or
thalassemia, indicating the level of periodontal disease is still high.
Keywords: periodontal disease, pediatric, leukemia, thalassemia.

BACKGROUND
Periodontal tissue is the tissue that surrounds the teeth and tooth serves as a
buffer, consisting of the gingiva, cementum, periodontal ligament and alveolar
bone 1. Both normal and abnormal circumstances of the periodontal tissues is
important to note before getting periodontal tissue disorder. Disruption of periodontal
tissues can affect the state of the network buffer fourth gear, so it can cause
periodontal disease. At the initial stage is called gingivitis, gingival become swollen
and red due to inflammation. In a more serious form called periodontitis, gingival
recession and supporting tissues damaged 2.
Indonesian society many infections in dental hygiene problems associated with the
oral cavity. The focal infection theory which has existed since the 19th century and
20 current, generates an epidemiological study, that oral infections, especially in the
marginal part of the gingival and apical periodontitis is a risk factor for systemic

1
diseases 2,3. The prevalence of periodontal disease can be seen with the number of
cases on the epidemiology of periodontal disease, especially in children that occurred
in several countries. The prevalence obtained from various nations and countries, but
will be discussed in the next chapter 3,4,5.
The prevalence of periodontal disease in children is very high and the presence of
periodontal disease is closely associated with the occurrence of systemic
disease 6. Until now, the lack of data describing the prevalence of periodontal disease
in children with systemic diseases, especially those in Makassar.

OBJECTIVE
The purpose of the authors in this study is to determine how much the level of
prevalence of periodontal disease in pediatric patients with leukemia and
thalassemia, in RS.Wahidin Sudirohusodo Makassar in 2013.

MATERIALS AND METHOD

MATERIALS
Periodontal disease can be classified as either gingivitis or periodontitis that
occurs as a result of the presence of plaque, bacteria, or the supra-gingival
calculus. In general, periodontal disease begins as gingivitis, and only in some
individuals will progress to periodontitis. 1999 International Workshop on research
cited VS Chauhan et al. 7, in the classification of periodontal disease, periodontal
disease to classify children as follows: chronic gingivitis, aggressive
periodontitis, chronic periodontitis, periodontitis as a manifestation of systemic
disease, and necrotizing periodontal disease 7.
Periodontal disease in children and adolescents may be limited to the gingival
tissues or tissue damage in the form of the periodontium, and in some cases can lead
to tooth loss.Gingivitis is a common occurrence in children aged 5 years, mainly
occurs around the age of adolescence that affects more than 80% of young children,
while almost all of the population has gingivitis experience 4.
Periodontitis is usually accompanied by gingivitis lead to irreversible damage
of the supporting tissues around the teeth, including the alveolar bone. Severe form,
for example, from aggressive periodontitis that results in damage to the periodontium
during childhood. Periodontal disease occurs at any age, and the process occurs
slowly. The initial phase, generally occurs in adolescence. Therefore, it is very
important to recognize the problem of periodontal and oral health attention to the
child to achieve a healthy mouth circumstances in adulthood 4.
Peridontitis as Manifestations of Systemic Disease
Periodontitis as a manifestation of systemic disease can occur in people with
diabetes are dependent on insulin (Insulin Dependent Diabetes Mellitus

2
/ IDDM), Syndrome Papillon, Hypophosphatasia, neutropenia, Chediak-Higashi
syndrome, Leukemia, Histiocytosis X, Acrodynia, Acquired Immunodeficiency
Syndrome (AIDS ), Down syndrome, and leukocyte adhesion deficiency. Cianciola
et al study and found that in children, often teerjadi periodontitis clear on the first
molars and incisors, although periodontitis can also be found in the general
pattern. In subgingival bacteria Actinobacillus actinomycetemcomitans there and
Capnocytophaga sp. Among children infected with AIDS can be in the form
ofAcute Necrotizing Ulcerative Gingivitis (ANUG). However, there are no reports of
patients suffering from AIDS prepubertal children with alveolar bone loss 4.
Periodontitis as a manifestation of systemic disease children is a rare disease
that often starts between the time of the eruption of primary teeth until the age of 4 or
5 years. Periodontitis occurs in localized and generalized forms. In localized form,
the affected area showed rapid bone loss and minimal inflammation of the gingiva. In
a generalized form, there is rapid bone loss around the teeth and almost all
marked with gingival inflammation. Increased pathogen is suspected,
namely Actinobacillus actinomycetemcomitans, Prevotella intermedia, Eikenella
corrodens, and Capnocytophaga sputigena 4.
Etiology of Periodontal Disease
Endodontal human infections and periodontal microflora associated with the
complex in which approximately 200 species (section apical periodontitis disease),
and more than 500 species (section marginal periodontitis disease) that have been
found. The infection is predominantly anaerobic bacteria, and most gram-negative
rods. Periodontitis is caused by bacteria found in dental plaque, where bacteria levels
can reach up to more than 10 11 microorganisms per mg of dental plaque, and there
are 10 identified species are pathogenic in periodontitis disease, such as gram-
negative rods. Some gram-negative bacteria that is widely available in periodontitis
is Actinobacillus actinomycetemcomitans, Prophyromonas gingivalis, and
Bacteroides forsythus 2.
Factors that cause periodontal disease can be divided into two factors, namely
local and systemic factors. Local factors that are a cause of the environment around
the teeth, whereas systemic factors associated with metabolism and general
health. Bone destruction in periodontal disease is mainly caused by local factors that
gingival inflammation and trauma from occlusion or a combination of both. Damage
caused by gingival inflammation resulted in a reduction of alveolar bone height,
while trauma from occlusion causes loss of alveolar bone on the side of the root
surface 20.
Tissue response to the bacteria, physical and chemical stimuli can be aggravated by
systemic disorders. Network required for the metabolism of materials such as
hormones, vitamins, nutrients and oxygen. When the balance is disturbed material
can result in severe local disturbance. Balance disorders can be a lack of materials
needed by cells for healing 20.
Systemic factors include : High fever, vitamin deficiency, drugs or drug use,
and hormonal 20. Many systemic diseases that manifest in the oral. The disease may
worsen the situation of the oral cavity. Periodontal diseases are serious and
aggressive periodontitis can also be seen occasionally in children and some diseases

3
are signs of systemic disease. This leads to bone loss and migration of the junctional
epithelium in the apical region, thus forming a periodontal pocket. In a recent article
stated, that periodontitis may affect host susceptibility to systemic disease in three
ways: by shared risk factors, by subgingival biofilms acting as reservoirs of gram-
negative bacteria, and through the periodontium acting as a reservoir of
inflammatory mediators 2.
Hematologic Disorders
Hematology is the branch of medicine that studies the blood, blood-forming
organs and tissues limforetikuler and disorders arising therefrom 28. Disturbances in
the blood can cause abnormalities in the blood and disorder can be acquired or
congenital 29. Iron deficiency (anemia) is usually unknown and can accompany other
forms of anemia, such as β-thalassemia that can appear at the beginning of the
birth. Sudden onset of anemia is rare in children, but is a continuation of the blood
loss, hemolysis, acute leukemia, and bone marrow aplasia 31.Hematologic disorders in
children in general, namely anemia, and leukemia thallasemia 32.
Thalassemia is a blood disorder because there is no or lack of hemoglobin
chains are complex, which is characterized by a decrease in the speed of synthesis or
production capability of one or more globin chains α- or β-, or other globin
chains 28,29,30. As a result, the type of thalassemia occurs according to the globin chains
that disrupted production, as shown below 30.

a. Thalassemia- α, occurs due to reduced (partial deficiency) (thalassemia- α +) or

not produced at all (total deficiency) (thalassemia- α 0) globin- α production
chain.
b. Thalassemia- β, occurs due to reduced β chain globin- (thalassemia- β +) or not
produced at all globin- chain β (β thalassemia- 0).
c. Thalassemia- δβ, occurs due to reduced or not produced two δ-chain and β-
chain. The same thing happened to thalassemia- ɤδβ, and thalassemia- αβ.
Leukemia is a cancer of a type of white blood cells in the bone marrow,
which causes the proliferation of a type of white blood cells to get rid of other cell
types, which means that the abnormal cancer cells proliferate uncontrollably, a group
of cells produce abnormal children. These cells inhibit all other blood cells in the
bone marrow to develop normally, so they accumulate in the bone marrow. In the
end, leukemic cells take over the bone marrow, resulting in lower levels of
nonleukemik cells in the blood which are the cause of many common symptoms of
leukemia 27. Leukemia is described as acute or chronic, depending on whether or not
the appearance and how fast differentiation of cancer cells is concerned. Acute
leukemia cells with poorly differentiated, whereas chronic leukemia cells are usually
well differentiated 27.
Acute Lymphoblastic Leukemia (ALL) is a malignant disease that is most
common in children, affecting about 475 per 100,000 people around the world, with

4
the highest age between 2-6 years. It accounts for 80% of all cases of leukemia in
children 33.
Hematological disorders caused by abnormalities of quantitative, qualitative
elements of the blood, circulating proteins, or vascular wall, drop in the platelet
count or platelet dysfunction, or lack of coagulation factors (eg, thrombocytopenia
and coagulation factor deficiencies in disseminated intravascular coagulation) 10.32. In
children, a lot of bleeding disorders occur due to background genes 32.
Dental implications of thalassemia is jaw malformations. This is caused by
excessive growth of the maxilla and zigomatikum. Thallasemia patient care is a
routine blood transfusion.Blood transfusions can cause discoloration of the gingiva
(hemosiderosis) due to the accumulation of iron. Treatment in patients with
thalassemia should be sufficient, with a dentist or specialist pediatric hematology
before dental treatment 10.
Oral manifestations in patients with leukemia may include pallor of the
gingiva, gingival bleeding spontaneously, lymphadenopathy, gingival hyperplasia or
atrophy, mucositis, infections (viral, bacterial or fungal), the presence of caries, the
occurrence of xerostomia, dermatitis, and trismus 4.31. In patients with acute leukemia,
oral manifestations are not much different from leukemia patients in general, which
may include swelling of the gingiva, oral ulceration, spontaneous gingival bleeding,
pale mucous area, herpes infection and candidiasis 32.33.

Epidemiology of Periodontal Diseases in Children.

There are reports of epidemiological studies on periodontitis of various
nations in the world 20. New epidemiological data, on periodontal status in the year
2009-2010 from the National Health and Nutrition Survey (National Health and
Nutrition Examination Survey / NHANES) which was written in the Journal of
Dental Research in the USA by Papapanou 21, in a recent publication, showed a total
prevalence of periodontitis in children in 2009 & 2010 19 which is from the state of
mild, moderate, and severe was 47.2% 21.
In contrast to the prevalence and risk of periodontal disease in the Islamic
Republic of Iran Tehran students quoted from research Hugar SM, et al. 20th, the
periodontal health of 867 students aged 15-19 years results showed that 88.7% of the
teenage years are very risky on the incidence of periodontal disease 20.
Epidemiological studies of periodontal disease in Jordan by Hugar et al. 20th, just
explain the prevalence of gingival disease at the age of 6-7 years. The results of this
study indicate that gingivitis in children aged 6-7 years in Jordan in general is 69%,
but in most cases it is mild. The results of this study is almost similar to previous
research that has been conducted in several countries and it is higher than in some
other countries, and there are also 10 studies that discuss the prevalence of gingivitis
in children aged 5-7 years and give different results, namely 9% -85% 21.
A study conducted by Moller of Ayesh HSD 23 research citations, assessing
gingivitis in children Iceland and showed, that 23% of children aged 6 years have

5
gingivitis, while the results of other studies using the Russell index found that 75%
of children children aged 5-9 years with mild gingivitis and relatively wide variation
in the real prevalence between different samples or associated with a variety of
methods used to assess gingivitis. The prevalence of gingivitis increased from 3-5
years of age until puberty, and this increase is caused by changes in the population of
microorganisms of the oral cavity 23.
While the distribution of periodontal disease sites in India by Papanou, in
men and women produce 68% of men have a higher periodontal disease compared
with only 32% of women21.

METHOD
Type of research is observational research is to see and observe the condition
of the periodontal tissues of children who become the object of research. The data is
taken based on direct observation of oral pediatric patients with systemic disease in
the hospital. Wahidin Sudirohusodo Makassar, use the diagnostic tool to probe
measurement of periodontal disease.
The study design used was a cross-sectional approach is to observe the
research object only once within a certain time.
This study was conducted in March-June 2013 Location research will be
conducted in the pediatric ward inpatient unit Lontara 4, and space poly outpatient
children, RS. Wahidin Sudirohusodo Makassar.
The study population was all patients who take children, either outpatients or
inpatients who had leukemia and thalassemia in the hospital. Wahidin Sudirohusodo
Makassar.Furthermore, a sample of children who were patients aged 5-15 years. The
sample size obtained using the nomogram table harry king.
The samples in this study were drawn from the entire population by using
accidental sampling method, the sampled population was inpatients and outpatients
(leukemia, thalassemia) at the time of the study.
To facilitate the assessment of the use of pocket depth measurements using
CPITN index. The patient's mouth is divided into six sektan, namely sektan upper
right, upper anterior sektan, sektan upper left, lower left sektan, sektan lower
anterior, and sektan bottom right, as shown in Table 1 below 5.

6
 Table 1. Sektan On examination CPITN
SEKTAN 1 SEKTAN 2 SEKTAN 3
7 6 5 4 3 2 1 1 2 3 4 5 6 7
7 6 5 4 3 2 1 1 2 3 4 5 6 7
SEKTAN 4 SEKTAN 5 SEKTAN 6
Source: Daughter MH, Herijulianti E, N. Science Nurjannah hard tissue disease prevention and
tissues supporting the teeth. Jakarta, EGC, 2010; case 206 5.

A sektan can be checked if there are at least 2 teeth and is not an indication
for revocation. If on the sektan there is only one tooth, the tooth is inserted into
sektan next. In sektan are not toothed, not given a score. Assessment for the sektan is
the worst state (highest score) 5.
Teeth should be checked on an index that depends CPITN assessment of the age of
the individual. There are three age groups for these measurements, the group aged 20
years or older, the age group 16 to 19 years, and the group aged less than 15
years. Determination of the index teeth are examined along with age group can be
seen in Table 2 below 5.

Table 2. Teeth Age Group and Its Possible index scores were checked and were obtained
Age Teeth Index Score
7 6 1 1 6 7
20 years and over 0,1,2,3,4
7 6 1 1 6 7
6 1 1 6
19 and under 0,1,2,3,4
6 1 1 6
15 years and 6 1 1 6
0,1,2
under 6 1 1 6
Source: Daughter MH, Herijulianti E, N. Science Nurjannah hard tissue disease prevention and
tissues supporting the teeth. Jakarta, EGC, 2010; case 207 5.

Associated with the index tooth and possible scores obtained on CPITN
measurement, there are several things that must be considered, namely 5:

 If one molar and incisor teeth there, no need for the replacement tooth.
 If there is a sektan index teeth, all teeth present in the sektan examined and
assessed, take the worst, that which has the highest score.
 For ages 19 and under, no need for a dental examination M2 to avoid false
pockets.
 For ages 15 years and under the recording is done only if there is bleeding and
tartar alone.
 If there is no index tooth or tooth replacement, such sektan marked x.

Once the index selected teeth, each tooth on probing is done by moving the
probe around the tooth to assess at least six points around the teeth, namely:
mesiofasial, midfacial, distofasial. Also similar place on the lingual or palatal

7
aspect. The most serious findings recorded as the score sektan. Code 5 scores are
recorded as follows:
Score 0: in the deepest pocket in a sektan, colored areas on the probe still
looks full. Healthy gingival bleeding on probing did not show. Not found calculus. In
these individuals are not required special care, preventive programs continue.
Score 1: Area full color still visible in the deepest groove on a sektan, but found no
calculus was found bleeding after probing light. Individuals such as these require
proper oral hygiene instructions to the actions that can clean and subgingival plaque
disupra.
Score 2: Area full color still visible in the deepest groove on a sektan, can be
found bleeding after probing, and supra-or subgingival calculus was
found. Treatments include scaling to remove plaque and calculus supra and
subgingival, and oral hygiene instruction.
Score 3: Areas colored in the probe entered partially into the pocket. This
suggests a shallow pocket with a depth of more than 3.5 mm but less than 5.5
mm. Necessary treatment to remove subgingival calculus with a more comprehensive
oral hygiene instruction.
Score 4: Areas colored in the probe enter everything into the pocket, showed
pocket depth is more than 5.5 mm. Required a more complex periodontal treatment,
includes a thorough periodontal examination, records or charts on a periodontal chart
and plan perawtan appropriate for each case.

The rate of periodontal tissue conditions for each sektan can be seen in Table 3.

Table 3. Levels of Periodontal Network Conditions Each Sektan

Network conditions
Value / Score
Periodontal
0 Healthy
1 Bleeding of the gums
2 There subgingival tartar
Shallow pockets (3.5-5.5
3
mm)
Deep pockets (greater than
4
5.5 mm)
Source: Daughter MH, Herijulianti E, N. Science Nurjannah hard tissue disease
prevention and tissues supporting the teeth. Jakarta, EGC, 2010; case 209
5.

This study to obtain the primary data in the form of tables and data
processing using SPSS 16.0 (Statistical Package for the Social Sciences 16.0).

RESULTS
The study took place from the date of 6 March to 4 June 2013, the study
sample was 26 respondents with sampling methods accidental sampling. Obtained

8
pediatric patients suffering from leukemia were 18 patients (69.2%), and pediatric
patients with thalassemia 8 patients (30.8%).

Leukemia
Based on the research results of the patient's age characteristics of children
with leukemia as follows:

Table 4. Frequency Distribution of Child Patients Leukemia Disease Patients According to Age in
ES. Wahidin Sudirohusodo Makassar in 2013

No. Age Frequency Percent (%)

1 5-9 10 55.5%
2 12-14 7 38.9%
> 14 1 5.6%
Total 18 100.0
Source: Primary Data, 2013

Table 4 shows that of the 18 children penderitaa leukemia, most patients are
children with leukemia is 5-9 years old, 10 patients (55.5%), while 12-14 year olds
were 7 patients (38.9%), and children aged> 14 years by 1 patient (5.6%).

Table 5. Frequency Distribution of Child Patients with Leukemia Patients by Sex in the
hospital. Wahidin Sudirohusodo Makassar in 2013
No. Sex Frequency Percent (%)
1 Women 7 38.9%
2 Male 11 61.1%
Total 18 100.0
Source: Primary Data, 2013

Table 5 shows the frequency distribution of children with leukemia by sex

there is more in males as many as 11 patients (61.1%), and women were 7 patients
(38.9%).

Table 6. Frequency Distribution of Patients According to the Children's Leukemia Patients CPITN
scores in RS. Wahidin Sudirohusodo Makassar in 2013
No. CPITN scores Frequency Percent (%)
1 0 2 11.1%
2 1 6 33.3%
3 2 10 55.6%
Total 18 100.0
Source: Primary Data, 2013.

Table 6 describes the distribution of 18 children with leukemia according to CPITN

scores. In children with leukemia who received a score of 2 more that as many as 10

9
patients (55.6%), a score of 1 as 6 patients (33.3%), and a score of 0 were 2 patients
(11.1%).

Thalassemia
Based on the results obtained the following results:

Table 7. Frequency Distribution of Patients According to Age Children Thalassemia Patients in

the hospital. Wahidin Sudirohusodo Makassar in 2013
No. Age Frequency Percent (%)
1 <8 1 12.5%
2 8-10 4 50%
3 11-14 3 37.5%
Total 8 100.0
Source: Primary Data 2013

Table 7 shows that of the 8 children with thalassemia patients found that
children aged 8-10 more as many as 4 patients (50%), and fewer at age <8 years as
many as 1 patients (12.5%).

Table 8. Frequency Distribution of Child Patients with Thalassemia Patients by Sex in the
hospital. Wahidin Sudirohusodo Makassar in 2013
No. Sex Frequency Percent (%)
1 Women 4 50%
2 Male 4 50%
Total 8 100.0
Suimber: Primary Data, 2013.

Table 8 shows the distribution of 8 children with thalassemia by sex. There

are the same number of children with thalassemia many anatara sex men and women
respectively were 4 patients (50%).

10
 Table 9Frequency Distribution of Child Patients with Thalassemia Patients According CPITN
scores in RS. Wahidin Sudirohusodo Makassar in 2013
No. CPITN scores Frequency Percent (%)
1 0 1 12.5%
2 1 6 75%
3 2 1 12.5%
Total 8 100.0
Source: Primary Data, 2013.

Table 9describes the distribution of 8 children with thalassemia number of

patients according to the acquisition of CPITN scores. In children with thalassemia
who obtained a score of 1 is much more as many as 6 patients (75%), and a score of
0 and 2 in 1 patient (12.5%).

DISCUSSION
This research was conducted by means of primary data collection for children
with leukemia and thalassemia. When viewed in general, it is found that pediatric
patients suffering from leukemia more as many as 18 patients (69.2%), and the least
amount of children suffering from thalassemia patients 8 patients (30.8%).
Of the characteristics of a child with leukemia showed that of 18 children
with leukemia, most patients are children with leukemia is 5-9 years old, 10 patients
(55.5%), while 12-14 year olds were 7 patients (38, 9%), and children aged> 14
years by 1 patient (5.6%). Of the characteristics of children who suffer from
thalassemia showed that of 8 children with thalassemia patients found that children
aged 8-10 more as many as 4 patients (50%), and fewer at age <8 years as many as 1
patients (12.5%) .
This proves that in the age of adolescence, pediatric patients are at risk of
periodontal disease. In accordance with research on the prevalence and risk of
periodontal disease in students of Tehran Islamic Republic of Iran by Hugar SM, et
al. about periodontal health of 867 students aged 15-19 years the results showed that
88.7% of the teenage years are very risky to the onset of periodontal disease 20.
Whereas an epidemiological study of periodontal disease in Jordan by Hugar et al.
explained that the prevalence of gingival disease at the age of 6-7 years. The results
of this study indicate that gingivitis in children aged 6-7 years in Jordan in general is
69%, but in most cases it is mild, and there are also 10 studies that discuss the
prevalence of gingivitis in children aged 5-7 years and give different results, namely
9% -85% as well as a study conducted by Moller of Ayesh HSD research citations,
assessing gingivitis in children Iceland and showed 23% of children aged 6 years
have gingivitis, while the results of other studies Russell uses the index found that
75% of children aged 5-9 years with mild gingivitis. The prevalence of gingivitis
increased from 3-5 years of age until puberty, and this increase is caused by changes
in the population of microorganisms of the oral cavity 21,22,23.

11
Of the characteristics of a child with leukemia by sex, there is more in males as many
as 11 patients (61.1%), and women were 7 patients (38.9%). Of the characteristics of
children who suffer from thalassemia showed a lot of the same number of children
with thalassemia sex men and women respectively were 4 patients (50%).
This is consistent with the distribution of periodontal disease sites in India by
Papanou 21, in men and women, resulting in 68% of men have a higher periodontal
disease compared with only 32% of women 21. In the same study, the prevalence of
the presence of supragingival and subgingival calculus, nearly 50% of men and
women simply indicate the presence of plaque. This is due to the presence of
plaque. Both sexes showed higher than supragingival calculus subgingival calculus
in all age groups, and the results of other studies indicate that boys have a higher
prevalence of periodontal disease than girls.
Distribution of pediatric patients with leukemia based on CPITN scores earn
a score of 2, 10 patients (55.6%), a score of 1 as 6 patients (33.3%), and a score of 0
were 2 patients (11.1%). For CPITN scores in children with thalassemia scored 1
more as many as 6 patients (75%), and a score of 0 and 2 in 1 patient (12.5%).
In children with leukemia gives the highest score on the score 2 as many as
10 patients (55.6%) of 18 patients. This is evidenced from the presence of oral
manifestations in children with acute leukemia who are not much different from
leukemia patients in general, which is a swelling of the gingiva 32.33. Swelling or
inflammation that may affect the structure of the software and hardware that supports
the teeth 9. At first it may be gingivitis and the impact of the occurrence of
periodontal disease, the bone can be lost and separated from its attachments to the
teeth 17. This is why the more leukemia patients get a score of 2.
Different things found in children suffering from thalassemia, the highest
score obtained on a score of 1, as many as 6 patients (75%) of 8 patients. This
indicates systemic factors may influence the occurrence of periodontal disease.

CONCLUSION
From the studi, it can be concluded that in children who have leukemia or
thalassemia, indicating the level of periodontal disease is still high.

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