Impact of Saliva and Cariogenic Microbiota on the Chemotherapy-Induced Oral Mucositis in Oncopediatric Patients: A Preliminary Longitudinal Study

Abstract

The aim of this study is to evaluate salivary and microbiological parameters of pediatric oncological patients and their correlation with severe oral mucositis (SOM).This study aims to evaluate the salivary parameters and cariogenic microbiota of pediatric oncological patients and their correlation with severe oral mucositis (SOM). A preliminary longitudinal study The prospective study included patients in the age range from 4 to 18 years (n = 26), with diagnosis of primary cancer, who were followed up before and after time intervals of two, five, and ten weeks of induction chemotherapy. Oral mucosa examinations were performed by means of the modified Oral Assessment Guide (OAG) by calibrated examiners (κ > 0.70). Saliva analysis (unstimulated saliva flow (USF), clinical saliva viscosity (CSV), and pH) and microbiological (total Streptococcus (TS) and Streptococcus of the mutans group (SMG)) tests were performed using unstimulated saliva. The data were analyzed by the Wilcoxon and Spearman Correlation tests (α = 5%). The patients were predominantly of the female sex (n = 15; 57.7%), adolescents (n = 15; 57.7%), and patients with hematological tumors (n = 21; 80.8%). SOM was more frequent in the tenth week (n = 7; 28.6%). The values of USF, CSV, pH, TS, and SMG were not changed by the institution of chemotherapy (p>0.05). These values were correlated with SOM and the time, TS and SMG, and CSV and SMG. The salivary and microbiological parameters investigated did not influence the severity of oral mucositis in the pediatric patients oncological..

Unstimulated salivary flow and oral streptococci in pediatric patients with hematological tumors: A longitudinal study

“…This induction phase is known to be characterized by intense medication protocols with high doses of cytotoxic chemotherapy agents, attempting to achieve complete remission and restore normal hematopoiesis of these patients. 35 Indeed, our preliminary study 14 and others 12,36 have shown that the induction phase is a critical time for hematological cancer treatment with more impact on oral physiological parameters such as saliva, oral microbiota, and host cell interactions. Although some previous studies have also evaluated these response variables (USF and oral streptococci load), the results are crosssectional 11,13,18 or longitudinal of short-term periods (50 days for the endpoint), 9,22,37,38 which are not able to completely evaluate the impact of cancer therapy on different follow-up time-points.…”

“…21,22 Furthermore, cariogenic-associated microbiota may also induce harmful effects in the severity of chemotherapyrelated oral diseases. 18 In fact, our preliminary study 14 showed a trend towards a progressive total load of salivary Streptococcus spp. (TS) in childhood cancer, and this finding needed to be more investigated in hematological pediatric patients.…”

“…This is a longitudinal, prospective, paired, and observational study. It is a secondary analysis of our preliminary study 14 considering only hematological patients. The research was conducted in the Pediatric Oncology Department of the Napoleāo Laureano Hospital in João Pessoa, Paraíba, Northeastern Brazil.…”

“…The inclusion and exclusion criteria for participation in the study were previously described. 14 First, the selected…”

“…10,11 Salivary changes in children have consequently been associated with deteriorating oral health status during chemotherapy. 9,[12][13][14] However, some cross-sectional studies 15,16 have shown controversial results regarding chemotherapy's effect on the salivary flow rate because the saliva exams were performed in different early stages of cancer treatment. Moreover, stimulated saliva has been commonly used, 17,18,19,20 but the method applied to stimulate salivation can overestimate the saliva flow results and is not indicated for understanding the specific effect of chemotherapy under clinical saliva parameters.…”