Prevention of oral mucositis in paediatric patients treated with chemotherapy

Abstract

This study compared the efficacy of two protocols for oral care using either chlorhexidine or benzydamine as oral rinses to alleviate mucositis in children undergoing chemotherapy. Eligible participants were randomised to receive either protocol for 3 weeks in a two-period crossover design. The occurrence of ulcerative lesions and severity of mucositis were measured at baseline and twice weekly, using the modified Oral Assessment Guide (OAG). Data were continuously analysed by plotting them directly on predefined sequential charts. According to this sequential analysis, the study could be terminated at the 34th within subject comparison, with a statistically significant reduction in ulcerative lesions (P<0.05) and severity of mucositis (P<0.05) in children on the chlorhexidine protocol. These findings suggest that chlorhexidine together with oral care might be helpful in alleviating mucositis when given prophylactically to children on chemotherapy, but the therapeutic benefit needs to be confirmed in a larger trial.

Oral Mucositis in Children Suffering from Acute Lymphoblastic Leukaemia”

“…Especially chlorhexidine solutions 0.2% or 0.3% are not recommended for children with acute lymphoblastic leukaemia, due to their flavour and tendency to discoloration. According to some researchers, both chlorhexidine and benzydamine have a positive effect on reduction of oral mucositis during chemotherapy, but only in children over 6 years of age (22,23,24) . All physicians agree that the most important factor lowering the risk of oral complications is regular, at least twice a day, brushing of teeth, mouth washing and effective motivation of the patient to clean dental surfaces and oral tissues of the oral cavity.…”

“…All physicians agree that the most important factor lowering the risk of oral complications is regular, at least twice a day, brushing of teeth, mouth washing and effective motivation of the patient to clean dental surfaces and oral tissues of the oral cavity. Some studies recommend that during chemotherapy, the toothbrush should be placed in a 2% chlorhexidine solution after each use, and thoroughly rinsed prior to use (23,24,25,26,27) . In conclusion: local treatment of oral mucositis with a polyantibiotic and antifungal mixture supported by antifungal general treatment and improvement in blood morphology in children suffering from acute lymphoblastic leukaemia improves the condition of the oral mucosa.…”

Treatment of severe oral mucositis in a pediatric patient undergoing chemotherapy

“…The dentistry team of the pediatric sector of the hospital where the present case was registered and treated uses the Oral Assessment Guide modified by Cheng et al 6 , an instrument that allows oral monitoring, ranging from saliva changes, which are the most common in chemotherapy patients 14 , to changes in the oral skin and mucosa, and palatal, buccal, and gingival mucosa. The instrument also verifies whether the patient is experiencing pain or inability to swallow and talk.…”

“…A brown 13-year-old boy with chondroblastic osteosarcoma in the left distal thigh and acute lymphoblastic leukemia presented with severe oral mucositis (Oral Assessment Guide / OAG) 6 , namely, ulcerated skin and mucosa in the upper and lower lips (Figure 1), and complaints of pain and much discomfort, especially when talking and eating. According to the medical record, the patient had been undergoing cancer treatment for one year and eight months.…”

Patient and family management of mucositis in children and adolescents with Acute Lymphoblastic Leukemia undergoing chemotherapy in Qatar: A narrative review

“…[11,25] The Multinational Association of Supportive Care in Cancer (MASCC)/International Society for Oral Oncology (ISOO) "clinical practice guidelines for the management of mucositis secondary to cancer therapy" recommend mouth care protocols and patient education as effective modalities. [22] They also recognize that monitoring the patient's mouth for symptoms of OM, providing mouth care, evaluating pain related using valid measurement scales, reinforcing mouth care education, and demonstrating mouth care using written and visual materials are the essential components of OM management.…”