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Liu M, An R, Wu Z, Dai L, Zeng Q, Chen W. The Trajectory of Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy and its Influencing Factors. EAR, NOSE & THROAT JOURNAL 2024:1455613241228211. [PMID: 38334289 DOI: 10.1177/01455613241228211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Oral mucositis (OM) is a common and severe side effect of radiotherapy in head and neck cancer (HNC). The study aimed to investigate the longitudinal changes in OM and its influencing factors in patients with HNC during radiotherapy. METHODS This was a retrospective longitudinal observational study. From July 2022 to March 2023, patients with HNC undergoing radiation therapy were enrolled. OM, oral hygiene, oral infections, oral pain, feeding route, and laboratory indicators were measured at 7 times. The influencing factors of OM were analyzed using generalized estimation equations (GEEs). RESULTS A total of 160 patients were included in this study. The prevalence of severe OM at T0, T1, T2, T3, T4, T5, and T6 was 0, 0, 2.5%, 9.4%, 26.9%, 24.4%, and 26.9%, respectively. The prevalence of grade 1-2 OM at T0, T1, T2, T3, T4, T5, and T6 was 0, 16.3%, 53.1%, 65.1%, 61.9%, 70.7%, and 71.3%, respectively. Duration of diagnosis, clinical stage, N stage, M stage, surgery, diabetes, radiotherapy dose, oral hygiene, oral infection, oral pain, feeding route, and lymphocyte impacted OM significantly in the GEEs multivariate model. CONCLUSIONS OM occurs in almost all patients with HNC who undergo radiotherapy. Changes in the severity of OM are a dynamic process, with the severity increasing with the cumulative radiotherapy dose. Specialist oral evaluation and oral care are needed to alleviate the severity of OM in HNC patients.
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Affiliation(s)
- Meizi Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Ran An
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Zitong Wu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Leping Dai
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Qiaomiao Zeng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Wenfeng Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, Changsha, Hunan, China
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Filetici P, Gallottini SG, Corvaglia A, Amendolea M, Sangiovanni R, Nicoletti F, D'Addona A, Dassatti L. The role of oral microbiota in the development of oral mucositis in pediatric oncology patients treated with antineoplastic drugs: a systematic review. BMC Oral Health 2024; 24:183. [PMID: 38317151 PMCID: PMC10840280 DOI: 10.1186/s12903-024-03938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In the pediatric oncology population, oral mucositis as a consequence of chemotherapy is a highly prevalent complication which strongly affects both the quality of life and treatment possibilities of the patients. Still, the etiopathological mechanisms carrying to its development are not fully understood, although a possible role of oral dysbiosis has been previously investigated with unclear conclusions. The aim of this systematic review was to assess the available evidence on the role of microbiota in the development of oral mucositis. METHODS A systematic literature search was performed following PRISMA guidelines. Three electronic databases were searched up until April 2023 and a following manual search included the reference lists of the included studies and reviews. Studies reporting microbiological and clinical data of pediatric patients treated by antineoplastic drugs were included. RESULTS Thirteen studies met the inclusion criteria, reporting an average mucositis prevalence of 57,6%. Candida albicans infections were frequently observed in studies performing microbiological analysis on oral lesions, in contrast with the low rate detection of the Herpes simplex viruses. Bacterial species such as coagulase-negative Staphylococci and Streptococcus viridans were detected more frequently on lesion sites. Studies reporting a quantitative analysis of the general flora did not show comparable results. Risk of bias assessment among studies was generally considered high or very high. CONCLUSIONS While the specific role of certain microbiological agents, such as Candida albicans, was frequently reported among studies, data regarding the general dynamics of oral microbiota in the development of oral mucositis are lacking in the current literature. Thus, more studies are needed to provide the knowledge required in order to improve protocols for the prevention and treatment of this threatening complication.
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Affiliation(s)
- Pierfrancesco Filetici
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy.
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | - Sofia Germana Gallottini
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corvaglia
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Amendolea
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Roberta Sangiovanni
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Nicoletti
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio D'Addona
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Leonardo Dassatti
- Department of Head and Neck and Sensory Organs, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
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Pombo Lopes J, Rodrigues I, Machado V, Botelho J, Bandeira Lopes L. Chemotherapy and Radiotherapy Long-Term Adverse Effects on Oral Health of Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 16:110. [PMID: 38201538 PMCID: PMC10777916 DOI: 10.3390/cancers16010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The survival rate for pediatric cancer has increased over the past few decades, short- and long-term complications have been detected and studied, and oral complications have emerged as an important topic of research. Here, we aimed to highlight the importance of oral manifestations that may only become apparent years or even decades after cancer treatment. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched articles using PubMed via the MEDLINE, Web of Science, and LILACS databases until October 2023. Overall, 35 observational studies were included, and the results estimated a pooled prevalence of the following dental anomalies: discoloration, 53%; crown-root malformations and agenesis, 36%; enamel hypoplasia, 32%; root development alterations, 29%; unerupted teeth, 24%; microdontia, 16%; hypodontia, 13%; and macrodontia, 7%. Most childhood cancer survivors have at least one dental sequela. Childhood cancer survivors presented a higher risk of having dental alterations than control counterparts. Additional analyses reveal possible sex-based differences that should be explored in future studies. These results collectively highlight the importance of oral healthcare and the prevention of disease in childhood cancer survivors.
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Affiliation(s)
- Joana Pombo Lopes
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
| | - Inês Rodrigues
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
| | - Vanessa Machado
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - João Botelho
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Luísa Bandeira Lopes
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
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Paranjape MN, Shah P, Patil S, Shah R, Jagtap C, Lakade L. Assessment of the Changes in the Salivary Profile and Its Clinical Correlation in Children with Acute Lymphoblastic Leukemia Undergoing Chemotherapy: A Follow-up Study. Int J Clin Pediatr Dent 2023; 16:268-271. [PMID: 38268631 PMCID: PMC10804290 DOI: 10.5005/jp-journals-10005-2692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Aim To assess the changes in salivary profile and its clinical correlation in patients with acute lymphoblastic leukemia (ALL) undergoing chemotherapy. Materials and methods Children who have been diagnosed with ALL undergoing chemotherapy at Bharati Hospital, Pune, were included in the study. Those children were included who fulfilled the following inclusion and exclusion criteria. Stimulated salivary samples were collected in sterile vials at 1-, 3-, and 6-month intervals and ware assessed for salivary pH and buffering capacity. Caries and oral manifestations were also checked at each interval. Results A total of 25 children with ALL undergoing chemotherapy were included to participate in the study. The results were analyzed using Statistical Package for the Social Sciences software. There was a statistically significant difference in the change in salivary pH during the 1st and 6th months of chemotherapy (p-value of 0.001). Salivary buffering capacity was also found to be low in these patients during the 1st month of chemotherapy, which gradually increased during the entire course of chemotherapy (p-value of 0.011). Progression of dental caries was seen during the entire course of treatment. Conclusion All the major changes were seen in the 1st month, that is, the induction phase of chemotherapy. Hence, we can say this is the most affected phase of chemotherapy. Clinical significance The parents and children should be educated and motivated to maintain proper oral hygiene. Whenever possible, all preventive dental procedures should be undertaken before the start of chemotherapy to avoid future complications. How to cite this article Paranjape MN, Shah P, Patil S, et al. Assessment of the Changes in the Salivary Profile and Its Clinical Correlation in Children with Acute Lymphoblastic Leukemia Undergoing Chemotherapy: A Follow-up Study. Int J Clin Pediatr Dent 2023;16(S-3):S268-S271.
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Affiliation(s)
- Madhura N Paranjape
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Preetam Shah
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Smita Patil
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Rohan Shah
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Chetana Jagtap
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Laxmi Lakade
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
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Rout SR, Kar B, Pradhan D, Biswasroy P, Haldar J, Rajwar TK, Sarangi MK, Rai VK, Ghosh G, Rath G. Chitosan as a potential biomaterial for the management of oral mucositis, a common complication of cancer treatment. Pharm Dev Technol 2023; 28:78-94. [PMID: 36564887 DOI: 10.1080/10837450.2022.2162544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Oral mucositis is a serious issue in patients receiving oncological therapies. Mucosal protectants considered to be one of the preferred choices used in the management of mucositis. However, the protective efficacy of currently available mucosal protectants has been significantly compromised due to poor retention, lack of lubrication, poor biodegradability, and inability to manage secondary complications. Chitosan is a promising material for mucosal applications due to its beneficial biomedical properties. Chitosan is also anti-inflammatory, anti-microbial, and capable of scavenging free radicals, makes it a good candidate for the treatment of oral mucositis. Additionally, chitosan's amino polysaccharide skeleton permits a number of chemical alterations with better bioactive performance. This article provides a summary of key biological properties of chitosan and its derivatives that are useful for treating oral mucositis. Current literature evidence shows that Chitosan has superior mucosal protective properties when utilised alone or as delivery systems for co-encapsulated drugs.
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Affiliation(s)
- Sudhanshu Ranjan Rout
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Biswakanth Kar
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Deepak Pradhan
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Prativa Biswasroy
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Jitu Haldar
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Tushar Kanti Rajwar
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Manoj Kumar Sarangi
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Lucknow, India
| | - Vineet Kumar Rai
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Goutam Ghosh
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
| | - Goutam Rath
- School of Pharmaceutical Sciences, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, India
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Ribeiro ILA, de Castro RD, Costa RC, Damascena LCL, de Lucena NNN, Maracajá PMB, Dos Santos FG, de Medeiros Serpa EB, Sousa SA, Valença AMG. Integrated oral care contributes positively to the course of treatment of oncopediatric patients. Eur J Pediatr 2021; 180:2757-2764. [PMID: 33754206 DOI: 10.1007/s00431-021-04024-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
| | - Ricardo Dias de Castro
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus I, João Pessoa, PB, 58051900, Brazil
| | - Raphael Cavalcante Costa
- Postgraduate Program in Clinical Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | | | | | | | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus I, João Pessoa, PB, 58051900, Brazil
| | | | - Simone Alves Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus I, João Pessoa, PB, 58051900, Brazil
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de Araújo ECF, Costa RC, Ribeiro ILA, Almeida LDFDD, Serpa EBDM, Valença AMG. Unstimulated salivary flow and oral streptococci in pediatric patients with hematological tumors: A longitudinal study. SPECIAL CARE IN DENTISTRY 2021; 42:49-59. [PMID: 34240441 DOI: 10.1111/scd.12628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the unstimulated salivary flow (USF) and salivary colonization of total Streptococcus spp. (TS) and mutans-group (MS) in pediatric patients with hematological tumors. Correlations of salivary and microbiological changes with chemotherapy and patient-related factors were also verified. METHODS AND RESULTS Eligible children (n = 31) were evaluated before (control) and after (2, 5, and 10-weeks) the chemotherapy protocol was applied. Saliva samples were collected by the traditional spitting method to determine the USF (ml/min). Salivary TS and MS were determined by colony-forming units (CFU ) counts in a selective medium. The caries experience was evaluated by DMFT/dmft indexes. Data were submitted to Student's t-test, one-way ANOVA, and correlation tests (α = 0.05). The USF rate at baseline was 0.89 (±0.73) ml/min with up to 20% reduction during the follow-up and did not differ statistically during chemotherapy (p > .05). Chemotherapy did not modify the salivary TS load (p > .05), but induced a dysbiotic shift with higher MS counts (∼ 5 fold-increase) at 10-weeks (p < .05). There is a correlation of USF with age (r = .390) and SM load with caries experience (rs = -.540) at 5-weeks. CONCLUSION Chemotherapy may promote a specific increase of mutans-group streptococci without changing the Streptococcus spp. load and unstimulated saliva flow. Correlation reinforced the need for further enlightenment about the chemotherapy mechanisms in the salivary and microbiological parameters.
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Affiliation(s)
| | - Raphael Cavalcante Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | | | | | - Ana Maria Gondim Valença
- Department of Clinical and Social Dentistry, University of Paraíba (UFPB), João Pessoa, PB, Brazil
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