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de Macêdo TS, de Melo MCF, Ferreira AKA, da Silva-Selva ELMS, Godoy GP, Caldas Júnior ADF. Chemotherapy-induced oral mucositis: hierarchical analysis of recurrence factors. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00919-1. [PMID: 38969937 DOI: 10.1007/s40368-024-00919-1] [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: 08/03/2023] [Accepted: 06/01/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE This study aimed to analyze, through a hierarchical model, the risk factors associated with the recurrence of chemo-induced oral mucositis (OM) in children and adolescents. METHODS A retrospective cohort with 31 individuals of both sexes, aged 1-18 years, who were undergoing chemotherapy, and presented OM lesions was conducted. Data collection included analysis of medical records, interviews, and intraoral examination. Information regarding patients' socioeconomic and demographic profile, underlying disease, antineoplastic regimen, hematological condition, and oral health status were collected. To assess the association of independent variables with the outcome, the Chi-square, Fisher's Exact, and Mann-Whitney tests were used, in addition to a binary logistic regression model, with a maximum error of 5% and a 95% confidence interval. RESULTS Significant associations were observed between the history of OM and the diagnosis of the child/adolescent, neutrophil count, previous cancer treatments and the chemotherapy scheme in use (p < 0.05). Binary logistic regression revealed a 13.69 higher risk of developing OM recurrence in individuals who received high-dose methotrexate (MTX) therapy. CONCLUSION Socioeconomic and demographic factors did not influence OM recurrence. However, clinical variables, such as neutropenia, diagnosis of leukemia, and high-dose MTX protocols increase the chance of OM new cases.
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Affiliation(s)
- T S de Macêdo
- Post-Graduation Program in Dentistry, Federal University of Pernambuco (UFPE), Professor Moraes Rego Avenue, 1235, Recife, Pernambuco, Brazil
| | - M C F de Melo
- Post-Graduation Program in Dentistry, Federal University of Pernambuco (UFPE), Professor Moraes Rego Avenue, 1235, Recife, Pernambuco, Brazil
| | - A K A Ferreira
- Post-Graduation Program in Dentistry, Federal University of Pernambuco (UFPE), Professor Moraes Rego Avenue, 1235, Recife, Pernambuco, Brazil
| | - E L M S da Silva-Selva
- Post-Graduation Program in Dentistry, Federal University of Pernambuco (UFPE), Professor Moraes Rego Avenue, 1235, Recife, Pernambuco, Brazil
| | - G P Godoy
- Pathology Department, Federal University of Pernambuco (UFPE), Professor Moraes Rego Avenue, 1235, Recife, Pernambuco, Brazil
| | - A de F Caldas Júnior
- Clinical and Preventive Dentistry Department, Federal University of Pernambuco (UFPE), Professor Moraes Rego Avenue, 1235, Recife, Pernambuco, Brazil.
- , Estrada de Aldeia, Km 13, Prive Portal de Aldeia, Aldeia, Camaragibe, Pernambuco, Brazil.
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Al Beesh FA, Martini N, Suleiman S, Aljoujou A. Oral manifestations associated with neutropenia in Syrian patients diagnosed with hematological malignancies and undergoing chemotherapy: A cross-sectional study. Medicine (Baltimore) 2024; 103:e36780. [PMID: 38215147 PMCID: PMC10783351 DOI: 10.1097/md.0000000000036780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024] Open
Abstract
Neutropenia can be caused by a variety of congenital and acquired factors, with Chemotherapy-induced myelosuppression being the most common cause. Neutropenia significantly affects oral health, leading to the manifestation of oral lesions such as ulcers, fungal and viral infections, and mucositis. This study aims to investigate oral lesions in patients with hematological malignancies who developed neutropenia after chemotherapy. This cross-sectional study included 50 patients with hematological malignancies. The participants were divided into 2 groups: the first group consisted of 25 patients with hematological malignancies who developed chemotherapy-induced neutropenia and the second group consisted of 25 patients with hematological malignancies who did not develop chemotherapy-induced neutropenia. Patients were assigned to one of the groups based on the absolute neutrophil count (ANC). Full oral clinical examination was performed to determine the presence of oral lesions. In the Chemotherapy-Induced Neutropenia group, the most common lesion was ulceration, observed in 12 patients (48%). Fungal infections were the second most common, present in 5 patients (20%), followed by viral infections in 4 patients (15%), and mucositis, which occurred in a single patient (4%). A statistically significant association was found between neutropenia and the presence of oral ulcers (P value = .015). In contrast, in the Chemotherapy group, oral changes were less frequent. Fungal infections were the most common, occurring in 4 patients (15%), followed by oral mucositis in 3 patients (12%). Ulceration and viral infections were the least common, each observed in 1 patient (4%). The frequency of various forms of oral ulcers increases with the severity of neutropenia. However, there was no significant increase in other oral lesions in patients with neutropenia.
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Affiliation(s)
- Fatima AlZahraa Al Beesh
- University of Damascus, Faculty of Dentistry, Department of Oral Medicine, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- University of Damascus, Faculty of Medicine, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Siham Suleiman
- University of Damascus, Faculty of Medicine, Department of Hematology-Oncology, Damascus, Syrian Arab Republic
| | - Abeer Aljoujou
- University of Damascus, Faculty of Dentistry, Department of Oral Medicine, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
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Nguyen KT, Hoang HTX, Bui QV, Chan DNS, Choi KC, Chan CWH. Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial. PLoS One 2023; 18:e0293060. [PMID: 37922279 PMCID: PMC10624313 DOI: 10.1371/journal.pone.0293060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/03/2023] [Indexed: 11/05/2023] Open
Abstract
Beneficial effects of music intervention and progressive muscle relaxation alone on psychological issues were reported, however, studies evaluating their combined effects are limited. This study aimed to investigate the feasibility, acceptability and preliminary effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life among breast and gynaecological cancer patients receiving chemotherapy. METHODS The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points. RESULTS A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future. CONCLUSIONS Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov with ID: NCT05262621.
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Affiliation(s)
- Khanh Thi Nguyen
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
- Nam Dinh University of Nursing, Nam Dinh, Vietnam
| | | | | | - Dorothy N. S. Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai C. Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen W. H. Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ribeiro ILA, Caccia-Bava MDCGG, Sampaio MEA, Limeira RRT, de Carvalho LGA, Dos Santos FG, Bezerra PMM, Sousa SA, Valença AMG. The Implementation of an Integrated Oral Care Protocol for Pediatric Cancer Patients: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:940-947. [PMID: 36029416 DOI: 10.1007/s13187-022-02210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 06/02/2023]
Abstract
AIM In this study, we evaluated the impact of an integrated oral care protocol for pediatric patients undergoing antineoplastic treatment from the perspective of the multidisciplinary team, oral healthcare team, and caregivers. SUBJECT AND METHODS This was a qualitative study carried out in the pediatric sector of a reference cancer hospital in Brazil. Focus group and individual semi-structured interview techniques were used, and the data were analyzed by the Discourse of the Collective Subject (DCS) method. RESULTS A total of 44 professionals involved in providing care to children and adolescents with cancer and 38 caregivers were interviewed. All interviewees perceived an improvement in the patients' oral health condition. Health professionals reported a reduction in the occurrence and severity of oral mucositis (OM). Communicating with the medical team and understanding the importance of oral care to the patient's systemic condition were the greatest difficulties reported by the oral healthcare team. CONCLUSION This implementation project contributed to establishing a complete multidisciplinary team to assist pediatric patients in all their needs during antineoplastic treatment. The integrated oral care protocol further contributed to reducing the occurrence and severity of OM by increasing its surveillance and diagnostic efficiency, which, altogether, improved the patients' quality of life.
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Affiliation(s)
| | | | | | - Rebecca Rhuanny Tolentino Limeira
- Postgraduate Program in Development and Technological Innovation in Medicines, Federal University of Paraíba, João Pessoa, PB, Brazil
| | | | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa, PB, Brazil.
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Falahinia N, Razeghi S, Shamshiri AR, Firoozi M, Mohebbi SZ. The effectiveness of motivational interviewing on the oral health of leukemic children and oral health care knowledge, attitude and practice of their mothers: a hospital-based intervention. BMC Pediatr 2023; 23:261. [PMID: 37226158 DOI: 10.1186/s12887-023-04078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 05/17/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Some studies suggest a higher effectiveness of motivational interviewing compared to common oral health instruction in healthy individuals. As regards to higher prevalence of dental diseases like early childhood caries, oral mucositis, and gingivitis are reported for leukemic children, the present study aims to compare the effectiveness of educating mothers through MI with the common instruction (CI) for the oral health of children with leukemia under six years old. METHOD This quasi-experimental study was designed in Tehran University of Medical Sciences, School of Dentistry and conducted on 61 mothers with leukemic children under age six hospitalized in Mahak Hospital and Rehabilitation Complex which is a Pediatric Cancer Research and Hospital Center, in 2021. Mother and child pairs were allocated to MI or CI (using pamphlets) groups. Data was collected using a questionnaire of mothers' knowledge, attitude, motivation, and practice concerning oral health care in leukemic children. The children underwent clinical examination to assess plaque index before and three months after the intervention. The data were analyzed using SPSS version 25 (IBM, Armonk, NY, USA) by ANCOVA test. RESULTS The preschoolers mean ages were 4.23 ± 1.41 and 4.32 ± 1.33 (ranged from 2 to 6 years old) in the MI and CI group, respectively. There were 16 girls (53.3%) and 14 boys (46.7%) in the MI group, and 15 girls (48.4%) and 16 boys (51.6%) in the CI group. Significant differences were observed in the amount of plaque index between the MI group and the CI group (0.20 ± 0.04, p-value < 0.001). A significant increase was observed in the mean of changes in scores of knowledge, attitude, motivation, mother's practice concerning child's oral health, mother's practice concerning personal oral health in the MI group (p-value < 0.001). CONCLUSIONS Considering that instruction using MI showed to be effective in improving oral health adherence in mothers and reducing plaque in children with Leukemia, it may be recommended as a promising method to promote the oral health of such susceptible children in places that they are constantly present for treatment. TRIAL REGISTRATION The study was registered in the Iranian Registry of Clinical Trials (IRCT) on 11.03.2021 (code: IRCT20131102015238N5).
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Affiliation(s)
- Niloofar Falahinia
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Razeghi
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Manijeh Firoozi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Simin Zahra Mohebbi
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Shayeghi S, Hamzeh M, Tamaddoni A, Khafri S, Abesi F. Complications of patients with hematologic malignancies in a selected Iranian population. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:10-15. [PMID: 36741492 PMCID: PMC9878901 DOI: 10.22088/cjim.14.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/19/2022] [Accepted: 07/27/2022] [Indexed: 02/07/2023]
Abstract
Background Hematologic malignancies in childhood and their treatments can cause dental anomalies and jaw bone abnormalities; therefore, the aim of this study was to assess the prevalence of these disorders in children. Methods This cross-sectional study was conducted on all children diagnosed with hematologic malignancies that referred to in Amirkola Children's Hospital from 2011 to 2018. All of children underwent clinical evaluation in a Dental Radiology Clinic and panoramic imaging was performed. The radiographs were examined for dental anomalies and jaw bone abnormalities. The data were analyzed by descriptive analysis using chi-square, Mann-Whitney and Kruskal-Wallis with a 95% confidence interval. Results The study population consisted of 32 children and 9.46% of these patients showed intraoral signs in clinical evaluations. Panoramic radiographs indicated dental anomalies in 12 (63.9%) and jaw bone abnormalities in 17 (89.4%) patients. The most common dental anomaly and bone abnormality were taurodontism and changes in lamina dura, respectively. By measuring the mandibular cortical index (MCI), it was revealed that 13 had osteopenia, in which 4 of them had severe osteopenia (osteoporosis). The statistical analysis demonstrated that there was a significant difference between the incidence of osteoporosis and changes in lamina dura with the gender (p<0.05). Conclusion Due to early onset of osteopenia and osteoporosis and the presence of dental and bone abnormalities in half of study population, early assessment of their clinical and radiographic condition can be helpful in the prevention and the early treatment of their oral complications.
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Affiliation(s)
| | | | - Ahmad Tamaddoni
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Soraya Khafri
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farida Abesi
- Dental Materials Research Center, Babol University of Medical Sciences, Babol, Iran,Correspondence: Farida Abesi, Dental Materials Research Center, Babol University of Medical Sciences, Babol, Iran. E-mail: , Tel: +98 1132291408
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Docimo R, Anastasio MD, Bensi C. Chemotherapy-induced oral mucositis in children and adolescents: a systematic review. Eur Arch Paediatr Dent 2022; 23:501-511. [PMID: 35779225 DOI: 10.1007/s40368-022-00727-5] [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: 04/30/2021] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- R Docimo
- Paediatric Dentistry, Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - M D Anastasio
- UOSD Maxillofacial Surgery, Belcolle Hospital, Viterbo, Italy
| | - C Bensi
- Paediatric Dentistry Post-Graduate School, University of Rome "TorVergata", Via Montpellier 1, Rome, Italy.
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Shayani A, Aravena PC, Rodríguez-Salinas C, Escobar-Silva P, Diocares-Monsálvez Y, Angulo-Gutiérrez C, Rivera C. Chemotherapy as a risk factor for caries and gingivitis in children with acute lymphoblastic leukemia: A retrospective cohort study. Int J Paediatr Dent 2022; 32:538-545. [PMID: 34653279 DOI: 10.1111/ipd.12932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/11/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dental and oral anomalies are among the most common long-term side effects of childhood cancer therapy. AIM To evaluate chemotherapy as a risk factor for caries lesions and gingivitis in children with acute lymphoblastic leukemia (ALL) treated with the ALL IC-BFM 2009 chemotherapy protocol. DESIGN A retrospective cohort study was designed. Clinical records of 23 paediatric patients with ALL exposed to chemotherapy in the Regional Hospital in Valdivia, Chile, and 46 unexposed patients assessed every 3 months for 24 months were analyzed. The data on gender, age, index of the number of decayed, missing, or filled teeth, and the presence of gingivitis were recorded (Mann-Whitney U test and logistic regression analysis, p ≤ .05). RESULTS A significantly greater frequency of gingivitis (69.57%; p < .002) and a mean of new caries lesions were observed in children treated with chemotherapy than in the unexposed children (p < .01). The chemotherapy protocol presented a relative risk of 2.15 (95% CI = 1.22 - 2.66; p = .01) for new caries lesions and 2.29 (95% CI = 1.76 - 3.82; p = .002) for gingivitis. CONCLUSION The ALL IC-BFM 2009 chemotherapy protocol in patients with ALL is a risk factor for new caries lesions and gingivitis.
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Affiliation(s)
- Anis Shayani
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | | | | | - Pamela Escobar-Silva
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | | | | | - César Rivera
- Oral Medicine and Pathology Research Group, Department of Basic Biomedical Sciences, Faculty of Health Sciences, Universidad de Talca, Talca, Chile
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Salivary Test Assessment in an Oncohematological Pediatric Sample: A Case Control Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: In recent years, the incidence of neoplastic diseases in children has increased significantly. Immunodepression triggers undesirable effects in the oral cavity such as mucositis, opportunistic infections, oral bleeding, xerostomia, dysgeusia, decay, dental malformations and pain. Objective: We aim to assess, through salivary tests, the quality of saliva in pediatric patients affected by oncohematological diseases and treated with chemo/radiotherapy compared to non-treated subjects. Methods: A total of 20 subjects aged between 5 and 18 years, with oncological pathologies undergoing radio and/or chemotherapy, were evaluated. The control group consisted of 20 healthy children of the same age. The two groups of subjects were asked to undergo salivary tests. Descriptive statistics were computed for each item. Fisher’s exact test was conducted to compare case and control groups. Results: Subjects treated with chemo/radiotherapy had a lower pH and therefore a higher salivary acidity that predisposes to caries and the oral hygiene of children with oncohematological diseases was more deficient than that of the control group. Conclusions: The early detection of these indicators, and the prevention carried out to limit their severity, is an important aspect of the comprehensive care of oncohematological subjects. Pediatric dentists can play a crucial a role enabling good quality of life during cancer therapy.
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Coêlho MC, Viana Filho JMC, Souza BFD, Valença AMG, Persuhn DC, Oliveira NFPD. Genetic polymorphisms of genes involved in oxidative stress and inflammatory management in oncopediatric patients with chemo-induced oral mucositis. J Appl Oral Sci 2022; 30:e20210490. [PMID: 35319668 PMCID: PMC8963388 DOI: 10.1590/1678-7757-2021-0490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Marina Castro Coêlho
- Universidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, João Pessoa, Paraíba, Brasil
| | - José Maria Chagas Viana Filho
- Universidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, João Pessoa, Paraíba, Brasil
| | - Beatriz Fernandes de Souza
- Universidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, João Pessoa, Paraíba, Brasil
| | - Ana Maria Gondim Valença
- Universidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, João Pessoa, Paraíba, Brasil
| | - Darlene Camati Persuhn
- Universidade Federal da Paraíba - UFPB, Centro de Ciências Exatas e da Natureza, Departamento de Biologia Molecular, João Pessoa, Paraíba, Brasil
| | - Naila Francis Paulo de Oliveira
- Universidade Federal da Paraíba - UFPB, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, João Pessoa, Paraíba, Brasil.,Universidade Federal da Paraíba - UFPB, Centro de Ciências Exatas e da Natureza, Departamento de Biologia Molecular, João Pessoa, Paraíba, Brasil
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11
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Dholam KP, Sharma MR, Gurav SV, Singh GP, Prabhash K. Oral and dental health status in patients undergoing neoadjuvant chemotherapy for locally advanced head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:539-548. [PMID: 34489214 DOI: 10.1016/j.oooo.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/03/2021] [Accepted: 07/19/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE A prospective, longitudinal assessment of oral and dental health status was done from baseline until treatment completion in patients scheduled to receive neoadjuvant chemotherapy (NACT) for locally advanced head and neck cancer (LAHNC). STUDY DESIGN One hundred fifty consecutive, treatment-naïve adult patients with biopsy-proven LAHNC scheduled to receive NACT were recruited. One hundred thirty-five patients completed all assessments at 3 designated time points: baseline (T0), midtreatment (T1), and posttreatment (T2). Variables assessed were: Oral Hygiene Index-Simplified (OHI-S) score; decayed, missing, or filled teeth (DMFT) score; mucositis grade; pain score; and grade of trismus. RESULTS Median OHI-S scores showed a statistically significant increase (higher the score, poorer the oral hygiene) when the patients were evaluated from baseline to completion of NACT (T1 vs. T2; T0 vs. T2; P < .001), which indicated a decrease in oral health. There was no change in median DMFT score (P = .32), but a significant change was seen in all-grade mucositis over time (P < .001). Median pain scores and trismus grades decreased significantly (P < .001) over time. CONCLUSIONS There was a decrease in oral health status without any change in dental health seen in patients undergoing NACT. Mucositis was initially noted as an aftermath of chemotherapy, which resolved with time.
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Affiliation(s)
- Kanchan P Dholam
- Professor and Head of Department, Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, India
| | - Madhura R Sharma
- Assistant Dental and Prosthetic Surgeon, Department of Dental and Prosthetic Services, Tata Memorial Centre - Advanced Centre for Treatment, Research, and Education in Cancer, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India.
| | - Sandeep V Gurav
- Professor, Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, India
| | - Gurkaran P Singh
- Assistant Professor, Department of Dental and Prosthetic Services, Homi Bhabha National Institute, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai, India
| | - Kumar Prabhash
- Professor and Head of Department, Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Parel, Mumbai, India
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12
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Ptasiewicz M, Maksymiuk P, Chałas R. Changes of Dentition State in Leukemic Patients during Chemotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8193. [PMID: 34360486 PMCID: PMC8346006 DOI: 10.3390/ijerph18158193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022]
Abstract
A number of systemic diseases including hematological disorders have manifestations in the oral cavity region. These manifestations may often represent early signs of the underlying hematopoietic disease and occur frequently in leukemia. Despite the fact that leukemia has long been known to be associated with oral health deterioration, the available literature on this topic consists mostly of case reports, without data to conclude these. The aim of the study was to assess dentition state in leukemic patients during one cycle of chemotherapy and its correlation with blood parameters. The study included 102 adults treated because of leukemia at the Clinic of Haemato-Oncology and Bone Marrow Transplantation at the university hospital in Lublin, Poland. The sample group consisted of 51 women and 51 men aged 22 to 72 (54.07 ± 10.33) with following diagnoses: Acute myelogenous leukemia (AML)-55 patients (53.92%), Chronic lymphocytic leukemia (CLL)-17 patients (16.67%), Acute lymphoblastic leukemia (ALL)-16 patients (15.69%), Chronic myelogenous leukemia (CML)-10 patients (9.80%), Acute promyelocytic leukemia (APL) -3 patients (2.94%), Chronic hairy cell leukemia (HCL)-1 patient (0.98%). DMFT index was used to assess dentition state. After the cycle of chemotherapy, their dentition state changed in terms of decayed, missing and filled teeth and correlated with hematological parameters. Adult patients with leukemia have high dental treatment needs, and high number of missing teeth; thus, a comprehensive and fast dental treatment is necessary to avoid systemic complications and ensure better quality of life.
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MESH Headings
- Adult
- Dentition
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Male
- Quality of Life
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Affiliation(s)
| | - Paweł Maksymiuk
- Department of Oral Medicine, Medical University of Lublin, ul. Chodźki 6, 20-093 Lublin, Poland; (M.P.); (R.C.)
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Gutiérrez-Vargas R, Villasis-Keever MÁ, Portilla-Robertson J, Ascencio-Montiel ID, Zapata-Tarrés M. Effect of zinc on oropharyngeal mucositis in children with acute leukemia undergoing chemotherapy. Med Oral Patol Oral Cir Bucal 2020; 25:e791-e798. [PMID: 33037810 PMCID: PMC7648919 DOI: 10.4317/medoral.23798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Oropharyngeal mucositis (OM) is one of the main side-effects of oncological therapy. There is no treatment to prevent its occurrence, but some zinc-based therapies have been proven to help in decreasing its intensity. The objective of this study was to determine the effect of zinc in OM in children with acute leukemia in the early stages of oncological treatment.
Material and Methods This quasi-experimental study evaluated OM in 2 groups (control group: conventional hospital management, and experimental group: administration of 50 mg of zinc gluconate daily plus conventional hospital management). OM severity was recorded at a two-month follow-up.
Results Forty-nine patients (26 in the control group and 23 in the experimental group) were included. The mean age of the patients was 11.1 ± 2.7 years; 65.3% had a diagnosis of pre-B acute lymphoblastic leukemia. The incidences of OM in the control group and the experimental group were 46.2% and 26.1%, respectively, but the difference was not significant. Based on a negative binomial regression model, females had, on average, 1.5 more days with OM (p = 0.002), and patients assigned to the experimental group had, on average, 2 less days with OM than the control group (p = 0.001). The pain score was higher in the control group (p = 0.0009), as was the mean score on the WHO scale (p = 0.0012).
Conclusions Zinc facilitated a reduction in the severity and duration of OM; further studies focusing on children are needed to confirm the effects of this trace element. Key words:Oropharyngeal, mucositis, zinc, chemotherapy, children, leukemia.
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Affiliation(s)
- R Gutiérrez-Vargas
- Oncology Department National Institute of Pediatrics, Health Secretary Insurgentes Sur 3700-C, Insurgentes Cuicuilco Coyoacan, Mexico City, 04530
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Proc P, Szczepańska J, Zubowska M, Wyka K, Młynarski W. Salivary immunoglobulin A level during steroids and chemotherapy treatment administered in remission induction phase among pediatric patients with acute lymphoblastic leukemia. Medicine (Baltimore) 2020; 99:e22802. [PMID: 33080754 PMCID: PMC7571880 DOI: 10.1097/md.0000000000022802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The agents used in the treatment of acute lymphoblastic leukaemia (ALL) might affect the oral health of cancer patients.The study aims to assess the changes in the levels of immunoglobulin A (IgA) in saliva and blood, during first 22 days of intensive chemotherapy of ALL in children.Saliva and blood samples were taken from 24 patients, including 13 boys and 11 girls (age range: 4 - 17 years) on days 1, 8 and 22 of treatment. The levels of immunoglobulin A and total protein were estimated in samples at each time-point. The distribution of the quantitative variables was assessed using the Shapiro-Wilk test. Non-parametric statistics were used to compare the levels of repeated measurements and post hoc non-parametric analysis was applied for between time-point comparisons.A constant relationship was found between the levels of Ig A in blood and saliva (r = 0.28; P = .031). No change in salivary IgA level was observed in the prednisone-only prephase, but it dropped significantly on day 22 (10.7+/-4.8 vs 9.6+/-6.4 vs 5.7+/-3.9 ng/mL; P = .04), when chemotherapy was given (anthracycline, vincristine, L-asparaginase).In blood, the total protein level decreased significantly between day 1 and 22 (6.2+/-0.4 vs 5.1+/-0.3 g/dL; P = .001). Lymphocyte count (per microliter) also decreased (2.12+/-0.8 vs 0.41+/-0.1 vs 1.08+/-0.5; P = .002). Four children suffered from oral mucositis graded 1 or higher between days 8 and 22.Chemotherapy given during the treatment of childhood ALL is associated with a reduction in the level of salivary immunoglobulin A. Prevention of the drop of salivary IgA may diminish the risk of occurrence of acute mucosal complications.
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Affiliation(s)
- Patrycja Proc
- Department of Paediatric Dentistry, Medical University of Lodz, Pomorska 251, 92-213 Lodz
| | - Joanna Szczepańska
- Department of Paediatric Dentistry, Medical University of Lodz, Pomorska 251, 92-213 Lodz
| | | | - Krystyna Wyka
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
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Sahni P, Punyani SR, Jain S, Nayak KC, Charan A, Karwasra K. Oral alterations and oral health-related quality of life assessment in patients undergoing chemotherapy at a tertiary care center. SPECIAL CARE IN DENTISTRY 2020; 40:450-456. [PMID: 32710806 DOI: 10.1111/scd.12499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
AIMS This study was designed to assess the oral alterations and oral health related quality of life (OHRQoL) in patients undergoing chemotherapy for malignancies other than oral cancer. METHODS AND RESULTS Oral alterations were studied by careful clinical examination prior to and at the end of three cycles of chemotherapy in 100 patients. OHRQoL was assessed by oral health impact profile (OHIP)-14 questionnaire. Fifty-four patients developed oral complications among which oral mucositis and pigmentation were the most commonly observed. OHRQoL was hampered in all patients as indicated by higher postchemotherapy scores as compared to prechemotherapy scores (P < .0001). Postchemotherapy scores were higher for patients who developed visible oral changes as compared to those who did not (P = .001). There was a weak positive correlation between the number of oral alterations and postchemotherapy scores for OHRQoL. CONCLUSIONS Our study emphasizes the role of oral physicians in the healthcare team delivering chemotherapeutic treatment as regular oral examination, and timely symptomatic treatment is important for the overall well-being of the patient.
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Affiliation(s)
- Priya Sahni
- Department of Dentistry, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Silky R Punyani
- Department of Dentistry, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Sachin Jain
- Department of General Medicine, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Kailash C Nayak
- Department of General Medicine, S P Medical College, Bikaner, India
| | - Abhishek Charan
- Department of General Medicine, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Kapil Karwasra
- Department of Dentistry, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
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Venkatasalu MR, Murang ZR, Ramasamy DTR, Dhaliwal JS. Oral health problems among palliative and terminally ill patients: an integrated systematic review. BMC Oral Health 2020; 20:79. [PMID: 32188452 PMCID: PMC7079519 DOI: 10.1186/s12903-020-01075-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions. METHODS An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included. RESULTS Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients. CONCLUSIONS This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.
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Affiliation(s)
- Munikumar Ramasamy Venkatasalu
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Zaidah Rizidah Murang
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Divya Thirumalai Rajam Ramasamy
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam.
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Lee Y, Hong J, Kim I, Choi Y, Park H. Prospective evaluation of clinical symptoms of chemotherapy-induced oral mucositis in adult patients with acute leukemia: A preliminary study. Clin Exp Dent Res 2020; 6:90-99. [PMID: 32067405 PMCID: PMC7025998 DOI: 10.1002/cre2.253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to prospectively evaluate the clinical features of chemotherapy-induced oral mucositis (CIOM) in adult patients with acute leukemia and the aggravating factors for such symptoms. SUBJECTS Thirty-seven prospective patients aged ≥19 years with acute leukemia undergoing chemotherapy were enrolled. Oral and clinical investigations were performed at baseline and on Day 14 after starting chemotherapy. The presence and severity of cancer-induced oral mucositis were demonstrated using the World Health Organization (WHO) scoring system. RESULTS On Day 14, we found that oral mucositis had developed in eight patients (21.6%). Hematopoietic stem cell transplantation (HSCT) in patients was a predictor of increased WHO scores (β = 1.937, p < .001). Regarding oral sites, ventral tongue (β = 1.670), soft palate (β = 1.242), and buccal mucosa (β = 0.593) were predictors for increased scores. In addition, the increase in WHO scores was positively correlated with the number of oral lesions (r = .521), the difficulty in eating (r = .250), and the overall oral health (r = .534; all p < .05). CONCLUSION The main factors affecting the severity of CIOM symptoms were the treatment with HSCT and the location of oral lesions. The incidence of CIOM and WHO scores were not significantly different between the subgroups of disease. Our findings will help clinicians investigate the oral findings after chemotherapy in adult patients with acute leukemia.
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Affiliation(s)
- Yeon‐Hee Lee
- Department of Orofacial Pain and Oral MedicineKyung Hee University Dental HospitalSeoulKorea
| | - Junshik Hong
- Department of Internal MedicineSeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
- Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Inho Kim
- Department of Internal MedicineSeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
- Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Youngnim Choi
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research InstituteSeoul National UniversitySeoulKorea
| | - Hee‐Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research InstituteSeoul National University Dental Hospital, Seoul National University School of DentistrySeoulKorea
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Alkhouli M, Laflouf M, Alhaddad M. Evaluation of the effectiveness of olive oil to prevent chemotherapy induced oral mucositis: A randomized controlled clinical trial. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kowlessar A, Naidu R, Ramroop V, Nurse J, Dookie K, Bodkyn C, Lalchandani S. Oral health among children attending an oncology clinic in Trinidad. Clin Exp Dent Res 2019; 5:665-669. [PMID: 31890303 PMCID: PMC6934352 DOI: 10.1002/cre2.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives Little is known about the oral health of paediatric oncology patients in the Caribbean. Poor oral health can complicate oncology treatment, negatively affecting a child's health. In children undergoing chemotherapy or bone marrow transplant, odontogenic infections can progress to life-threatening sepsis. The aim of this study is to investigate the oral health among children attending an oncology clinic in Trinidad. Material and Methods Sample population included paediatric oncology patients attending a children's hospital in Trinidad. Subsequent to obtaining informed consent, a 14-item questionnaire was administered to parents/caregivers. An intra-oral examination was undertaken by two dentists to assess soft tissues, gingival health, and dentition status, using visual examination only. Results Seventy-one children and their caregivers participated in the study. The children consisted of both patients warded or attending as outpatients; 53.5% of patients were male and the mean age 6.64 (SD 3.33) years with a range of 1 to 15 years. Gingivitis and mucositis were present among 41.3% and 3% of patients, respectively. The prevalence of visible dental caries was 54.3%. Caries experience (dmft) was 2.28 (SD 3.63), and for those children with some caries experience (dmft > 0), this was 5.59 (SD 3.72). The majority (62.5%) had never visited a dentist. The most common dental treatment needs were dental prophylaxis (98.4%) and restorative treatment (50.8%). Acute lymphocytic leukaemia (39.1%) was the most common malignancy among this sample, and patients were at varying stages of cancer treatment. Conclusions Oral health among this sample of paediatric oncology patients was generally poor, with untreated caries being common, and the majority of children not having had any previous dental care. Preventive dental care for these patients should include oral hygiene instruction, dietary advice, topical fluoride application along with management of carious lesions, and odontogenic infections. This preliminary study highlights the need for closer collaboration between general dental practitioners, paediatric dentists, and paediatric oncology physicians, in caring for these patients.
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Affiliation(s)
- Anne Kowlessar
- School of DentistryUniversity of the West Indies, St. Augustine CampusSt. AugustineTrinidad and Tobago
| | - Rahul Naidu
- School of DentistryUniversity of the West Indies, St. Augustine CampusSt. AugustineTrinidad and Tobago
| | - Visha Ramroop
- School of DentistryUniversity of the West Indies, St. Augustine CampusSt. AugustineTrinidad and Tobago
| | - Janelle Nurse
- School of DentistryUniversity of the West Indies, St. Augustine CampusSt. AugustineTrinidad and Tobago
| | - Kavita Dookie
- School of DentistryUniversity of the West Indies, St. Augustine CampusSt. AugustineTrinidad and Tobago
| | - Curt Bodkyn
- School of DentistryUniversity of the West Indies, St. Augustine CampusSt. AugustineTrinidad and Tobago
| | - Sanjay Lalchandani
- Department of Medical SciencesEric Williams Medical Sciences ComplexMt HopeTrinidad and Tobago
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The Contribution of Motor Changes to Oral Mucositis in Pediatric Cancer Patients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183395. [PMID: 31540206 PMCID: PMC6765829 DOI: 10.3390/ijerph16183395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 12/22/2022]
Abstract
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.
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Parra JJ, Alvarado MC, Monsalve P, Costa ALF, Montesinos GA, Parra PA. Oral health in children with acute lymphoblastic leukaemia: before and after chemotherapy treatment. Eur Arch Paediatr Dent 2019; 21:129-136. [PMID: 31214964 DOI: 10.1007/s40368-019-00454-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
AIM To evaluate changes in the oral health status of children under the age of 14 years with acute lymphoblastic leukaemia (ALL) attending a cancer centre before and after chemotherapy treatment. MATERIALS AND METHODS A total of 32 children with ALL without distinction of gender were selected for study. The oral cavity of the patients was evaluated before the induction stage and 17 days later. Clinical evaluation of the submandibular, submental, and cervical lymph nodes was performed. Saliva samples were collected during the early morning hours. Bacterial plaque was assessed by using the Silness and Löe plaque index (SLPI) and gingiva status was evaluated with the gingival Löe and Silness index (GLSI). The WHO toxicity oral scale was used to record the degree of oral mucositis. The resulting data were analysed with McNemar's test, t test (for related samples), and Wilcoxon test. RESULTS There were statistically significant differences for palpable lymph nodes, paleness of oral mucosa, and ecchymoseis, respectively, P ≤ 0.000, P = 0.03, and P = 0.01, with these manifestations decreasing significantly after treatment. Incipient gingivitis had frequencies of 71.9% and 75% before and after treatment, respectively. The mean SLPI score declined significantly from 1.16 ± 0.52 (before treatment) to 0.56 ± 0.36 (after treatment) (P < 0.000); salivary flow increased significantly from 0.54 ± 0.34 to 1.22 ± 1.07 after chemotherapy treatment (P < 0.00). Oral mucositis was present in 24 children (75%) with a 1-2 severity level. CONCLUSIONS After chemotherapy treatment, there were changes in the oral conditions of children with ALL. Some manifestations decreased after treatment, whereas in others increased.
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Affiliation(s)
- J J Parra
- Department of Pediatric Dentistry, School of Pediatric Dentistry, University of Cuenca-Ecuador, Av. 12 de Abril y El Paraíso 3-52, Cuenca, Ecuador.
| | | | - P Monsalve
- Cancer Institute, SOLCA-Cuenca, Cuenca, Ecuador
| | - A L F Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, SP, Brazil
| | - G A Montesinos
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - P A Parra
- Department of Pneumology, José Carrasco Arteaga Hospital, Cuenca, Ecuador
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Abstract
Background Childhood cancer is the second most common cause of death in children in the United States. Treatments for childhood cancers usually incorporate chemotherapy, radiation therapy, immunotherapy, and/or surgery. This review of contemporary literature highlights the necessity for interprofessional care to achieve the best dental outcomes for this patient population during cancer treatment, as well as for children who are long-term cancer survivors. Methods A literature search at PubMed identified research and review articles about oral and dental complications in children diagnosed with cancer. Also included were evidence and current best practices from guidelines published by the American Academy of Pediatric Dentistry on dental management of pediatric patients receiving chemotherapy, hematopoietic cell transplantation, and/or radiation therapy. Finally, clinical recommendations from the European Society for Medical Oncology Guidelines Working Group on management of oral and gastrointestinal mucositis were included. The literature search was limited to articles published in the English language. Results Children with a new diagnosis of cancer should have dental care provided by a pediatric dentist to mitigate the oral complications from cancer treatment as well as to avoid dental infections during immunosuppressed states. An individualized oral care program can be developed for each patient to manage and treat acute and long-term oral complications related to cancer treatment. Conclusion Childhood cancer survivors present with unique challenges for dental management because of dental anomalies caused by cancer therapy. Interprofessional collaborative care between the pediatric dentist and the oncologist during and after cancer therapy will enable best outcomes for the pediatric patient. In addition, dental professionals must be prepared to meet the unique needs of long-term cancer survivors because of the increasing survival rates of childhood cancers.
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Factors Contributing to the Duration of Chemotherapy-Induced Severe Oral Mucositis in Oncopediatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061153. [PMID: 29865201 PMCID: PMC6025254 DOI: 10.3390/ijerph15061153] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 11/17/2022]
Abstract
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.
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Ribeiro ILA, Limeira RRT, Dias de Castro R, Ferreti Bonan PR, Valença AMG. Oral Mucositis in Pediatric Patients in Treatment for Acute Lymphoblastic Leukemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121468. [PMID: 29182564 PMCID: PMC5750887 DOI: 10.3390/ijerph14121468] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Isabella Lima Arrais Ribeiro
- Post-Doctorate Researcher in Post-Graduate Program in Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
| | | | - Ricardo Dias de Castro
- Department of Clinical and Social Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
| | - Paulo Rogério Ferreti Bonan
- Department of Clinical and Social Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
| | - Ana Maria Gondim Valença
- Department of Clinical and Social Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
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