Prevention of oral mucositis in paediatric patients treated with chemotherapy

TNF-α promoter hypomethylation is frequent in oncopediatric patients who recovered from mucositis

The aim of this study was to investigate the DNA methylation profile in genes encoding catalase (CAT) and superoxide dismutase (SOD3) enzymes, which are involved in oxidative stress mechanisms, and in genes encoding pro-inflammatory cytokines interleukin-6 (IL6) and tumor necrosis factor-alpha (TNF-α) in the oral mucosa of oncopediatric patients treated with methotrexate (MTX®). This was a cross-sectional observational study and the population comprised healthy dental patients (n = 21) and those with hematological malignancies (n = 64) aged between 5 and 19 years. Oral conditions were evaluated using the Oral Assessment Guide and participants were divided into 4 groups: 1- healthy individuals; 2- oncopediatric patients without mucositis; 3- oncopediatric patients with mucositis; 4- oncopediatric patients who had recovered from mucositis. Methylation of DNA from oral mucosal cells was evaluated using the Methylation-Specific PCR technique (MSP). For CAT, the partially methylated profile was the most frequent and for SOD3 and IL6, the hypermethylated profile was the most frequent, with no differences between groups. For TNF-α, the hypomethylated profile was more frequent in the group of patients who had recovered from mucositis. It was concluded that the methylation profiles of CAT, SOD3, and IL6 are common profiles for oral cells of children and adolescents and have no association with oral mucositis or exposure to chemotherapy with MTX®. Hypomethylation of TNF-α is associated with oral mucosal recovery in oncopediatric patients who developed oral mucositis during chemotherapy.

Oral Mucositis Management in Children under Cancer Treatment: A Systematic Review

Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as cryotherapy, low-level laser therapy, and natural compounds for this condition. The aim of this systematic review was to identify and compare therapies for the management of cancer treatment-induced oral mucositis in pediatric patients. From 2655 articles obtained in initial searches, 39 articles were considered in this systematic review, after applying inclusion/exclusion criteria. Low-level laser therapy, palifermin, honey, and zinc demonstrated reductions in oral mucositis incidence, duration, severity, and pain reported by the patient. Although there are several therapies in place for the prevention and treatment of oral mucositis in children, evidence of their efficacy is still inconclusive to establish accurate clinical protocols.

A hospital-based oral health education program impacts in pediatric cancer patients-A pilot study

OBJECTIVES

To assess the impact of an oral health education and preventive program (OHEPP) for pediatric cancer patients.

METHODS

This was a single-arm study with 27 children and adolescents undergoing antineoplastic treatments. Patients were followed up for 10 weeks, and their oral health conditions were evaluated using the Modified Gingival Index (MGI), Visible Plaque Index (VPI), and the modified Oral Assessment Guide (OAG). Audiovisual resources, storytelling, and ludic instruments were used to provide oral health education to patients and parents/caregivers.

RESULTS

The patients' mean age was 9.41 (±4.49) years, and acute lymphoblastic leukemia was the most prevalent diagnosis (22.2%). Mean MGI and VPI values were 0.82 (±0.59) and 54.11% (±19.92%) at baseline and 0.33 (±0.29) and 19.83% (± 11.47%) after 10 weeks, respectively (p < .05). The mean OAG score was 9.51 (±2.54) and 36 cases (19.8%) of severe oral mucositis (SOM) were documented. Patients with higher MGI were more likely to develop SOM.

CONCLUSION

The OHEPP had a positive impact on pediatric patients undergoing cancer therapy by improving their periodontal health, reducing biofilm accumulation, and preventing the development of OM lesions.

Polymorphism but not methylation status in the vitamin D receptor gene contributes to oral mucositis in children

OBJECTIVE

To investigate the relationship between the polymorphisms rs1544410 (BsmI), rs2228570 (FokI) and rs731236 (TaqI) and DNA methylation status in the VDR gene (vitamin D receptor) with oral mucositis (OM) in oncopaediatric patients treated with methotrexate (MTX®).

METHODS

The population comprised healthy patients with haematological malignancies aged between 5 and 19 years. An evaluation of oral conditions was performed using the Oral Assessment Guide. Demographic, clinical, biochemical and haematological data were obtained from medical records. Genomic DNA from oral mucosal cells was used for the analysis of polymorphisms (n = 102) (PCR-restriction fragment length polymorphism) and DNA methylation (n = 81) (methylation-specific PCR).

RESULTS

Males predominated (57.8%), and the mean age was 10.3 years (±4.7). OM affected 84.3% of patients, of which 53.1% developed severe oral mucositis (SOM). Patients with OM had lower platelet and leukocyte counts (p < 0.05). The G allele of rs1544410 (p = 0.040) and the CT genotype of rs2228570 polymorphisms were associated with SOM (p = 0.038). A partially methylated status in the VDR promoter was found in all patients.

CONCLUSION

OM is associated with lower leukocyte and platelet counts. SOM is associated with the rs1544410 and rs2228570 polymorphisms. The methylation status of the VDR is not associated with inflammation or exposure to MTX®.

DNA Methyltransferase Genes Are Associated with Oral Mucositis and Creatinine Levels in Oncopediatric Patients

The aim of this study was to investigate the association of single-nucleotide polymorphisms (SNPs) and the DNA methylation profiles of the DNA methyltransferase (DNMT) gene family with oral mucositis in children and adolescents with hematologic malignancies treated with methotrexate (MTX^®). The population was comprised of healthy and oncopediatric patients aged between 4 and 19 years. An evaluation of oral conditions was performed using the Oral Assessment Guide. Demographic, clinical, hematological, and biochemical data were obtained from medical records. Genomic DNA extracted from oral mucosal cells was used for the analysis of polymorphisms in DNMT1 (rs2228611), DNMT3A (rs7590760), and DNMT3B (rs6087990) using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique (n = 102) and for DNA methylation using the methylation-specific PCR (MSP) technique (n = 85). The allele and genotypic frequencies of SNPs did not reveal any differences between patients with or without oral mucositis. An increase in the methylation frequency for DNMT1 in patients recovered from mucositis was detected. The DNMT3A methylated profile associated with the CC genotype (SNP rs7590760) appeared to be connected to higher values of creatinine. In addition, the DNMT3B unmethylated profile associated with the CC genotype (SNP rs6087990) appeared to be connected with higher values of creatinine. We conclude that the DNMT1 methylation profile is associated with the post-mucositis period and that the genetic and epigenetic profiles of DNMT3A and DNMT3B are associated with creatinine levels.

Evaluation of the Effect of Grape Seed Extract (GSE) on Oral Mucositis in Patients with Head and Neck Radiotherapy History- A Randomized Clinical Trial

Background: Mucositis is one of the most important complications of radiotherapy. Some factors such as type of treatment and degree of patient sensitivity affect mucositis occurrence. Objective: This research was implemented to evaluate the effect of grape seed extract on radiation-induced mucositis. Methods: This research is a double-blinded randomized clinical trial implemented on 78 patients undergoing head and neck radiotherapy in the oncology ward of Imam Reza Hospital of Tabriz. The patients were randomly divided into 2 groups, the intervention, and the control group. Each group included 39 patients. The intervention group used 2% grape seed extract mouthwashes and the control group used placebo mouthwashes. The mouthwashes were used 3 times a day for 2 weeks. For statistical analysis of collected data, SPSS 20 software was applied. Results: The results showed that according to the Friedman test, on the 10th and 14th days, mucositis grade and incidence had a significant difference between the intervention and control groups. Conclusions: The findings indicated that grape seed extract mouthwash in preventing radiation-induced mucositis was more effective than a placebo. Thus, this agent can be recommended as an appropriate medication to eliminate oral mucositis symptoms.

Factors Associated With Oral Mucositis Severity in Children Who Have Received Chemotherapy

Oral mucositis (OM) is a major complication for pediatric oncology patients undergoing cancer therapy. This paper aimed to report on the relationship between OM severity and various patient factors as well as to compare 2 scales used to assess OM severity. The severity of 68 separate episodes of OM in 47 pediatric oncology patients who had received chemotherapy was regularly assessed using the Children's International Mucositis Evaluation Scale (ChIMES) and World Health Organization (WHO) scale. The mean time from the start of the patients' chemotherapy block to the onset of OM was 8.4 days (±4.0), the median duration of OM was 7.0 days (4.0, 10.5) and median admission duration was 7.0 days (4.5, 13.5). There was a significant relationship between the severity of OM and the duration of symptoms ( P <0.001), patient's admission length ( P <0.001) and low neutrophil count. With decreasing neutrophil count, the severity of OM and number of pain medications used increased. Neutrophil count recovery coincided with resolution of OM. No significant relationship was found between OM severity and the child's cancer diagnosis. The 2 scales used to measure OM severity showed substantial agreement.

The therapeutic effect of bovine colostrum on 5-Fluorouracil-Induced oral mucositis in rats

OBJECTIVE

The purpose of this study is to determine the effect of bovine colostrum on 5-fluorouracil-induced oral mucositis in rats.

MATERIAL AND METHOD

Twenty-four male Wistar albino rats were randomly divided into three groups as the Preoperative, Postoperative and Control groups. All rats were administered 100 mg/kg 5-fluorouracil on the first day and 65 mg/kg 5-FU on the third day intraperitoneally. On the third and fifth days, a superficial incision was created on the mucosa of the right cheek pouch. The oral mucositis protocol was applied in the control group. The preoperative group was given bovine colostrum by gavage from the 1st day of the 5-FU procedure to the 5th day, while the postoperative group was given bovine colostrum by gavage from the 5th day to the 10th day.

RESULTS

According to the scoring made in terms of secondary infections, two cases in the control group had moderate infections, and two cases in each of the preoperative and postoperative groups had severe infections. The difference between the control group and the preoperative and postoperative groups was significant (p=0.020). There was no significant difference between the preoperative and postoperative groups. While the degree of wound healing in the postoperative group was higher than the other groups, the difference was not statistically significant.

CONCLUSION

No significant effect of bovine colostrum on the healing of oral mucositis was observed. Additional studies are needed to shed light on the pathogenic inflammatory mechanisms in mucositis and the prophylactic and therapeutic roles of antioxidants.

Chemotherapy-induced oral mucositis in children and adolescents: a systematic review

PURPOSE

The present systematic review aims to describe the incidence and severity of chemotherapy-related oral mucositis in children and adolescents affected by hematologic and solid tumors.

METHODS

An electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO up to the 8th November 2020. The PRISMA protocol was followed for the article selection and inclusion. The risk of bias in individual studies was evaluated through the Newcastle-Ottawa Scale. Data were summarized using mean and standard deviation for continuous variables, while categorical ones were described with frequency and percentage.

RESULTS

A number of 9940 records were obtained after the electronic search. Seventeen of them were included in the qualitative analysis after the two stages of screening, while none of these articles was considered eligible for the quantitative analysis. The mean incidence of oral mucositis was 53.6% and it ranged from 16.7 to 91.5%, while severe oral mucositis accounted for the 15.8% (0.0-35.2%) among selected studies. Most of the articles included both patients with solid and hematologic tumors, while only five of them described oral mucositis in children with acute lymphoblastic leukemia. Even the kinds of chemotherapy administered were extremely variable.

CONCLUSION

In conclusion, about half of the patients submitted to cancer chemotherapy developed oral mucositis with an incidence and severity that varies depending on the primary disease and the kind of drugs administered.

Prevention and Treatment of Oral Complications in Hematologic Childhood Cancer Patients: An Update

Cancers have a highly negative impact on the quality of life of paediatric patients and require an individualised oral treatment program for the phases of the disease. The aim of this study was to update existing research on oral care in children diagnosed with cancer. We carried out a literature search (in English, Spanish and Portuguese) in the Pubmed, Cochrane Library, EBSCO, WOS, SciELO, Lilacs, ProQuest, and SCOPUS databases and the websites of hospitals that treat childhood cancers. We found 114 articles and two hospital protocols. After review, we describe the interventions necessary to maintain oral health in children with cancer, divided into: phase I, before initiation of cancer treatment (review of medical record and oral history, planning of preventive strategies and dental treatments); phase II, from initiation of chemo-radiotherapy to 30-45 days post-therapy (maintenance of oral hygiene, reinforcement of parent/patient education in oral care, prevention and treatment of complications derived from cancer treatment); phase III, from 1 year to lifetime (periodic check-ups, maintenance, and reinforcement of oral hygiene, dental treatments, symptomatic care of the effects of long-term cancer treatment). The use of standardised protocols can avoid or minimise oral cancer complications and the side effects of cancer therapies.

Genetic polymorphisms of genes involved in oxidative stress and inflammatory management in oncopediatric patients with chemo-induced oral mucositis

Oral mucositis (OM) is a painful inflammatory oral condition that affects children who undergo chemotherapy. Oxidative stress is a known OM mediator and pro-inflammatory cytokines contribute to the amplification of the immune response.

ABCG2 polymorphism, age and leukocyte count may contribute to oral mucositis in oncopediatric patients

The study investigated the relationship between genetic polymorphisms and the development of oral mucositis in pediatric patients undergoing chemotherapy involving methotrexate. A longitudinal study was conducted with 64 patients, and oral mucositis was evaluated by the modified Oral Assessment Guide, which aims to diagnose and classify oral mucositis. Epithelial cells were obtained by mouthwash and DNA was extracted. The polymorphisms MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) and ABCG2 (rs2231142) were analyzed by PCR-RFLP method. Demographic, hematological and biochemical data were collected from medical records. Statistical analysis was performed using the SPSS software adopting a p-value of 0.05. Male sex predominated (56.2%), and the mean age was 10.8 years (± 4.9). Oral mucositis affected 65.6% of the patients, of which 61.9% developed the severe form of the disease. For the ABCG2 gene (rs2231142), the rare A allele and CA genotype were more frequent in individuals with mucositis (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). The severity of the disease was mainly observed in younger patients (median = 9 years; p=0.02). Patients with severe oral mucositis presented lower leukocytes count (median = 2.150 mm3) compared to patients with the mild/moderate form (median = 4.200 mm3; p=0.03). Female patients and each 10,000-platelet increase were protective factors against the onset of oral mucositis (p=0.02). It is concluded that rs2231142 polymorphism increases the likelihood of oral mucositis and younger patients and patients with low leukocytes counts are more likely to develop severe form.

Integrated oral care contributes positively to the course of treatment of oncopediatric patients

The purpose of this study was to implement a model of permanent oral health care for oncopediatric patients and to observe its effects on severe oral mucositis and subsequent treatment interruptions. We performed a quasi-experimental study in the Pediatric Department of Napoleão Laureano Hospital, in the city of João Pessoa, Brazil. A integrated oral care was implemented by a dentistry team for prevention of comorbidities, such as infections, oral pain, oral function maintenance, oral mucositis, and interventions for lesions due to severe oral mucositis. The oral comorbidities were compared before and after the implementation. The duration of severe oral mucositis (SOM) before and after the interventions and the interruptions in treatment due to SOM were the main outcome measures. Permanent oral health care reduced the duration of SOM and reduced pediatric chemotherapy interruptions due to SOM by 81.8%.Conclusion: The permanent oral health care to offer to oncopediatric patients increased surveillance regarding oral comorbidities and reduced chemotherapy interruptions due to severe oral mucositis. This care plan could be adopted anywhere around the world. What is Known: • Several studies on oral care for pediatric oncology patients, especially regarding both prevention of and treatment for oral mucositis during antineoplastic therapy, have been published. What is New: • This study describes the benefits of permanent oral care with daily oral surveillance for pediatric patients, which reduced the duration of severe oral mucositis, increased surveillance and the efficiency in diagnostic for signs of oral mucositis, enabling early intervention, and decreased chemotherapy interruptions, contributing positively to the course of treatment.

Prebiotics protect against acute graft-versus-host disease and preserve the gut microbiota in stem cell transplantation

Acute graft-versus-host disease (aGVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Therefore, management of aGVHD is important for successful transplantation. Mucosal damage and alteration of the gut microbiota after allo-HSCT are key factors in the development of aGVHD. We conducted a prospective study to evaluate the ability of prebiotics, which can alleviate mucosal damage and manipulate the gut microbiota, to mitigate posttransplantation complications, including aGVHD. Resistant starch (RS) and a commercially available prebiotics mixture, GFO, were administered to allo-HSCT recipients from pretransplantation conditioning to day 28 after allo-HSCT. Prebiotic intake mitigated mucosal injury and reduced the incidence of all aGVHD grades combined and of aGVHD grades 2 to 4. The cumulative incidence of skin aGVHD was markedly decreased by prebiotics intake. Furthermore, the gut microbial diversity was well maintained and butyrate-producing bacterial population were preserved by prebiotics intake. In addition, the posttransplantation fecal butyrate concentration was maintained or increased more frequently in the prebiotics group. These observations indicate that prebiotic intake may be an effective strategy for preventing aGVHD in allo-HSCT, thereby improving treatment outcomes and the clinical utility of stem cell transplantation approaches. This study was registered on the University Hospital Medical Information Network (UMIN) clinical trials registry (https://www.umin.ac.jp/ctr/index.htm) as #UMIN000027563.

The incidence of severe oral mucositis and its occurrence sites in pediatric oncologic patients

Background

Childhood cancer is one of the main causes of child mortality and its treatment has debilitating effects on the oral cavity. Several oral mucositis (SOM) is one of the most common and may cause undesirable symptoms such as pain and risk of systemic infection.

Material and Methods

This was a longitudinal, retrospective, and observational study determining the incidence of severe oral mucositis (SOM) and its occurrence sites in pediatric oncologic patients, in João Pessoa, Brazil, between 2013 and 2018. Data from 56 patients aged 1 to 18 years were collected from their medical records and through an oral mucosa examination, from the 1st to 5th week of chemotherapy treatment (CT) using the modified Oral Assessment Guide, by previously calibrated examiners (Kappa index > 0.7). The data were analyzed by the Chi-square test, and Odds Ratios were calculated.

Results

Most patients were females (54.5%), aged 8.8 years (± 4.8), with hematologic tumors (73.2%), predominantly Acute Lymphoid Leukemia (50.0%). An increase in the occurrence of SOM was observed throughout the CT (P = 0.05), ranging from 12.5% in the 1st to 35.7% in the 5th CT week. In the 1st CT week, there was a predominance of alterations in the lips (5.5%) and saliva (5.5%), while in the 5th, the jugal / palate mucosa (21.4%) remained the most affected site by SOM. Differences in the severity of SOM in the jugal / palate mucosa (P = 0.01) and labial mucosa (P = 0.04) were observed over time. In the 5th CT week, the likelihood of developing SOM was 13.3-fold higher (95% CI: 1.5 - 105.6) in patients with hematologic tumors.

Conclusions

The incidence of SOM was higher in the 5th CT week, most commonly affecting the jugal / palate mucosa, and patients with hematologic tumors were more prone to develop SOM.

Key words:Mucositis, oncology, pediatric dentistry.

Impact of severe oral mucositis in pediatric cancer patients on resource utilization and cancer treatment plans

BACKGROUND

Oral mucositis is a common chemotherapy-related adverse event that may result in serious complications. Few studies have evaluated mucositis in pediatric patients.

OBJECTIVE

To evaluate the impact of severe mucositis on resource utilization and on treatment plans of pediatric cancer patients.

SETTING

Comprehensive cancer center in Amman, Jordan.

METHOD

Retrospective study on pediatric patients undergoing active cancer treatment with a hospital admission diagnosis of severe oral mucositis (January 2015-December 2019). Patients undergoing bone marrow transplant were excluded. Severe oral mucositis was defined as interfering with oral intake and requiring intravenous opioids.

MAIN OUTCOME MEASURE

We reviewed the electronic billing system and patient medical charts to determine the resources utilized during hospitalization, cost, and the impact on subsequent treatment protocols.

RESULTS

During the study period, 200 patients were eligible; the average age was 8.6±5.6 years (SD) and 45% had acute lymphoblastic leukemia. The median hospital stay was 6 days (range 2-21) with a total median cost of US$ 2,176 (range 635-13,976) per admission. The median medication cost was US$ 1,075 (range 135-9010), and 85% of the patients received antibiotics during hospitalization, at a median cost of US$ 487 (range 23-2,193). Modification of the chemotherapy treatment protocol was required in 110 patients, which included dose reduction (60%), delay (38%), and discontinuation (2%).

CONCLUSION

Severe oral mucositis is associated with significant resource utilization and modification of the treatment protocols. Further studies are needed to identify strategies to reduce the impact of mucositis in this patient population.

MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients

OBJECTIVE

The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population.

METHODS

This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications.

RESULTS

A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature.

CONCLUSION

There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.

The Effect of Cheese and Milk on Buffering Capacity of Saliva in Children 10-12 Years

Saliva have significant roles in maintaining the health of oral cavity. Salivary flow and composition of saliva play a critical role. Saliva also serves as buffer system. Increasing the salivary flow will increase salivary buffer capacity and pH of saliva. Salivary buffer capacity serves to protect the teeth from the acid that comes from food which is formed by acidogenic microorganisms. Milk and dairy are good diet for children that recommended by American Heart Association (AHA). Cheese as one of dairy mild can increase the salivary flow, that help keep the dental hygiene, and prevent bacteria sticking to the teeth. The aim of the study was to identify the effect of cheese and milk consumption on salivary buffer capacity of students aged 10-12 year at Sekolah Dasar Negeri 57 Banda Aceh. Salivary buffer capacity after consume cheese measured after chewing cheese 4 gram about 32 times whereas salivary buffer capacity after consume milk consumption was measured after gargling 25 ml milk 34 times. Salivary buffer capacity measured with Saliva-check buffer (GC). Results of Wilcoxon test showed significant differences (p<0.05) salivary buffer capacity after consumption of milk compared with cheese. Capacity buffer salivary after consumption of cheese higher than milk. In conclusion, cheese and milk consumption have effect on salivary buffer capacity. Salivary buffer capacity after cheese consumption is higher than after milk consumption.

Evaluating the additive effect of Persica and chlorhexidine mouthwashes on oral health status of children receiving chemotherapy for their hematomalignancy: A randomized clinical trial

Background

No definitive protocol has been introduced for treatment or prevention of chemotherapy induced mucositis. The aim of this study was to assess the additive effect of Persica and chlorhexidine on chemotherapy induced mucositis of children with hematomalignancies.

Material and Methods

This randomized clinical trial was performed on 44 children aged 6 to 12 years who were under a similar maintenance chemotherapy protocol for their hematomalignancies. The clinician instructed oral hygiene cares to the patients and their parents and the severity of the mucositis and oral health status of patients were evaluated according to Oral Assessment Guide index. Then, the patients were randomly assigned to one of two experimental groups and were instructed to rinse either with Persica oral drops or normal saline, twice a day for two weeks. Subsequently, the patients in both groups were educated to rinse with chlorhexidine for 30 seconds and avoid eating for an hour. Second and third oral examinations were performed on the 8th and 15th day using the same questionnaire.

Results

Comparing severity of mucositis and oral health status of patients did not show any significant difference between treatment groups in either of examination sessions (p>0.05). However, both treatment groups showed statistically significant oral health improvement, in terms of mucositis, plaque accumulation and gingival condition, in 14 days following mouthrinses administration (p<0.05).

Conclusions

Both mouth-rinse combinations were effective on mucositis, plaque and gingival status of children receiving chemotherapy. However, Persica does not seem to pose additional effect on chlorhexidine in decreasing severity of chemotherapy induced mucositis.

Key words:Mucositis, chemotherapy, children, chlorhexidine, Persica.

Severe Oral Mucositis in Pediatric Cancer Patients: Survival Analysis and Predictive Factors

This paper investigates the occurrence of severe oral mucositis and associated factors in blood and solid cancer pediatric patients subjected to cancer treatment, using a survival analysis. A longitudinal, descriptive, observational and inductive study of 142 pediatric patients aged from 0 to 19 years was conducted from 2013 to 2017. Data were collected using a form to record the sociodemographic characteristics and health-related aspects of patients and the modified Oral Assessment Guide (OAG). Survival analysis was performed using the Kaplan-Meier method and Cox semiparametric model. The median times to occurrence of severe oral mucositis were 35.3 and 77.1 days for patients with hematologic malignancies and solid tumors, respectively. The Cox model showed that white cell changes and platelet counts as well as the use of natural chemotherapeutic agents are risk factors for the occurrence of oral mucositis among patients with hematologic malignancies. Nonetheless, among patients with solid tumors, the occurrence of oral mucositis was associated with female sex, mixed ethnicity, the presence of metastasis, abnormal creatinine levels, a combination of chemotherapy, radiotherapy, and surgery, and the administration of chemotherapeutic agents included in the miscellaneous group. The time to occurrence of severe oral mucositis and its associated factors varied according to cancer type.

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

Abstract This study aimed to evaluate the factors associated with the occurrence of severe oral mucositis (SOM) in pediatric oncology patients during the chemotherapeutic treatment. This is a nested case-control to a prospective cohort that monitored 105 patients for 10 consecutive weeks after the beginning of the chemotherapy treatment. Logistic regression was used to identify the factors associated with SOM, by group of malignancy (hematologic or solid tumors) (Sig.=5%). To patients with hematologic tumors were found factors associated with SOM in two weeks of treatment: in the 6th week (increase in frequency of chemotherapy doses (OR=3.02)) and in the 7th week (female sex (OR=21.28); and increase in frequency of chemotherapy doses (OR=2.51)); and to patients with solid tumors were found factors associated with SOM in five weeks of treatment: in the 1st week (female sex (OR=14.43); age increase (OR=1.24)); in the 2nd week (Miscellany (OR=6.39)); in the 5th week (Antimetabolites (OR=17.44); Miscellany (OR=45.42); and platelets reduction (OR=1.12)); in the 6th week (creatinine increase (OR=1.63)); and in the 7th week (creatinine increase (OR=2.39)). For patients with hematologic tumors, to be female, and the increase in the frequency of chemotherapy doses increased the risk for SOM and for patients with solid tumors, to be female, the increase in age and in level blood concentration of creatinine, the reduction in number of platelets and the use of chemotherapy with miscellany and antimetabolites agents were associated with an increase in risk for occurrence of SOM.

Differences between the oral changes presented by patients with solid and hematologic tumors during the chemotherapeutic treatment

Objective:

This study sought to identify the differences between the oral changes presented by patients with solid and hematologic tumors during chemotherapeutic treatment.

Methodology:

This is an observational, prospective and quantitative study using direct documentation by follow-up of 105 patients from 0 to 18 years using the modified Oral Assessment Guide (OAG). Of the 105 patients analyzed, 57 (54.3%) were boys with 7.3 years (±5.2) mean age. Hematologic neoplasms accounted for 51.4% of all cases.

Results:

Voice, lips, tongue, and saliva changes were not significantly different (p>0.05) between patients with solid or hematologic tumors and during the follow-up. From the 6^th until the 10^th week of chemotherapeutic treatment alterations in swallowing function, in the mucous membrane (buccal mucosa and palate), in the labial mucosa, and in the gingiva occurred and were distributed differently between the two tumors groups (p<0.05). The main alterations were observed in patients with hematologic tumors.

Conclusion:

It was concluded that the oral changes during the chemotherapeutic treatment occurred especially in swallowing function, in the mucous membrane, in the labial mucosa and in the gingiva, and these alterations were found mainly in patients with hematologic tumors.

The Contribution of Motor Changes to Oral Mucositis in Pediatric Cancer Patients: A Cross-Sectional Study

This study aimed to investigate the contribution of motor changes to oral mucositis in children and adolescents with cancer undergoing antineoplastic treatment in a referral hospital. This was an observational, cross-sectional study with 70 patients aged 2 to 19 years, diagnosed with any type of cancer and treated in a pediatric hospital cancer ward from April to September 2017. A questionnaire related to the patients' socioeconomic and clinical conditions was used, followed by the Oral Assessment Guide and selected domains of the activity and participation section of the International Classification of Functioning, Disability, and Health tool. The data were collected by previously calibrated examiners (kappa index > 0.75) and analyzed using descriptive statistics and logistic regression (α = 5%). Children and adolescents aged 7 to 10 years were more likely to develop oral mucositis (OR: 3.62). In addition, individuals who had severe difficulty in maintaining a body position (OR: 14.45) and walking (OR: 25.42), and those diagnosed with hematologic cancers (OR: 6.40) were more likely to develop oral mucositis during antineoplastic treatment. Within the limitations of this study, it is concluded that motor changes may contribute to the occurrence of oral mucositis in pediatric cancer patients.

Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines

PURPOSE

The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis.

METHODS

A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines.

RESULTS

A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other anti-inflammatory agents due to inadequate and/or conflicting evidence.

CONCLUSIONS

Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings.

Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis

BACKGROUND

It is known that chemotherapeutic agents are not equally stomatotoxic and oral cavity lesions are the most frequent complications encountered in antineoplastic chemotherapy.

AIMS

The objective of this study was to evaluate the occurrence of severe oral mucositis during a chemotherapy treatment and to identify its relationship with the chemotherapeutic class used.

MATERIALS AND METHODS

This is a longitudinal, prospective, and observational study that used an intensive direct observation technique for assessing the oral clinical conditions and the chemotherapy treatment administered to 105 patients (both children and adolescents).

RESULTS

Severe oral mucositis occurred in all the 10 weeks of evaluation (ranging from 16.2 to 31.4%) and the association between the type of chemotherapy and the occurrence of severe oral mucositis is recorded only in the 6th week, with the chance to develop severe oral mucositis being 3.07 (3.85-2.29) times higher in patients underwent chemotherapy with antimetabolites than in those who have not used chemotherapy (p = 0.012).

CONCLUSION

It was concluded that the chemotherapeutic agents most related to severe oral mucositis and to the interruption in chemotherapy are those of the class of antimetabolites, especially the methotrexate and the Ara C.

HOW TO CITE THIS ARTICLE

Ribeiro ILA, de Andrade Lima Neto E, et al. Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis. Int J Clin Pediatr Dent 2019;12(4):261-267.

The Effect of Oral Care with Chlorhexidine, Vitamin E and Honey on Mucositis in Pediatric Intensive Care Patients: A Randomized Controlled Trial

PURPOSE

This study was performed to determine the effect of oral care using chlorhexidine, vitamin E and honey on oral mucositis (OM) management in children treated in a pediatric intensive care unit (PICU).

DESIGN AND METHODS

The study was a randomized controlled trial with a parallel design. The study sample was composed of 150 children who were treated in the PICU of a university hospital in Turkey. Children enrolled in the study were randomly divided into six groups based on the oral care solutions used (n = 25 in each group). The Demographic Information Form and the World Health Organization Oral Mucositis Index were used for data collection.

RESULTS

The mucositis indices of the children presenting with and without OM upon admission to the PICU were compared on days 1, 3, 6, 9, 12, 15, 18 and 21 and the study found that the mucositis index values of the children treated with vitamin E were significantly lower than in the other groups (p < 0.05 for each), while those of the children given chlorhexidine were significantly higher than in the other groups (p < 0.05 for each).

CONCLUSIONS

At the end of the study, vitamin E was determined to be the most effective agent in OM management, followed by honey as the second most effective agent. Chlorhexidine was found to be less effective in OM management compared to the other two agents. Based on this, vitamin E is recommended for use in oral mucositis-preventive and therapeutic oral care practices.

PRACTICE IMPLICATIONS

The results of the present study conducted with PICU patients will be useful in the administration of oral care. These findings are also important for nurses who have the responsibility of oral mucositis management.

Management of oral mucositis in pediatric patients receiving cancer therapy: A systematic review and meta-analysis

BACKGROUND

One of the most common complications of cancer chemotherapy is oral mucositis (OM). OM affects more than 75% of patients undergoing chemotherapy and represents a significant burden to patients and caregivers. We performed a systematic review and meta-analysis of published studies to investigate the effects of agents and techniques in reducing OM.

PROCEDURE

This systematic review investigated, critically appraised, and rated the evidence on agents used to manage OM in children undergoing cancer therapy. A comprehensive search of the relevant literature was performed from January 2006 to December 2017. MEDLINE, Scopus, the Cochrane Database of Systematic Reviews, EMBASE, and the Web of Science were searched. Nine eligible studies were identified. Using random-effects models, standardized mean difference was estimated between treated and control groups across all studies. The Cochran test and the I2 index were performed for heterogeneity between studies. The significance level was set at P = 0.05.

RESULTS

Palifermin reduced the incidence (OR = 4.131, P = 0.000), duration (St diff mean = 0.803, P = 0.000), and severity (St diff mean = 0.637, P = 0.000) of OM in pediatric cancer patients significantly. However, the laser did not show significant efficacy in decreasing the incidence rate of OM (OR = 2.870, P = 0.364).

CONCLUSION

This review provided a comprehensive examination of available options for children who have OM. The results support the possibility of a positive effect of palifermin on reducing OM in children receiving cancer therapy.

Dental Caries in Children and Adolescents During and After Antineoplastic Chemotherapy

OBJECTIVE

To assess caries incidence, intensity, and treatment in children and adolescents under/after antineoplastic treatment.

STUDY DESIGN

Patients with permanent and mixed dentition were divided into three groups of 60 patients each (5-18 years): CH - under chemotherapy; PCH - after chemotherapy; CG - generally healthy subjects. Caries incidence, intensity (DMFT/dmft, DMFS/dmfs), and mean numbers of teeth/surfaces with white spot lesions-WSL (D₁₊₂/d₁₊₂) were assessed following the ICDAS-II criteria.

STATISTICAL ANALYSIS

Mann-Whitney U test, significance at p≤0.05).

RESULTS

Caries incidence was significantly higher in PCH and CH (88.33% and 90%) than in CG (66.66%). Caries intensity was higher in both mixed and permanent dentition in patients under and after chemotherapy. The DMFS/DMFT correlation was the highest in PCH. Treatment indexes for primary and permanent teeth treatment were significantly lower in PCH and CH than CG.

CONCLUSION

Antineoplastic chemotherapy is associated with caries development and its high incidence during/after treatment. As dental hygiene was poor in patients under and after antineoplastic treatment, dental checkups need to be more frequent and thorough.

Factors Contributing to the Duration of Chemotherapy-Induced Severe Oral Mucositis in Oncopediatric Patients

This study analyzes the factors contributing to the duration of severe oral mucositis in oncopediatric patients. A longitudinal study was conducted in the pediatric department of a cancer referral hospital between 2013 and 2017. Seventy-three patients diagnosed with cancer undergoing chemotherapy protocols were analyzed. Oral evaluations were performed using the Modified Oral Assessment Guide criteria, and the data were collected from the patients’ records. The Kaplan-Meier method was used to estimate survival curves. Most patients were males (52.1%), of mixed race (“pardo”) (49.3%), with a mean age of 7.56 years (±5.34). There was a predominance of patients diagnosed with solid tumors (52.1%), with no metastasis (86.3%), using natural product chemotherapeutics (56.2%), who had not undergone a bone marrow transplant (97.3%); amputation was observed in 35.6% of patients, while death rates were as high as 8.2%. The survival analysis estimated a mean time of 30.6 days until complete remission of severe oral mucositis. The regression analysis showed that patients over 10 years old had a median mucositis duration 1.4 times greater than those at the age of 10 years or younger. Patients without metastasis had a median mucositis duration 1.7 times greater than those with metastasis (p-value ≤ 0.10). Increasing age and the absence of metastasis were conditions that prolonged the duration of severe oral mucositis.

The Prevalence and Investigation of Risk Factors of Oral Mucositis in a Pediatric Oncology Inpatient Population; a Prospective Study

BACKGROUND

Oral mucositis can be a frequent and severe complication of chemotherapy in children. It can result in pain, infection, depression, prolonged admission, treatment delays, increase in patient morbidity, and increased costs.

AIM

To record the prevalence and severity of oral mucositis among inpatients and explore the relationship of risks factors and the development of oral mucositis.

DESIGN

During an 18-month period 643 clinical inpatient assessments were completed on 73 children who were admitted and had received chemotherapy in the last 14 days.

RESULTS

There were 43 episodes of oral mucositis in 31 children; 42.5% of the inpatient population. World Health Organization assessment identified 32.6% of episodes were grade 1, 34.9% grade 2, 14.0% grade 3, and 18.6% grade 4. Analysis revealed significant associations between patient diagnosis (P<0.0001), chemotherapy cycles (P<0.0001), day 8 and 9 of the chemotherapy cycle (P<0.05), and neutropenia (P<0.0001) and oral mucositis. Children had increased length of admission with increasing severity of oral mucositis (P=0.0005).

CONCLUSIONS

The prevalence of oral mucositis was 42.5% among inpatients and admission length was increased with increasing severity. Patient diagnosis, chemotherapy treatment block, day of chemotherapy cycle, and neutropenic status were shown to influence the risk of developing oral mucositis.

US oncology-wide incidence, duration, costs and deaths from chemoradiation mucositis and antimucositis therapy benefits

Approximate oncology-wide incidence, duration, costs and deaths associated with mucositis and identify health economic benefits of antimucositis therapies. Review the literature relevant to the clinical experience of mucositis by pathophysiology, incidence, duration, costs and deaths. Use US insurance actuarial and epidemiology on cancer to generalize an oncology-wide impact of toxic mucositis. Toxic mucositis causes oropharyngoesophageal ulcerations, chemo-induced nausea, vomiting and diarrhea. Acutely, it lasts 102 days/six cycles of chemotherapy, 60 days in human stem-cell transplantation patients and 70-84 days in head and neck cancer patients at annual costs of US$13.23 billion/522,166 treated patients (US$20,892/erosive-type mucositis patient, US$25,337/physiologic mucositis patient) and 46,699 deaths. Using antimucositis therapies prior to 2013 provided fractional benefits at high costs. By completely preventing and rapidly reversing mucositis, high-potency polymerized cross-linked sucralfate promises superior health economic benefits.

Oral Mucositis in Pediatric Patients in Treatment for Acute Lymphoblastic Leukemia

Oral mucositis in oncologic patients is the most undesirable event of the chemotherapeutic treatment. This study aimed to identify damage to the oral cavity resulting from chemotherapy in pediatric patients with acute lymphoblastic leukemia (ALL). This is a prospective study with a sample of 42 children and adolescents evaluated for 10 consecutive weeks after diagnosis. The modified Oral Assessment Guide (OAG) was used, and data were analyzed by Spearman’s rank correlation coefficient (α = 5%). Changes to the normal lips and saliva were positively related to an increase in the OAG score during all 10 weeks of evaluation. Alterations to the labial mucosa were correlated with an increase in the OAG score from the 2nd to 10th week, which was also found for changes in the tongue and in the swallowing function in Weeks 1, 6, 8, 9, and 10 and for gum changes from the 5th to 7th week. No significant vocal changes were correlated with the total OAG score at any point during the monitoring period. Changes in lips, cheek and/or palatal mucosa, labial mucosa, and gum areas and in swallowing function were positively correlated with an increase in the severity of oral mucositis in patients with ALL after beginning chemotherapeutic treatment.

A Randomized Placebo- Controlled Double Blind Clinical Trial of Quercetin in the Prevention and Treatment of Chemotherapy-Induced Oral Mucositis

INTRODUCTION

Oral Mucositis (OM) is a serious complication of chemotherapy that results in painful debilitating inflammation that sometimes ends in interruption of treatment.

AIM

The study evaluated the effect of quercetin (a natural flavonoid) on preventing and treating chemotherapy induced OM in patients with blood malignancies. Materials and Methods: This double-blind, placebo controlled randomized trial was carried out on 20 adult patients who underwent high dose chemotherapy for blood malignancies. Patients were divided into two groups (10 patients in the intervention group and 10 patients in the control group). Patients in the intervention group were administered 250 mg quercetin capsules twice daily for four weeks.

RESULTS

Nine out of 20 patients developed OM (three in the intervention group and six in the control group). The incidence of OM was lower in the intervention group although it was not statistically significant (p=0.189). The mean severity of OM was higher in the intervention group (2.6 vs 2). Healing time, age, gender, type of malignancy, drug type and duration of OM were not different in two groups.

CONCLUSION

The incidence of mucositis was lower in the quercetin group, but mucositis was more severe in the intervention group, which may be due to lower oral health status in the intervention group.

Preventive Intervention Possibilities in Radiotherapy- and Chemotherapy-induced Oral Mucositis: Results of Meta-analyses

The aim of these meta-analyses was to evaluate the effectiveness of interventions for the prevention of oral mucositis in cancer patients treated with head and neck radiotherapy and/or chemotherapy, with a focus on randomized clinical trials. A literature search was performed for reports of randomized controlled clinical studies, published between 1966 and 2004, the aim of which was the prevention of mucositis in cancer patients undergoing head and neck radiation, chemotherapy, or chemoradiation. The control group consisted of a placebo, no intervention, or another intervention group. Mucositis was scored by either the WHO, the National Cancer Institute-Common Toxicity Criteria (NCI-CTC) score, or the absence or presence of ulcerations, or the presence or absence of grades 3 and 4 mucositis. The meta-analyses included 45 studies fulfilling the inclusion criteria, in which 8 different interventions were evaluated: i.e., local application of chlorhexidine; iseganan; PTA (polymyxin E, tobramycine, and amphotericin B); granulocyte macrophage-colony-stimulating factor/granulocyte colony-stimulating factor (GM-CSF/G-CSF); oral cooling; sucralfate and glutamine; and systemic administration of amifostine and GM-CSF/G-CSF. Four interventions showed a significant preventive effect on the development or severity of oral mucositis: PTA with an odds ratio (OR) = 0.61 (95% confidence interval [CI], 0.39–0.96); GM-CSF, OR = 0.53 (CI: 0.33–0.87); oral cooling, OR = 0.3 (CI: 0.16–0.56); and amifostine, OR = 0.37 (CI: 0.15–0.89). To date, no single intervention completely prevents oral mucositis, so combined preventive therapy strategies seem to be required to ensure more successful outcomes.

Oral Mucositis in Pediatric Acute Lymphoblastic Leukemia Patients: Evaluation of Microbiological and Hematological Factors

OBJECTIVE

to investigate the associations of oral microbiota, leucocytes count, neutrophil count, platelet counts and hemoglobin level, and the severity of oral mucositis in pediatric patients with acute lymphoblastic leukemia (ALL) receiving chemotherapy.

MATERIALS AND METHODS

71 prospective patients were included. Analyses of oral microbiota and blood sample were conducted on days 14 (D14) and 56 (D56) of the Brazilian GBTLI-99 treatment protocol. Herpes simplex virus (HSV) identification was performed by PCR followed by DNA sequencing analysis. Bacteria and fungi identification was obtained by standard microbiological culture tests.

RESULTS

103 episodes of mucositis occurred, being 65 at D14 and 38 at D56. Most cases positive for herpes viral DNA sequences were identified as HSV-1. At D14, we found a significant association between the severity of mucositis and presence of HSV-1 (p = 0.0347), Candida spp. (p = 0.0078), and low platelet count (p = 0.0064). At D56, we found a significant association between the severity of mucositis and the presence of HSV-1 (p = 0.0317), previous HSV-1 presence on D14 (p < 0.0001) and neutrophil count (p = 0.0211).

CLINICAL RELEVANCE

the identification of risk factors for mucositis in children and adolescents may contribute to the development of new strategies for prevention and/or treatment, reducing the complications associated with this condition.

CONCLUSIONS

the presence of HSV, platelet count, and Candida spp. presence at D14 of ALL induction treatment is associated with increased severity of mucositis in children and adolescents. At D56 of ALL treatment, mucositis severity was associated with neutrophil count, HSV presence, and previous presence of HSV (at D14).

Oral hygiene grade and quality of life in children with chemotherapy-related oral mucositis: a randomized study on the impact of a fluoride toothpaste with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol

AIM

The aim of this study was to assess the impact of the use of a fluoride toothpaste (Bioxtra^® , Biopharm, Milan, Italy) with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol on the oral hygiene grade and on the quality of life (QoL) of children with oral mucositis (OM) grade 1 or 2 receiving chemotherapy for Acute Lymphoblastic Leukaemia (ALL).

METHODS

Patients between 6 and 14 years with OM were randomly assigned to two groups, group A (Bioxtra^® toothpaste) and group B (fluoride toothpaste without menthol). The patients were instructed to brush their teeth at least twice a day using a soft toothbrush with a small head. Oral hygiene grade was assessed using the simplified oral hygiene index (OHI-s); quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14) questionnaires. The patients were evaluated on day 1(diagnosis of OM-T0) and on day 8 (T1). Statistical analysis was performed.

RESULTS

A total of 64 patients were enrolled. A significant difference (P < 0.001) between the mean of the OHI-s in group A (0.9 ± 1.2) and in group B (1.5 ± 1.3) was found; the overall OHIP-14 scores were not associated with the use of one or the other toothpaste (P = 0.33).

CONCLUSIONS

Although the use of Bioxtra^® toothpaste does not affect the QoL of children undergoing chemotherapy, it may be recommended as clinically effective in improving the oral hygiene grade.

Comparison of efficacy of cryotherapy and chlorhexidine to oral nutrition transition time in chemotherapy-induced oral mucositis

The aim of this study was to compare the efficacy of cryotherapy and chlorhexidine to oral nutrition transition time in chemotherapy-induced oral mucositis. This randomised controlled trial with random assignments to the experimental and control groups was conducted with cancer patients. Study data were collected from 90 cancer patients. The first experimental group (n = 30) received chlorhexidine mouthwash, the second experimental group (n = 30) received oral cryotherapy and the control group (n = 30) received routine care. To collect data we used the 'Mucositis Rating Index'. Changes in patients' oral mucosa in each group were checked and oral feeding transition periods were recorded. There was an important statistical difference between the times of transition to oral nutrition for patients (P < 0.01). Oral nutrition transition time of patients in the first experimental group who had applied chlorhexidine was shorter than in other groups. Following the tests, we detected a significant shortening in oral nutrition transition time of patients in first group who used chlorhexidine gargle as compared to the second group and control group. There was no significant difference between cryotherapy application and control group. In parallel with these findings, we detected that the degree of oral mucositis decreased.

Prophylaxis for mucositis induced by ambulatory chemotherapy: systematic review

AIM

The aim of this study was to perform a systematic review of clinical trials covering interventions used as prophylaxis for oral mucositis induced by ambulatory antineoplastic chemotherapy.

BACKGROUND

Oral mucositis in patients undergoing chemotherapy is a side effect that can impact the quality of treatment and can interfere with eating and therapeutic adherence.

DESIGN

Quantitative systematic review.

DATA SOURCES

Relevant databases were searched, from January 2002-July 2013, by using the combination of the keywords mucositis, stomatitis, neoplasms, antineoplastic agents, drug therapy, prevention and control and chemotherapy.

REVIEW METHODS

Two researchers independently read the titles and abstracts from every cross-reference. The quality of the included studies was analysed by the Jadad Scale and the Cochrane Collaboration Risk of Bias Tool. Data were extracted from the selected studies with a data collection form developed specifically for this purpose.

RESULTS

Of the 23 controlled clinical trials that were identified in this study, five articles evaluated the use of oral cryotherapy to prevent oral mucositis and three studies analysed the prophylactic use of glutamine. Interventions of protocols for oral care, palifermin, allopurinol and chlorhexidine were evaluated by two articles each. Interventions of zinc sulphate, amifostine, chewing gum, sucralfate, recombination human intestinal trefoil factor, kefir and vitamin E were evaluated by one article each.

CONCLUSION

There is strong evidence that cryotherapy can prevent oral mucositis arising from ambulatory treatment with 5-flurouracil chemotherapy. Other interventions, although showing positive results in preventing oral mucositis, require further study to confirm their conclusions.

Investigation of the effects of planned mouth care education on the degree of oral mucositis in pediatric oncology patients

This study was designed as a longitudinal study with the purpose of investigating the effects of providing mouth care education to pediatric oncology patients on the degree of oral mucositis. The study sample included 16 children aged 8 to 18 years who were hospitalized in the pediatric oncology and hematology clinics at a university hospital. The results revealed a statistically significant difference between the degree of mucositis before and after the education given to children undergoing chemotherapy (P < .05). The median pain values were significantly different before and after the education (P < .05) as well. It was also found that there was a strong positive statistically significant correlation between the degree of mucositis and mean pain score both before and after the education (P < .001). Consequently, it is reported that both the degree of mucositis and pain levels decreased when children were given planned mouth care education before chemotherapy and when they regularly performed mouth care.

The effect of olive leaf extract in decreasing the expression of two pro-inflammatory cytokines in patients receiving chemotherapy for cancer. A randomized clinical trial

BACKGROUND

Oral mucositis is the most common side effects of chemotherapy of all cancer with intensive treatments regimen, and is the most common side effects of head and neck radiation therapy. For steam cell transplantation, its also regarded as the most debilitating side effects.

AIMS OF THE STUDY

The objectives of this study were to assess the effect of a mouth rinse containing olive leaf extract (OLE) in preventing severe oral mucositis in patients receiving chemotherapy, and to estimate its effect in decreasing pro-inflammatory cytokine production after chemotherapy.

MATERIALS AND METHODS

This study utilized a placebo-controlled, randomized, double-blind, and cross-over design. Twenty-five patients undergoing intensive chemotherapy were randomly assigned to receive a mouth wash containing OLE, benzydamine hydrochloride, or placebo in 3 different cycles of chemotherapy. Oral mucositis severity was assessed using the World Health Organization criteria and Oral Mycositis Assessment Scale. Patients were evaluated weekly until 15 days after chemotherapy for each cycle. Salivary levels of interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) were evaluated by enzyme-linked immunosorbant assay.

RESULTS

Oral mucositis rates and severity after 2 weeks were significantly lower in the OLE and benzydamine groups compared to the placebo group. The IL-1β and TNF-α levels were significantly decreased in the OLE group compared to the other groups.

CONCLUSION

Preliminary findings indicate that OLE is effective in reducing IL-1β and TNF-α levels after chemotherapy and exert a therapeutic effect and prevent development of severe oral mucositis.