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Sampaio MEA, Bezerra PMM, Santos FGD, Ribeiro ILA, Sousa SAD, Santiago BM, Valença AMG. A hospital-based oral health education program impacts in pediatric cancer patients-A pilot study. SPECIAL CARE IN DENTISTRY 2024; 44:196-205. [PMID: 36895126 DOI: 10.1111/scd.12847] [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: 07/21/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To assess the impact of an oral health education and preventive program (OHEPP) for pediatric cancer patients. METHODS This was a single-arm study with 27 children and adolescents undergoing antineoplastic treatments. Patients were followed up for 10 weeks, and their oral health conditions were evaluated using the Modified Gingival Index (MGI), Visible Plaque Index (VPI), and the modified Oral Assessment Guide (OAG). Audiovisual resources, storytelling, and ludic instruments were used to provide oral health education to patients and parents/caregivers. RESULTS The patients' mean age was 9.41 (±4.49) years, and acute lymphoblastic leukemia was the most prevalent diagnosis (22.2%). Mean MGI and VPI values were 0.82 (±0.59) and 54.11% (±19.92%) at baseline and 0.33 (±0.29) and 19.83% (± 11.47%) after 10 weeks, respectively (p < .05). The mean OAG score was 9.51 (±2.54) and 36 cases (19.8%) of severe oral mucositis (SOM) were documented. Patients with higher MGI were more likely to develop SOM. CONCLUSION The OHEPP had a positive impact on pediatric patients undergoing cancer therapy by improving their periodontal health, reducing biofilm accumulation, and preventing the development of OM lesions.
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Affiliation(s)
| | | | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Simone Alves de Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Bianca Marques Santiago
- Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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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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Evaluation of the Effect of Grape Seed Extract (GSE) on Oral Mucositis in Patients with Head and Neck Radiotherapy History- A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-130603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Mucositis is one of the most important complications of radiotherapy. Some factors such as type of treatment and degree of patient sensitivity affect mucositis occurrence. Objective: This research was implemented to evaluate the effect of grape seed extract on radiation-induced mucositis. Methods: This research is a double-blinded randomized clinical trial implemented on 78 patients undergoing head and neck radiotherapy in the oncology ward of Imam Reza Hospital of Tabriz. The patients were randomly divided into 2 groups, the intervention, and the control group. Each group included 39 patients. The intervention group used 2% grape seed extract mouthwashes and the control group used placebo mouthwashes. The mouthwashes were used 3 times a day for 2 weeks. For statistical analysis of collected data, SPSS 20 software was applied. Results: The results showed that according to the Friedman test, on the 10th and 14th days, mucositis grade and incidence had a significant difference between the intervention and control groups. Conclusions: The findings indicated that grape seed extract mouthwash in preventing radiation-induced mucositis was more effective than a placebo. Thus, this agent can be recommended as an appropriate medication to eliminate oral mucositis symptoms.
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Bezerra PMM, Vieira TI, Dos Santos FG, Ribeiro ILA, de Sousa SA, Valença AMG. The impact of oral health education on the incidence and severity of oral mucositis in pediatric cancer patients: a systematic review and meta-analysis. Support Care Cancer 2022; 30:8819-8829. [PMID: 35915339 DOI: 10.1007/s00520-022-07296-9] [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: 02/17/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
Oral health education is an effective measure to prevent oral mucositis (OM) by improving self-management and effectively engaging patients in their health care. This systematic review aimed to determine the impact of oral health education interventions on the incidence and severity of OM. Bibliographical searches were carried out by two independent examiners in Medline, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SIGLE, until June 2022. The eligibility criteria were based on the PICO strategy, considering studies with pediatric oncology patients, aged 0 to 19 years, who had attended oral health education activities and had been examined for the incidence and/or severity of OM. Data were extracted for qualitative synthesis and organized in spreadsheets. The quality assessment of the selected studies was performed using the ROBINS-I tool. Meta-analysis was based on the group frequencies of OM ulcerative lesions, adopting a significance level of 5%. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to define the certainty of the evidence. The primary search retrieved 1827 articles. After removing duplicate records and screening titles and abstracts for eligibility, a total of 21 articles were selected for full-text analysis. Of these, seven eligible studies were included for data extraction and qualitative synthesis, while four studies were selected for quantitative synthesis. All studies had a longitudinal design; three performed a before-after comparison and four were controlled studies. OM was assessed by the following scales: OAG, WHO, ChIMES, and WCCNR. While data analysis of the selected studies was heterogeneous, the implementation of oral health education strategies was found to reduce the incidence and severity of OM during the follow-up period. The meta-analysis showed a favorable outcome for the educational intervention. The likelihood of patients attending oral health education activities to manifest OM ulcerative lesions was significantly lower (P = 0.002) than that of the control. The GRADE analysis presented a low certainty of the evidence. To conclude, oral health education interventions improved OM outcomes in pediatric oncology patients with a low quality of evidence.
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Affiliation(s)
| | - Thiago Isidro Vieira
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
| | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
| | | | - Simone Alves de Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, Brazil
| | - Ana Maria Gondim Valença
- Postgraduate Program in Dentistry, Federal University of Paraíba, 58051-900, João Pessoa PB, 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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Bezerra PMM, Sampaio MEA, Dos Santos FG, Ribeiro ILA, Santiago BM, de Sousa SA, Valença AMG. The effectiveness of an oral health education and prevention program on the incidence and severity of oral mucositis in pediatric cancer patients: a non-randomized controlled study. Support Care Cancer 2021; 29:7877-7885. [PMID: 34189606 DOI: 10.1007/s00520-021-06387-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the effectiveness of an Oral Health Education and Prevention Program (OHEPP) on the incidence and severity of oral mucositis (OM) in pediatric cancer patients. The OHEEP was a ludic strategy for promoting oral health and monitoring the oral health condition. METHODS We compared the incidence and severity of OM in patients who attended the OHEPP against those under similar conditions who did not receive educational interventions. Both groups were examined for 6 weeks by calibrated examiners (k > 0.8) using the modified Oral Assessment Guide (OAG). A total of 14 patients aged 2 to 18 years were included in each group and matched for sex, age, tumor type, and treatment modality. The incidence and severity of OM were compared using the chi-squared test (α = 5%), and the relative risk and effectiveness of the OHEPP were calculated with a statistical power of 0.97. Differences in total OAG scores between the groups were determined by the Mann-Whitney test (α = 5%). RESULTS There was a higher incidence of OM in patients who did not attend the OHEPP (P = 0.005), and the relative risk of developing OM was significantly lower in OHEPP attendants (RR: 0.73; CI 0.60-0.92). No difference in the occurrence of severe OM was observed. OHEPP reduced the risk of developing OM by 1.4-fold, with an effectiveness of 27%. There was a difference in total OAG scores (P = 0.041). CONCLUSION Participation in OHEPP was an effective measure to reduce the incidence of OM in pediatric cancer patients.
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Affiliation(s)
- Paula Maria Maracajá Bezerra
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.
| | - Maria Eduarda Alves Sampaio
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Isabella Lima Arrais Ribeiro
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Bianca Marques Santiago
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Simone Alves de Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
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