Oral complications of cancer chemotherapy: prevention and management

Impact of leukemia and lymphoma chemotherapy on oral cavity and quality of life

This study aimed to understand how patients perceive their oral health and the resulting oral manifestations of antineoplastic chemotherapy, as well as to analyze the impact of these alterations on oral health-related quality of life. A total of 80 patients undergoing treatment participated in this study. A questionnaire was applied using the Oral Health Impact Profile (OHIP-14) index and open interviews. Items with the highest impact prevalence included "worsened taste of food sensation" (35.00%), "discomfort in eating food" (20.00%), and "feeling stressed" (17.50%). The outpatients showed the highest prevalence scores, whereas the inpatients presented higher quality of life impact severity. The ways in which the patients perceived how their oral alteration affected their quality of life were distinct and subjective. It is important that dentists act together with a multiprofessional team developing strategies to alleviate the impact of the disease and chemotherapy on oral cavity and patients' quality of life.

An efficacious oral health care protocol for immunocompromised patients

A twice-weekly oral and perioral examination was provided to 120 patients receiving antineoplastic therapy. Sixty patients were monitored while following the traditional hospital oral care protocol (chlorhexidine, hydrogen peroxide, sodium bicarbonate, thymol glycol, benzocaine mouthrinse, and nystatin). The mouth care protocol was then changed (experimental protocol = chlorhexidine, benzocaine lozenges, amphotericin B lozenges), and patients were monitored until the sample size matched that of the hospital mouth care regime. There was a statistically significant reduction in oral complications upon introduction and maintenance of the experimental protocol.

A longitudinal follow-up of salivary secretion in bone marrow transplant patients

Salivary gland dysfunction is a common sequela of the bone marrow transplantation procedure. We determined the effect of different bone marrow transplantation protocols on parotid salivary flow rate. Salivary secretion was substantially reduced during conditioning of all the recipients. A gradual flow rate reconstitution could be detected as soon as a few days after the bone marrow transplantation. Eight patients conditioned with total lymph node irradiation and chemotherapy or chemotherapy alone displayed earlier and complete recovery of saliva secretions 2 to 5 months after the grafting. Recovery was delayed and incomplete when total body irradiation was added to the conditioning regimen (seven patients). Six of these patients also developed graft-versus-host disease. The results suggest that total body irradiation induces irreversible damage to the parotid glands resulting in profound xerostomia followed by opportunistic infections. Chemotherapy with or without total lymph node irradiation does not induce such damage.

A scoring system for the quantitative evaluation of oral mucositis during bone marrow transplantation

A system for assessing the severity of mucositis in patients undergoing bone marrow transplantation (BMT) is presented. Ten criteria were graded to give component scores together with a total score. The overall severity score ranged from 0 through 21. Scores were assigned three times daily by nursing staff members and verified daily by the attending dental and medical practitioners. Total scores were highly reproducible and were related to the severity of neutropenia. Variation between sequential total scores was not related to interexaminer variation but rather to changes in the severity of oral mucositis. Component scores provided a useful means for transmitting oral health information between health care personnel. Total scores were used to regulate the nature and frequency of oral hygiene procedures for patients undergoing BMT as well as other hematology/oncology patients. Application of this oral assessment system to other institutional settings may be beneficial.