Risk factors associated with the development of oral mucositis in pediatric oncology patients: Systematic review and meta‐analysis

Abstract

Objectives Oral mucositis (OM) is an acute toxicity related to cancer treatment. This systematic review aimed to identify potential risk factors associated with the development of OM in pediatric cancer patients. Methods A search was performed in four electronic databases to identify studies that analyzed risk factors for OM in pediatric cancer patients. Results Nineteen articles were included. The incidence of OM ranged from 20% to 80.4%. Chemotherapeutic agents were potential risk factors for OM in eight (42%) studies. Hematological, hepatic, and renal parameters were also considered in eight (42%) studies, while specific individual factors were reported in five (26.3%) studies. Baseline disease, oral microbiota, genetic profile, and biomarkers were reported in four (21.5%) studies each. Meta‐analysis showed that groups submitted to high‐risk chemotherapy for OM had a 2.79‐fold increased risk of OM. Conclusions Identifying risk factors for OM is essential in order to allow individualized and early prevention treatment.

Dental Evaluation Prior to Cancer Therapy

“…Exacerbation of pre-existing oral or dental infections can also occur and may be complicated by superinfection and necrosis [ 10 – 13 ]. Oral mucositis, which is associated with the use of certain chemotherapy agents (e.g., methotrexate, doxorubicin, 5-fluorouracil, busulfan, bleomycin, and platinum co-ordination complexes) further increases the risk of a systemic infection from a local site due to the loss of an intact oral mucosal barrier [ 13 – 17 ].…”

Roles of Toll-Like Receptors in Radiotherapy- and Chemotherapy-Induced Oral Mucositis: A Concise Review

“…Chemotherapy and radiotherapy reduce microbial diversity, leading to an overpopulation of opportunistic pathogenic bacteria, disrupting the balance between the microbial community and host, leading to inflammatory responses in the oral mucosa ( Vanhoecke et al., 2015 ; Ingrosso et al., 2021 ). Furthermore, the composition and metabolic function of oral microorganisms are significantly altered during chemotherapy ( de Farias Gabriel et al., 2021 ). The binding of some oral microorganisms to pattern recognition receptors (PRRs), especially TLRs, activates the receptors and promotes the development of inflammation through a series of reactions that activate NF-ĸB ( Vasconcelos et al., 2016 ).…”

Oral manifestations in children undergoing cancer therapy

“…All systematic reviews covered a defined period. Regarding language restriction, three systematic reviews did not report this feature [9,10,11], twenty-one had a language restriction [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32], six had no language restriction [33,34,35,36,37,38], and the non-English studies were translated.…”

“…Several subtopics in the systematic reviews were addressed. For example: prevalence/incidence [12,14,17,21,22,23,24,27,33,38], description [9,11,12,13,15,21,22,24,26,32,38], prevention [10,14,16,18,20,21,22,24,26,28,29,30,31,33,35,37], and management [10,14,19,21,22,26,27,28,29,32,34,35].…”