Mucosite bucal rádio e quimioinduzida

Melatonin and oral diseases: possible therapeutic roles based on cellular mechanisms

Oral diseases, including periodontal disorders, oral cancer, periodontitis, and mucositis are the major challenges for both patients and healthcare providers. These conditions often involve inflammation, oxidative stress, and impaired cellular processes, leading to symptoms ranging from discomfort to severe debilitation. Conventional treatments for such oral diseases exhibit constraints, prompting the investigation of innovative therapeutic approaches. Considering the anti-inflammatory, anti-oxidant, and anti-cancer effects of melatonin, this study was carried out to investigate the potential protective effects of melatonin in mitigating the severity of oral diseases. Studies indicate that melatonin influences the differentiation of periodontal stem cells, inhibits oral cancer progression, reduces inflammation associated with periodontitis, and alleviates the severity of oral mucositis. Melatonin has demonstrated potential efficacy in both preclinical and clinical investigations; however, findings are frequently heterogeneous and contingent upon contextual factors. This review provides a comprehensiveoverview of current state of knowledge in this domain, elucidating the multifaceted role that melatonin may assume in combatingoral diseases. Further research should be directed toward determining the most effective dosing, timing, and administration methods for melatonin-based therapies for oral diseases.

Interventions for the Prevention of Oral Mucositis in Patients Receiving Cancer Treatment: Evidence from Randomised Controlled Trials

Oral mucositis is a common and most debilitating complication associated with cancer therapy. Despite the significant clinical and economic impact of this condition, there is little to offer to patients with oral mucositis, and the medications used in its management are generally only palliative. Given that mucositis is ultimately a predictable and, therefore, potentially preventable condition, in this study we appraised the scientific literature to evaluate effective methods of prevention that have been tested in randomised controlled trials (RCTs). Published high-level evidence shows that multiple preventative methods are potentially effective in the prevention of oral mucositis induced by radiotherapy, chemotherapy, or both. Anti-inflammatory medications (including benzydamine), growth factors and cytokines (including palifermin), cryotherapy, laser-and-light therapy, herbal medicines and supplements, and mucoprotective agents (including oral pilocarpine) showed some degree of efficacy in preventing/reducing the severity of mucositis with most anticancer treatments. Allopurinol was potentially effective in the prevention of radiotherapy-induced oral mucositis; antimicrobial mouthwash and erythropoietin mouthwash were associated with a lower risk of development of severe oral mucositis induced by chemotherapy. The results of our review may assist in highlighting the efficacy and testing the effectiveness of low-cost, safe preventative measures for oral mucositis in cancer patients.

The effects of herbal medicines on cancer therapy-induced oral mucositis: A literature review

Cancer therapy-induced oral mucositis (OM) is one of the most troublesome morbidities after radio-chemotherapy. Age, nutritional status, tumor type, oral hygiene, and treatment method are the determinants for OM incidence. In addition, oxygen-free radicals can act as a trigger for an inflammatory milieu that causes OM. Based on the debilitating nature of OM, finding a safe and inexpensive agent with anti-inflammatory, anti-microbial, and antioxidative properties can be valuable for this situation. Considering the harmful effects of some chemical agents, herbal medicine has been suggested as a potential alternative owing to unique properties such as safety, availability and low cost. Many studies have illustrated several pharmacological properties of herbal medicines in recent years, such as anti-inflammatory, anti-microbial, and antioxidative activities, which are essential factors in the palliation of cancer therapy-induced OM. This review aimed to evaluate herbal medicines' effects on cancer therapy-induced OM. According to this comprehensive review, it is concluded that medicinal plants and phytochemicals can be used as practical agents in the palliation of cancer therapy-induced OM without any serious side effects.

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.

Efficacy of gabapentin mouthwash in managing oral mucositis pain in patients undergoing chemotherapy: a prospective, randomised, double-blind, controlled clinical trial

Background and aims

Gabapentin has been used for the management of radiotherapy and chemotherapy induced stomatitis in a number of studies. Due to lack of sufficient evidence, the present study was designed to evaluate the efficacy of gabapentin mouthwash in oral mucositis associated pain in patients undergoing cancer chemotherapy.

Methods and results

This study was a prospective, randomised, double-blind, placebo-controlled trial. The patients were randomly divided into two groups receiving either the gabapentin or placebo mouthwash. Patients were advised to rinse their mouth with 7 ml of solution for 30 s three times a day and were visited 10 days after initiation of the trial. The intensity of pain and severity of oral mucositis were assessed. Thirty-one patients received gabapentin mouthwash while 27 patients received placebo. Both gabapentin and placebo mouthwashes had decreased the pain intensity almost equally and did not show a significant difference between the two groups (P = 0.73). Also both gabapentin and placebo had reduced and improved swallowing, inflammation and erythema. But there was no noticeable difference between groups (P > 0.05).

Conclusions

These findings indicate that gabapentin mouthwash did not show a significant activity as a pain relieving agent in chemotherapy induced oral mucositis associated pain.

Oral Mucositis: Melatonin Gel an Effective New Treatment

The current treatment for cervico-facial cancer involves radio and/or chemotherapy. Unfortunately, cancer therapies can lead to local and systemic complications such as mucositis, which is the most common dose-dependent complication in the oral cavity and gastrointestinal tract. Mucositis can cause a considerably reduced quality of life in cancer patients already suffering from physical and psychological exhaustion. However, the role of melatonin in the treatment of mucositis has recently been investigated, and offers an effective alternative therapy in the prevention and/or management of radio and/or chemotherapy-induced mucositis. This review focuses on the pathobiology and management of mucositis in order to improve the quality of cancer patients' lives.

Prevalence of oral manifestations in children and adolescents with cancer submitted to chemotherapy

Background

Oral complications may be observed during chemotherapy and are important side effects that may directly affect the anticancer treatment, even causing septicaemia in some cases. This research was done in order to evaluate changes in oral lesions during follow-up of children and adolescents in chemotherapy at Hospital Estadual Infantil Nossa Senhora da Glória (HEINSG).

Methods

The study design was longitudinal, 45 patients were evaluated and monitored for 1 month after the initiation of chemotherapy. Twenty-eight patients were male and 17 female, ranging from 3 months to 18 years old.

Results

The results show an increase in the number of mucositis cases and a decrease in xerostomia cases after the initiation of treatment, and other oral lesions were also found in low numbers.

Conclusions

It is possible to avoid oral complications by maintaining a good oral health, and reducing infectious outbreaks. It is also feasible to obtain an early diagnosis of, and treat these oral complications, preventing them from following a more severe clinical course that may negatively affect the individual’s treatment. This outcome requires the presence of a dental surgeon on the multidisciplinary cancer treatment team.

Prevalence of oral manifestations in children and adolescents with cancer submitted to chemotherapy

BACKGROUND

Oral complications may be observed during chemotherapy and are important side effects that may directly affect the anticancer treatment, even causing septicaemia in some cases. This research was done in order to evaluate changes in oral lesions during follow-up of children and adolescents in chemotherapy at Hospital Estadual Infantil Nossa Senhora da Glória (HEINSG).

METHODS

The study design was longitudinal, 45 patients were evaluated and monitored for 1 month after the initiation of chemotherapy. Twenty-eight patients were male and 17 female, ranging from 3 months to 18 years old.

RESULTS

The results show an increase in the number of mucositis cases and a decrease in xerostomia cases after the initiation of treatment, and other oral lesions were also found in low numbers.

CONCLUSIONS

It is possible to avoid oral complications by maintaining a good oral health, and reducing infectious outbreaks. It is also feasible to obtain an early diagnosis of, and treat these oral complications, preventing them from following a more severe clinical course that may negatively affect the individual's treatment. This outcome requires the presence of a dental surgeon on the multidisciplinary cancer treatment team.

Honey prevents oral mocositis in children undergoing chemotherapy: A quasi-experimental study with a control group

BACKGROUND

There are numerous pharmacological and non-pharmacological treatment options available in the treatment of oral mucositis. However, in spite of so many methods and products, medical professionals have not come to a consensus as to which of these offer the best results.

OBJECTIVES

This study was conducted to assess the effect of oral care with honey on children undergoing chemotherapy for the prevention and healing of oral mucositis.

METHODS

This quasi-experimental study was conducted on children undergoing chemotherapy. The study group consisted of 83 children who attended clinics and polyclinics for chemotherapy. All the children were included in the study period. The study was completed with a total of 76 children except for seven patients who were excluded from the study. The data were collected using a form and the World Health Organization Mucositis Assessment Index. The data were analyzed using percentage distributions, means, a chi-square test, a t-test, a variance analysis, and a Friedman test. Ethics approval of the study was obtained from the Institution Ethics Committee.

RESULTS

It was found that the severity of oral mucositis in the children in the experimental group was significantly less than the control group. The mucositis recovery period in the experimental group was significantly shorter than the control group.

CONCLUSION

Regular oral care with honey for children undergoing chemotherapy for hematological cancers prevents mucositis and also accelerates recovery of it when started after mucositis onset.

Efficacy of Sucralfate Mouth Wash in Prevention of 5-fluorouracil Induced Oral Mucositis: A Prospective, Randomized, Double-Blind, Controlled Trial

Sucralfate has been used for the prevention and treatment of radiotherapy- and chemotherapy-induced stomatitis and mucositis in a number of studies, but the results are contradictory. To answer such discrepancies, the present study was designed to evaluate the efficacy of sucralfate mouthwash in prevention of 5-fluorouracil (5-FU)-induced oral mucositis in patients with gastrointestinal malignancies. Patients with gastrointestinal cancers receiving 5-FU-based chemotherapy regimens were included in this randomized, blinded, controlled trial and were randomly allocated to either sucralfate mouthwash (every 6 h) or placebo. The patients were visited at fifth and tenth day of trial; the presence and severity of oral mucositis and the intensity of pain were assessed. The patients receiving sucralfate experienced lower frequency and severity of mucositis (76% vs. 38.5%, P = 0.005 and 84 vs. 38.5%, P < 0.001, respectively) and less intense pain (2.5 ± 2.2 vs. 5.08 ± 3.82, P = 0.004 and 1.33 ± 0.86 vs. 4.12 ± 3.5, P = 0.001, respectively) compared with the placebo group both at day 5 and day 10. Within the sucralfate group, a decrease in frequency and severity of mucositis was observed throughout the trial period, while in the placebo group no such effect was observed. Sucralfate mouthwash reduced the frequency and severity of 5-FU-induced oral mucositis in patients with gastrointestinal malignancies compared with placebo, indicating its efficacy in the prevention of chemotherapy-induced mucositis.

Incidence, severity and management of cancer chemotherapy related oral mucositis in Eastern Cape and Western Cape

This study explored the incidence, duration and severity of oral mucositis in patients receiving chemotherapy in the Eastern and Western Cape, how this symptom was managed and whether the patients considered the management to be effective. An exploratory, contextual, quantitative survey was conducted. The sampling method was convenience. One hundred and sixty patients were recruited, with 106, (66.3%) participating. Data were collected by means of self-reports, using a self-administered questionnaire. Oral mucositis was a common problem, with 71.7% (n = 76) reporting to have had mucositis. Pain was not effectively managed, as 69.8% (n = 53) of respondents experienced pain whilst only 17.1% (n = 13) reported to have used analgesics. More than half of the respondents used prescribed mouth and throat preparations, whilst 28.9% (n = 22) used non-prescribed self-care measures including potentially harmful products. A significant difference was found between using non-prescribed self-care measures and the duration of oral mucositis (χ² = 0.81; p = 0.01). The reported grade of mucositis did not influence the use of non-prescribed self-care measures, whilst the more pain patients experienced the less inclined they were to use these measures. The management of oral mucositis remains a challenge. Failure to palliate this distressing symptom can lead to the use of potentially harmful self-care measures. Die studie het die insidensie, tydsduur en intensiteit van orale mukositis in Oos en Wes Kaapse pasiënte wat kankerchemoterapie ontvang verken asook hoe hierdie simptoom hanteer is en die sukses hiervan volgens die pasiënte. ‘n Kwantitatiewe, ekploratiewe, kontekstuele opname is onderneem. ‘n Gerieflikheidsteekproef is gebruik om die deelnemers te verkry. Een hondered en sestig persone is genader en 66.3% (n = 106) het aan die studie deelgeneem. Die datainsamelingsmetode was self-rapportering met behulp van ’n vraelys en beskrywende statistiek is gebruik om die data te verwerk. Orale mukositis was ’n algemene probleem, aangesien 71.7% (n = 76) van die respondente die simptoom ondervind het. Pyn was nie goed beheer nie, aangesien 69.8% (n = 53) pyn ondervind het terwyl slegs 17.1% (n = 13) aangedui het dat hulle analgetika gebruik het. Meer as die helfte van die respondente het voorgeskrewe mond en keel preparate gebruik, terwyl 28.9% (n = 22) self gemedikeer het wat potensiële nadelige preparate ingesluit het. ’n Beduidende verskil is tussen die gebruik van nie voorgeskrewe medikasie en die duur van mukositis bevind (χ² = 0.81; p = 0.01). Die graad van die mukositis het nie die gebruik van die self-medikasie beinvloed nie. Hoe meer pyn ondervind is, hoe minder was die neiging om die mukositis self te behandel. Die hantering van orale mukositis bly ’n uitdaging. Die onsuksesvolle palliasie van hierdie simptoom kan tot die gebruik van potensieel nadelige self-sorg maatreëls lei.

Modulation of gut-associated lymphoid tissue functions with genetically modified Lactococcus lactis

Lactic acid bacteria are a group of taxonomically diverse, Gram-positive food-grade bacteria that have been safely consumed throughout history. The lactic acid bacterium Lactococcus lactis, well-known for its use in the manufacture of cheese, can be genetically engineered and orally formulated to deliver therapeutic proteins in the gastrointestinal tract. This review focuses on the genetic engineering of Lactococcus lactis to secrete high-quality, correctly processed bioactive molecules derived from a eukaryotic background. The therapeutic applications of these genetically modified strains are discussed, with special regards to immunomodulation.

Oral mucositis in morning vs. evening irradiated patients: a randomised prospective study

PURPOSE

Patients of head and neck cancer undergoing radiotherapy develop oral mucositis. The severity of mucositis may also depend on the time of administration of radiation apart from patient-related factors. The most radiosensitive phase of the cell cycle (G2-M) occurs in the late afternoon and evening in human oral mucosa; therefore, it is more vulnerable to radiation injury in the evening. The present study evaluated prospectively the severity of acute oral mucositis in head and neck carcinoma patients irradiated in the morning (08:00-11:00 h) versus late afternoon/evening (15:00-18:00 h).

METHOD

A total of 212 patients of head and neck carcinoma were randomised to morning (08:00-11:00 h) and evening (15:00-18:00 h) groups. The grades of oral mucosa ulceration were compared in the two groups.

RESULTS

The grades of mucositis were marginally higher in the evening-irradiated group than in the morning-irradiated group 38% vs. 26% (p = 0.08).

CONCLUSION

The observed incidence of grade III/IV mucositis in morning vs. evening irradiated patients may be because of the existence of circadian rhythm in the cell cycle of normal mucosa. This knowledge may provide a possibility of treating the patients with decreased toxicity to oral mucosa.

Living with head and neck cancer and coping with dying when treatments fail

Palliative care in patients who have head and neck cancer is a complex topic that requires a multifaceted approach. The head and neck surgeon has an important duty to fulfill in managing and following the wishes of the incurable cancer patient and is obligated to direct them to the appropriate services in this challenging time.

New pathways for alimentary mucositis

Alimentary mucositis is a major dose-limiting toxicity associated with anticancer treatment. It is responsible for reducing patient quality of life and represents a significant economic burden in oncology. The pathobiology of alimentary mucositis is extremely complex, and an increased understanding of mechanisms and pathway interactions is required to rationally design improved therapies. This review describes the latest advances in defining mechanisms of alimentary mucositis pathobiology in the context of pathway activation. It focuses particularly on the recent genome-wide analyses of regimen-related mucosal injury and the identification of specific regulatory pathways implicated in mucositis development. This review also discusses the currently known alimentary mucositis risk factors and the development of novel treatments. Suggestions for future research directions have been raised.

Homogenous amniotic membrane as a biological dressing for oral mucositis in rats: histomorphometric analysis

OBJECTIVE

Oral mucositis is a frequent and significant side effect of chemotherapy and/or radiation therapy. The purpose of this study was to evaluate the effects of the homogenous amniotic membrane (HAM) as a biological dressing for oral mucositis induced by 5-fluorouracil (5-FU) in the labial fornix region of inferior incisors in rats.

METHODS

Sixty rats were divided into three groups: control (50% acetic acid), 5-FU (50% acetic acid and 5-fluorouracil-induced oral mucositis) and 5-FU+HAM (50% acetic acid and 5-fluorouracil-induced oral mucositis, and treated with HAM). Histological analyses were done 3, 7, 14 and 21 days after applying the acetic acid.

RESULTS

HAM showed not only no signs of rejection as well as an excellent tissue adherence to the ulcerated surface. Histomorphometric analysis indicated a lower quantity of inflammatory cells in the 5-FU+HAM group in all periods when compared to the other groups and there was a statistically significant difference in the 3- and 7-day periods (P<0.001).

CONCLUSIONS

The results of this study suggest that HAM was biocompatible with great adhesive power to the ulcerated surface, accelerated the healing process and exhibited anti-inflammatory activity. Further studies should be done to investigate the potential benefits of this material in clinical trials. HAM could lead to improved results as a biological dressing in treatment and management of oral mucositis in patients submitted to chemotherapy and/or radiation therapy.