Fluxo salivar em pacientes pediátricos oncológicos comparado ao de crianças e adolescentes saudáveis

Hyposalivation is a comorbidity that affects pediatric patients with cancer, causing greater risk of development of oral infections. The literature shows the relationship between this condition and the antineoplastic treatment, but few studies evaluate the salivary properties before the therapeutic protocol had been initiated. This study proposed to verify if there is difference between the salivary flow of pediatric patients with cancer before initiating the antineoplastic treatment and healthy pediatric patients. For that, an observational, transversal research was conducted, whose sample consisted of 120 children and adolescents. Patients in the case group (G1; n=30) were selected for convenience at Hospital Napoleão Laureano in João Pessoa - PB. The control group (G2; n=90) was composed of individuals attended at the School of Dentistry Clinics of the Federal University of Paraíba, homogeneous regarding gender and age with the case group (p> 0.05). Data collection was performed in two stages, for both groups. The information related to the patient's identification and health was made through questioning the caregivers and searching the medical-hospital records in G1, while, for G2, by questioning those responsible. The saliva collection was performed with standard method in both groups; the unstimulated salivary flow (USF) being the volume quotient resulting from the active expiration of the buccal fluid for 2 minutes by the time of the examination. Data were analyzed descriptively and inferentially by the Shapiro Wilk, Komogorov Sminorv and Mann Whitney tests (α=5%). In addition, each group was subdivided, by age cluster, in children (younger than 10 years) and adolescents (aged 10 years or more). The mean USF for G1 and G2 was 0.52 ml/min and 0.66 ml/min, respectively, and in both groups a statistically significant difference (p<0.05) was observed between the mean USF values of their subgroups, being that of adolescents superior. No statistical difference was observed between the salivary flow values of G1 and G2. The conclusion is that there’s no decrease in unstimulated salivary flow in pediatric oncology patients before to initiating antineoplastic treatment compared to healthy pediatric patients.A hipossalivação é uma comorbidade que acomete pacientes oncopediátricos, desencadeando maior risco de desenvolvimento de outros agravos orais. A literatura aponta relação entre tal agravo e o tratamento antineoplásico, porém são raras as pesquisas que avaliam as propriedades salivares antes do protocolo terapêutico ser iniciado. Neste sentido, o presente estudo se propôs a verificar se há diferença entre o fluxo salivar de pacientes oncopediátricos antes de iniciarem o tratamento antineoplásico e de pacientes pediátricos saudáveis. Para tanto, delineou-se um estudo transversal, observacional, cuja amostra foi composta por 120 crianças e adolescentes de 3 a 18 anos. Os pacientes do grupo caso (G1; n=30) foram selecionados por conveniência no Hospital Napoleão Laureano em João Pessoa – PB. O grupo controle (G2; n=90) foi composto por indivíduos atendidos nas Clínicas Escola de Odontologia da Universidade Federal da Paraíba, pareados por idade. A coleta de dados foi realizada em duas etapas, para ambos os grupos. As informações relativas à identificação do paciente e sua saúde foram adquiridas por meio de questionamentos aos responsáveis e busca nos prontuários médicohospitalares, em G1, enquanto, para G2, por meio de questionamento aos responsáveis. A coleta de saliva foi realizada utilizando-se método padrão em ambos os grupos; sendo o fluxo salivar não estimulado (FSNE) o volume médio expelido em 1 minuto. Os dados foram analisados descritiva e inferencialmente pelos testes Shapiro-Wilk, Kolmogorov-Sminorv e Mann-Whitney (α=5%). Além disso, cada grupo foi subdivido, por faixa etária,em crianças (pacientes com idade inferior a 10 anos) e adolescentes (pacientes com idade igual ou superior a 10 anos). A média de FSNE para G1 e G2 foi de 0,52 ml/min e 0,66 ml/min, respectivamente, e em ambos os grupos foi observada diferença estatisticamente significante (p<0,05) entre os valores médios de FSNE dos seus subgrupos, sendo o de adolescentes superior. Não foi observada diferença significante entre os valores de fluxo salivar de G1 e G2. Conclui-se que não há diferença do fluxo salivar não estimulado em pacientes pediátricos oncológicos antes de iniciarem o tratamento antineoplásico em comparação com pacientes pediátricos saudáveis

Photobiomodulation for Oral Mucositis – A Microcosting and Budget Impact Analysis from a Brazilian Perspective

Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil’s Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario

Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient\u27s medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Objective:&nbsp;To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital.&nbsp;Material and Methods:&nbsp;This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed.&nbsp;Results:&nbsp;There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235.&nbsp;Conclusion:&nbsp;The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions

Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient's medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment

Salivary Flow in Pediatric Cancer Patients Compared to Healthy Children and Adolescents

Objective:To verify differences between salivary flow in pediatric cancer patients before starting antineoplastic treatment and in healthy pediatric patients. Material and Methods:This is an observational, cross-sectional, paired study with sample of 120 children and adolescents (3-18 years). Thirty pediatric cancer patients were selected for convenience at “Napoleão Laureano” Hospital (G1). Another group was composed of 90 individuals attended at the School of Dentistry Clinics of the Federal University of Paraíba, matched by age (G2). Data collection was performed in two steps for both groups. Information regarding pediatric cancer patients was obtained by interview with parents / guardians and searching medical records, while in the other group by interview with parents / guardians. Saliva collection was performed using standard method in both groups: unstimulated salivary flow rate (USFR) being the mean volume expelled in 1 minute. Data were analyzed by the Shapiro-Wilk, Kolmogorov-Smirnov and Mann-Whitney tests (α= 5%). Results:Mean USFR for G1 and G2 was 0.52 mL / min and 0.66 mL / min, respectively (p>0.05) and, in both groups, significant difference was observed (p <0.05) between the mean USFR values of its subgroups, and values of adolescents being higher than those of children. Conclusion:There is no difference in unstimulated salivary flow of pediatric cancer patients before starting antineoplastic treatment compared with healthy pediatric patients

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

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 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.