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

ABSTRACT 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.

Fatores associados ao tempo entre o diagnóstico e o início do tratamento do câncer infantojuvenil / Factors associated with the time between diagnosis and initiation of childhood cancer treatment

Objetivou-se analisar a distribuição do câncer infantojuvenil e identificar fatores associados ao atraso no início do tratamento oncológico, na Paraíba, a partir dos Registros Hospitalares de Câncer, de 2010 a 2018. Estudo observacional, descritivo e analítico, com 896 registros de crianças e adolescentes (0-19 anos), identificando-se características epidemiológicas, clínicas e o cumprimento da Lei Federal 12.732/12 (lei dos 60 dias para início do tratamento). Os dados foram analisados pela regressão logística (α=5%). Constatou-se que 80,2% dos pacientes iniciaram o tratamento no tempo previsto por lei (≤ 60 dias). Observou-se que indivíduos de 10 a 19 anos, com tumores sólidos, submetidos à cirurgia e tratados em um dos quatro RHC's da Paraíba apresentam maiores chances de terem a terapia antineoplásica iniciada em um tempo superior a 60 dias. Conclui-se que o atraso no início do tratamento contra o câncer infantojuvenil está associado a características epidemiológicas e clínicas dos pacientes oncológicos pediátricos.

This study aimed to analyze the distribution of childhood cancer and identify factors associated with delay in starting cancer treatment, in the state of Paraíba, from the Hospital-Based Cancer Registries (HBCR), from 2010 to 2018. Observational, descriptive and analytical study, with 896 records of children and adolescents (0-19 years), identifying epidemiological and clinical characteristics and compliance with Federal Law 12732/12 (maximum of 60 days to start treatment). Data were analyzed by logistic regression (α=5%). The results showed that 80.2% patients started treatment within the time prescribed by law (≤ 60 days). Individuals aged 10 to 19 years, with solid tumors, undergoing surgery and treated in one of the four HBCR in Paraíba are more likely to have anticancer therapy initiated after 60 days. The delay in starting treatment against childhood cancer is associated with epidemiological and clinical characteristics of pediatric cancer patients.

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

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.

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

Abstract Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: 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. Results: 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. Conclusion: 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.

Relação entre Senso de Coerência e experiência de cárie dentária em crianças de 5 a 10 anos / Relationship between Sense of Coherence and dental caries experience in children aged 5-10 years

O presente trabalho teve como objetivo compreender a relação entre o Senso de Coerência (SOC) dos responsáveis e a experiência de cárie dentária dos escolares de 5 a 10 anos da Escola de Educação Básica da Universidade Federal da Paraíba (EEBAS/UFPB). Participaram do estudo 120 crianças e responsáveis. Os exames clínicos foram realizados na própria escola, após assinatura do Termo de Consentimento Livre e Esclarecido (TCLE) pelos responsáveis. Os responsáveis responderam o SOC-13. Os dados obtidos foram submetidos à análise estatística descritiva e inferencial. Foi encontrado que os valores de ceo-d e CPO-d variaram 0 a 8, com 76,2% de valor para o componente cariado. Não houve associação estatisticamente significante entre o SOC dos responsáveis e a experiência de cárie dos alunos. Também não foi encontrada relação entre o SOC e ceo-d, idade, sexo e série escolar. No entanto, o SOC parece ter uma influência significativa no comportamento e impactar em aspectos socioeconômicos... (AU)

This study aimed to comprehend the relationship between parental Sense of Coherence (SOC) and dental caries experience in children aged 5-10 years at the Basic School of Federal University of Paraiba. The sample was composed of 120 children and their parents. Clinical examinations were performed at the school, after signing the Term of Free and Informed Consent (TFIC) by the parents. The parental SOC was measured using the 13-item version (SOC-13). The data obtained were submitted to descriptive and inferential statistical analyses. The values of dmft and DMFT ranged from 0 to 8, with a predominance of the decayed component (76.2%). There was no statistically significant association between parental SOC and dental caries experience in the students. In addition, parental SOC was not significantly associated with dmft, age, gender, or school grade. Nonetheless, the SOC seems to have a significant influence on behavior and impact on socio-economic aspects... (AU)

Violência contra crianças e adolescentes: conhecimentos dos odontopediatras da capital paraibana: estudo piloto / Violence against children and teens: knowledge of the dentists of the capital of Paraiba: pilot study

O Cirurgião-Dentista tem a obrigação ética e legal na identificação/notificação dos casos de maus-tratos. Objetivo: Objetivou-se com esse estudo analisar o conhecimento dos Odontopediatras da cidade de João Pessoa-PB sobre maus-tratos infantis. Tratou-se de um estudo quantitativo, exploratório, bibliográfico e descritivo. O universo dessa pesquisa compreendeu 44 Cirurgiões-Dentistas regularmente inscritos no Conselho Regional de Odontologia da Paraíba, com especialidade em Odontopediatria, em qualquer faixa etária de ambos os sexos. Para realização do cálculo amostral foi considerado grau de confiança de 95%, ficando uma amostra de 40 Odontopediatras. Métodos: Aplicou-se um questionário com 11 questões que atendiam aos objetivos da pesquisa. Os dados coletados foram tabulados em uma plataforma do Microsoft Excel e analisados mediante estatística descritiva (valores de frequência absoluta e percentual) no software IBM SPSS (21.0). Resultados: A maioria dos profissionais é do sexo feminino (93,5%) e 48,39% têm mais que a 4a década de vida. 51,61% definiram maus-tratos infantis de forma incompleta, 51,6% classificaram de forma completa, conforme a Associação Brasileira Multiprofissional de Proteção à Infância e à Adolescência; os sinais/sintomas bucais mais citados foram fraturas dentárias (41,07%), queimaduras (21,43%), lacerações (14,29%) e hemato¬mas (12,5%); já os sinais/sintomas corporais mais citados foram hematomas (35,6%), queimaduras (20,34%), fraturas (15,25%) e lacerações (10,17%). A maioria dos pesquisados relatou saber agir diante de casos de maus-tratos (93,5%), entre eles 76,92% denunciariam ao conselho tutelar e 54,8% demonstram interesse em capacitação. Conclusão: De forma geral, houve conhecimento parcialmente satisfatório dos Odontopediatras inscritos no CRO-PB sobre maus-tratos infantis.

The Dentist has ethical and legal obligation to identify/report cases of abuse. Objective: The objective of this study is to analyze the knowledge of dentists in the city of João Pessoa-PB-Brazil, on child abuse. The research carried out a quantitative, exploratory, bibliographic and descriptive study. The research universe comprises 44 pediatric dentists regularly registered in the Regional Council of Dentistry, specialized in pediatric dentistry in any age group of both genders. For performing the sample calculation was considered a confidence level of 95%, getting a sample of 40 dentists. Methods: They received a questionnaire with 11 questions that met the research objectives. The collected data were typed into a Microsoft Excel platform and analyzed using descriptive statistics (absolute and percentage frequency values) in IBM SPSS software (21.0). Results: Most professionals are female (93,5%), (48,39%) of these corresponded to more than four decades of life. 51.61% of the interviewed people defined child abuse incompletely, 51.6% rated child abuse completely, signs/symptoms most cited were oral dental fractures (41.07%), burns (21.43%), lacerations (14.29%) and he¬matomas (12.5%), the physical signs/symptoms most cited were hematomas (35.6%), burns (20.34%), fractures (15.25%) and lacerations (10.17%). 93.5% of respondents would know how to act on cases of child abuse, among them 76.92% would denounce the tutelary assistance and 54.8% have an interest in training. Conclusion: Overall, there was partially adequate knowledge of the registered dentists in the CRO-PB on child abuse.