Accuracy of Remote Examination for Detecting Potentially Malignant Oral Lesions: A Systematic Review and Meta-Analysis.

Objective: We aimed to investigate the accuracy of remote examination by photographs compared to in-person clinical examination for detecting potentially malignant oral lesions (PMOLs). Methods: The Reporting Guide and Guidelines for Writing Systematic Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analysis [PRISMA]) guided the reporting of findings. The search was conducted by two independent reviewers in six databases with no language restriction until November 2022. The Population, Test-Index, Reference Standard, Outcome and Study Design (PIROS) strategy guided the eligibility criteria, and studies with adult patients (P) examined remotely (I) and in-person (R) to verify the detection of PMOLs (O) were considered. The methodological quality was assessed by QUADAS-2, and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: A total of 769 files were identified. After removing duplicates and reading titles and abstracts, 16 were read in full, from which 6 articles then comprised the qualitative synthesis. The oral clinical examination was the reference standard in four studies. Five studies presented high risk of bias in at least one assessment domain. A high probability of detection of PMOL by remote examination (97.37%) was observed for the three studies included in the meta-analysis, which presented high heterogeneity among them. The certainty of evidence for the outcome was considered very low. Conclusions: Remote tools for detecting PMOLs may be feasible and assertive, but new studies are required to incorporate them into clinical practice. Clinical Relevance: Remote examination for the detection of PMOLs has the potential to favoring the early diagnosis of malignant lesions.

A hospital-based oral health education program impacts in pediatric cancer patients-A pilot study.

OBJECTIVES: To assess the impact of an oral health education and preventive program (OHEPP) for pediatric cancer patients. METHODS: This was a single-arm study with 27 children and adolescents undergoing antineoplastic treatments. Patients were followed up for 10 weeks, and their oral health conditions were evaluated using the Modified Gingival Index (MGI), Visible Plaque Index (VPI), and the modified Oral Assessment Guide (OAG). Audiovisual resources, storytelling, and ludic instruments were used to provide oral health education to patients and parents/caregivers. RESULTS: The patients' mean age was 9.41 (±4.49) years, and acute lymphoblastic leukemia was the most prevalent diagnosis (22.2%). Mean MGI and VPI values were 0.82 (±0.59) and 54.11% (±19.92%) at baseline and 0.33 (±0.29) and 19.83% (± 11.47%) after 10 weeks, respectively (p < .05). The mean OAG score was 9.51 (±2.54) and 36 cases (19.8%) of severe oral mucositis (SOM) were documented. Patients with higher MGI were more likely to develop SOM. CONCLUSION: The OHEPP had a positive impact on pediatric patients undergoing cancer therapy by improving their periodontal health, reducing biofilm accumulation, and preventing the development of OM lesions.

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

ABSTRACT 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.

DNA Methyltransferase Genes Are Associated with Oral Mucositis and Creatinine Levels in Oncopediatric Patients.

The aim of this study was to investigate the association of single-nucleotide polymorphisms (SNPs) and the DNA methylation profiles of the DNA methyltransferase (DNMT) gene family with oral mucositis in children and adolescents with hematologic malignancies treated with methotrexate (MTX®). The population was comprised of healthy and oncopediatric patients aged between 4 and 19 years. An evaluation of oral conditions was performed using the Oral Assessment Guide. Demographic, clinical, hematological, and biochemical data were obtained from medical records. Genomic DNA extracted from oral mucosal cells was used for the analysis of polymorphisms in DNMT1 (rs2228611), DNMT3A (rs7590760), and DNMT3B (rs6087990) using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique (n = 102) and for DNA methylation using the methylation-specific PCR (MSP) technique (n = 85). The allele and genotypic frequencies of SNPs did not reveal any differences between patients with or without oral mucositis. An increase in the methylation frequency for DNMT1 in patients recovered from mucositis was detected. The DNMT3A methylated profile associated with the CC genotype (SNP rs7590760) appeared to be connected to higher values of creatinine. In addition, the DNMT3B unmethylated profile associated with the CC genotype (SNP rs6087990) appeared to be connected with higher values of creatinine. We conclude that the DNMT1 methylation profile is associated with the post-mucositis period and that the genetic and epigenetic profiles of DNMT3A and DNMT3B are associated with creatinine levels.

The Implementation of an Integrated Oral Care Protocol for Pediatric Cancer Patients: a Qualitative Study.

AIM: In this study, we evaluated the impact of an integrated oral care protocol for pediatric patients undergoing antineoplastic treatment from the perspective of the multidisciplinary team, oral healthcare team, and caregivers. SUBJECT AND METHODS: This was a qualitative study carried out in the pediatric sector of a reference cancer hospital in Brazil. Focus group and individual semi-structured interview techniques were used, and the data were analyzed by the Discourse of the Collective Subject (DCS) method. RESULTS: A total of 44 professionals involved in providing care to children and adolescents with cancer and 38 caregivers were interviewed. All interviewees perceived an improvement in the patients' oral health condition. Health professionals reported a reduction in the occurrence and severity of oral mucositis (OM). Communicating with the medical team and understanding the importance of oral care to the patient's systemic condition were the greatest difficulties reported by the oral healthcare team. CONCLUSION: This implementation project contributed to establishing a complete multidisciplinary team to assist pediatric patients in all their needs during antineoplastic treatment. The integrated oral care protocol further contributed to reducing the occurrence and severity of OM by increasing its surveillance and diagnostic efficiency, which, altogether, improved the patients' quality of life.

Linear and areal surface roughness assessments for the study of tooth wear in human enamel.

OBJECTIVES: To test 8 models of linear surface roughness assessment in characterizing surface profile description and to correlate these models with equivalent areal parameters over sound human enamel in vitro. MATERIALS AND METHODS: Thirty enamel blocks were randomly selected. The roughness data (2D-Rp; Rv; Rz; Rc; Rt; Ra; Rq; Rsk; Rku/3D-Sp; Sv; Sz; Sa; Sq; Ssk; Sku) was obtained in duplicate in a non-contact 3D optical profilometer. The models were composed by 1 single vertical trace (model 1) until 8 traces (model 8 composed by three vertical traces, three horizontal traces, and two diagonal). RESULTS: The addition of linear sampling traces to the enamel blocks did not result in Rp, Rv, Rz, Rc, Rt, Ra, Rq, Rsk, and Rku value changes (low power-from 5 to 72%). Significant Spearman's correlation coefficients were obtained in most correlation analysis (Rp ↔ Sp; Rv ↔ Sv; Rz ↔ Sz; Ra ↔ Sa; Rq ↔ Sq; and Rku ↔ Sku). CONCLUSIONS: A single vertical trace in the middle of the sample was representative of the overall enamel surface roughness (Rp, Rv, Rz, Rc, Rt, Ra, Rq, Rsk, and Rku) models. The majority of the assessed models in the correlation evaluation presented significant and positive association. CLINICAL RELEVANCE: The findings highlight the applicable model for roughness analysis over human enamel recommended for research and in situ trials assessments.

Polymorphism but not methylation status in the vitamin D receptor gene contributes to oral mucositis in children.

OBJECTIVE: To investigate the relationship between the polymorphisms rs1544410 (BsmI), rs2228570 (FokI) and rs731236 (TaqI) and DNA methylation status in the VDR gene (vitamin D receptor) with oral mucositis (OM) in oncopaediatric patients treated with methotrexate (MTX®). METHODS: The population comprised healthy patients with haematological malignancies aged between 5 and 19 years. An evaluation of oral conditions was performed using the Oral Assessment Guide. Demographic, clinical, biochemical and haematological data were obtained from medical records. Genomic DNA from oral mucosal cells was used for the analysis of polymorphisms (n = 102) (PCR-restriction fragment length polymorphism) and DNA methylation (n = 81) (methylation-specific PCR). RESULTS: Males predominated (57.8%), and the mean age was 10.3 years (±4.7). OM affected 84.3% of patients, of which 53.1% developed severe oral mucositis (SOM). Patients with OM had lower platelet and leukocyte counts (p < 0.05). The G allele of rs1544410 (p = 0.040) and the CT genotype of rs2228570 polymorphisms were associated with SOM (p = 0.038). A partially methylated status in the VDR promoter was found in all patients. CONCLUSION: OM is associated with lower leukocyte and platelet counts. SOM is associated with the rs1544410 and rs2228570 polymorphisms. The methylation status of the VDR is not associated with inflammation or exposure to MTX®.

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.

The impact of oral health education on the incidence and severity of oral mucositis in pediatric cancer patients: a systematic review and meta-analysis.

Oral health education is an effective measure to prevent oral mucositis (OM) by improving self-management and effectively engaging patients in their health care. This systematic review aimed to determine the impact of oral health education interventions on the incidence and severity of OM. Bibliographical searches were carried out by two independent examiners in Medline, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SIGLE, until June 2022. The eligibility criteria were based on the PICO strategy, considering studies with pediatric oncology patients, aged 0 to 19 years, who had attended oral health education activities and had been examined for the incidence and/or severity of OM. Data were extracted for qualitative synthesis and organized in spreadsheets. The quality assessment of the selected studies was performed using the ROBINS-I tool. Meta-analysis was based on the group frequencies of OM ulcerative lesions, adopting a significance level of 5%. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to define the certainty of the evidence. The primary search retrieved 1827 articles. After removing duplicate records and screening titles and abstracts for eligibility, a total of 21 articles were selected for full-text analysis. Of these, seven eligible studies were included for data extraction and qualitative synthesis, while four studies were selected for quantitative synthesis. All studies had a longitudinal design; three performed a before-after comparison and four were controlled studies. OM was assessed by the following scales: OAG, WHO, ChIMES, and WCCNR. While data analysis of the selected studies was heterogeneous, the implementation of oral health education strategies was found to reduce the incidence and severity of OM during the follow-up period. The meta-analysis showed a favorable outcome for the educational intervention. The likelihood of patients attending oral health education activities to manifest OM ulcerative lesions was significantly lower (P = 0.002) than that of the control. The GRADE analysis presented a low certainty of the evidence. To conclude, oral health education interventions improved OM outcomes in pediatric oncology patients with a low quality of evidence.

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.

Genetic polymorphisms of genes involved in oxidative stress and inflammatory management in oncopediatric patients with chemo-induced oral mucositis.

OBJECTIVE: Oral mucositis (OM) is a painful inflammatory oral condition that affects children who undergo chemotherapy. Oxidative stress is a known OM mediator and pro-inflammatory cytokines contribute to the amplification of the immune response. To investigate the possible associations of rs4880 (superoxide dismutase 2, SOD2 47 C/T), rs7943316 (catalase, CAT -21 A/T), rs1800629 (tumor necrosis factor α, TNF- α -308 G/A), and rs1800795 (interleukin 6, IL-6 -174 G/C) polymorphisms with chemo-induced OM occurrence and severity in oncopediatric patients. METHODOLOGY: We conducted a single-center, observational cross-sectional study with sample collection of oral epithelial cells from 95 children and adolescents with hematological cancers who underwent chemotherapy, followed by genomic DNA extraction. Single-nucleotide polymorphisms (SNPs) were assessed with PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism). Demographic data and information concerning OM occurrence were obtained from dental charts of the multidisciplinary oral care team. Information on OM severity was obtained from appropriately-filled Oral Assessment Guide records. Descriptive and inferential statistics were conducted with Student's T test, chi-squared test, and Fisher's exact test, with p≤0.05. RESULTS: The mean age was 10 years-old and most patients were male individuals (57.89%). Female sex was considered a protective factor for OM occurrence (OR=4.83; CI=[1.14; 16.57]). The AA genotype for CAT was the most frequent amongst individuals with severe OM (p=0.04). The GA genotype for TNF- α was the most frequent amongst individuals without severe OM (p=0.03). For SOD2 and IL-6 , the most frequent genotypes were CT and GG respectively for all groups (p>0.05). CONCLUSION: The AA genotype for CAT -21 A/T was a tendency among the group with severe OM. Data on TNF- α -308 G/A were inconclusive. No associations were detected for SOD2 47 C/T and IL-6 -174 G/C polymorphisms in oncopediatric patients with chemo-induced oral mucositis.

Perception of Pediatric Oncological Patients and Their Parents/Guardians about a Hospital Oral Health Program: A Qualitative Study

BACKGROUND: The oral healthcare offered to pediatric cancer patients at the hospital level must include educational and preventive strategies based on dialogical and welcoming professional attitudes. Therefore, the current study aimed to evaluate the perception of pediatric cancer patients and their parents/guardians about an educational and preventive oral healthcare program implemented in a reference hospital for cancer treatment. METHODS: A qualitative follow-up investigation was conducted in which we evaluated the perception of pediatric cancer patients and their parents/guardians regarding an educational and preventive oral health program (OHEPP). The participants were 27 children and adolescents undergoing cancer treatment and their parents/guardians, and the assessment was carried out at 15 and 30 days after beginning the program through semi-structured interviews. The program used audiovisual resources, storytelling and playful instruments for the oral health education of patients and parents/guardians. The interviews were then transcribed and the Discourse of the Collective Speech (DCS) technique was performed for data analysis. RESULTS: Patients and parents/guardians reported improvement in oral hygiene habits and conditions. Patients reported greater enthusiasm for oral care and highlighted the recreational aspect of the program. Parents/guardians reported being more clear about oral changes and paying attention to the appearance of comorbidities resulting from anticancer treatment. CONCLUSIONS: This study suggests that implementation of the oral health program favored communication between health professionals, patients and their parents/guardians, expanding knowledge and generating behavior change in oral healthcare.

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.

Genetic polymorphisms of genes involved in oxidative stress and inflammatory management in oncopediatric patients with chemo-induced oral mucositis

Abstract Oral mucositis (OM) is a painful inflammatory oral condition that affects children who undergo chemotherapy. Oxidative stress is a known OM mediator and pro-inflammatory cytokines contribute to the amplification of the immune response. Objective: To investigate the possible associations of rs4880 (superoxide dismutase 2, SOD2 47 C/T), rs7943316 (catalase, CAT −21 A/T), rs1800629 (tumor necrosis factor α, TNF- α −308 G/A), and rs1800795 (interleukin 6, IL-6 −174 G/C) polymorphisms with chemo-induced OM occurrence and severity in oncopediatric patients. Methodology: We conducted a single-center, observational cross-sectional study with sample collection of oral epithelial cells from 95 children and adolescents with hematological cancers who underwent chemotherapy, followed by genomic DNA extraction. Single-nucleotide polymorphisms (SNPs) were assessed with PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism). Demographic data and information concerning OM occurrence were obtained from dental charts of the multidisciplinary oral care team. Information on OM severity was obtained from appropriately-filled Oral Assessment Guide records. Descriptive and inferential statistics were conducted with Student's T test, chi-squared test, and Fisher's exact test, with p≤0.05. Results: The mean age was 10 years-old and most patients were male individuals (57.89%). Female sex was considered a protective factor for OM occurrence (OR=4.83; CI=[1.14; 16.57]). The AA genotype for CAT was the most frequent amongst individuals with severe OM (p=0.04). The GA genotype for TNF- α was the most frequent amongst individuals without severe OM (p=0.03). For SOD2 and IL-6 , the most frequent genotypes were CT and GG respectively for all groups (p>0.05). Conclusion: The AA genotype for CAT −21 A/T was a tendency among the group with severe OM. Data on TNF- α −308 G/A were inconclusive. No associations were detected for SOD2 47 C/T and IL-6 −174 G/C polymorphisms in oncopediatric patients with chemo-induced oral mucositis.

Caracterização do câncer infantojuvenil no Brasil a partir dos Registros Hospitalares de Câncer (RHC), 2000-2016 / Characterization of childhood cancer in Brazil from the hospital-based cancer registries, 2000-2016 / Caracterización del cáncer infantil en Brasil a partir de los Registros de Cáncer del Hospital (RCH), 2000-2016

Objetivo: caracterizar o câncer infantojuvenil no Brasil, a partir da investigação nacional e regional dos registros hospitalares de câncer, no período de 2000 a 2016. Método: estudo observacional, retrospectivo e de base secundária, com amostra de 71.925 registros contendo informações de crianças e adolescentes (0 a 19 anos). Resultados: o câncer infantojuvenil foi mais frequente no sexo masculino com 39.049 (54,3%) casos, existindo 22.391 (31,1%) registros de crianças de 0 e 4 anos de idade e 19.892 (40,4%) com cor de pele parda. As leucemias, doenças mieloproliferativas e doenças mielodisplásicas acometeram 20.744 (28,8%) indivíduos. Os tumores sólidos foram diagnosticados em 42.087 (58,5%) crianças e adolescentes, sendo 23.941 (48,7%) submetidas a quimioterapia no início do tratamento e 56.518 (78,6%) que iniciaram o tratamento até 60 dias após comprovação diagnóstica. Conclusão: foi possível conhecer o perfil demográfico, clínico e assistencial das crianças e adolescentes com câncer no Brasil, e por regiões

Objective: to characterize childhood cancer in Brazil, based on the national and regional investigation of hospital-based cancer registries, from 2000 to 2016. Method: observational, retrospective and secondary-based study, with a sample of 71,925 records containing information of children and adolescents (0 to 19 years old). Results: infant-juvenile cancer was more frequent in males with 39,049 (54.3%) cases, with 22,391 (31.1%) records of children aged 0 and 4 years and 19,892 (40.4%) with color of brown skin. Leukemias, myeloproliferative diseases and myelodysplastic diseases affected 20,744 (28.8%) individuals. Solid tumors were diagnosed in 42,087 (58.5%) children and adolescents,23,941 (48.7%) of which underwent chemotherapy at the beginning of treatment and 56,518 (78.6%) who started treatment within 60 days of the diagnosis. Conclusion: it was possible to know the demographic, clinical and care profile of children and adolescents with cancer in Brazil, and by region

Objetivo: caracterizar el cáncer infantil en Brasil, con base en la investigación nacional y regional de registros hospitalarios de cáncer, de 2000 a 2016. Método: estudio observacional, retrospectivo y secundario, con una muestra de 71,925 registros que contienen información de niños. y adolescentes (0 a 19 años). Resultados: el cáncer infantil-juvenil fue más frecuente en el sexo masculino con 39.049 (54,3%) casos, con 22.391 (31,1%) registros de niños de 0 y 4 años y 19.892 (40,4%) con color de piel morena. Las leucemias, enfermedades mieloproliferativas y enfermedades mielodisplásicas afectaron a 20.744 (28,8%) individuos. Se diagnosticaron tumores sólidos en 42.087 (58,5%) niños y adolescentes, 23.941 (48,7%) de los cuales se sometieron a quimioterapia al inicio del tratamiento y 56.518 (78,6%) que iniciaron el tratamiento dentro de los 60 días del diagnóstico. Conclusión: fue posible conocer el perfil demográfico, clínico y de atención de niños y adolescentes con cáncer en Brasil y por región

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.

O ensino odontológico e os desafios relacionados ao cumprimento dos novos protocolos de biossegu-rança no contexto da pandemia da COVID-19 / Dental education and the challenges related to complying with the new biosafety protocols in the COVID-19 pandemic context

O objetivo deste estudo foi apresentar os desafios relacionados ao cumprimento dos novos protocolos de biossegurança, na perspectiva do retorno das atividades presenciais nas instituições de ensino superior em Odontologia,no cenário da pandemia da COVID-19.Tratou-se de um estudo qualitativo, de caráter exploratório, ancorado na técnica de pesquisa documental. Foram analisados os documentos publicados pelo Ministério da Educação (MEC), Conselho Federal de Odontologia (CFO) e Associação Brasileira de EnsinoOdontológico (ABENO).Os documentos foram coletados nos websitesdas entidades selecionadas. O tratamento dos dados qualitativos foi realizado por meio da análise de conteúdo temática, sendo comparadas qualitativamente as diferentes publicações, identificando-se pontos convergentes, divergentes ou ausentes entre os documentos.Combase na problematização do objeto em questão, foram emitidas sugestões a partir das fragilidades e potencialidades relacionadas à execução das recomendações. Os dados foram distribuídos nas unidades de análise "sala de espera", "clínica" e "laboratório". As principais potencialidades foram relacionadas à diminuição do risco biológico de transmissão de patógenos e à adequação de espaços físicos em ambientes mais ergonômicos de aprendizagem. Quanto às fragilidades, aponta-se o aumento de custos para discentes e instituições e a redução no número de atendimentos. Existem desafios a serem considerados em relação ao cumprimento dos novos protocolos de biossegurança no retorno das atividades práticas nos cursos deOdontologia durante a pandemia da COVID-19 (AU).

This study presents challenges related to the fulfillment of the new biosafety protocols aiming to return the face-to-face activities in higher education institutions in Dentistry considering the pandemic scenario of COVID-19. It was a qualitative, exploratory study, anchored in the technique of documentary research. We analyzed documents published by the Ministry of Education(MEC), the Federal Council of Dentistry (FCD) and the Brazilian Association for Dental Education (BADE). The documents were collected on websites of the selected entities. The treatment of qualitative data obtained was carried out by thematic content analysisto compare qualitatively the different documents by identifying convergent, divergent or absent points between them. From the problematization of the object under study, suggestions were made based on the weaknesses and potentialities related to the execution of the recommendations. Data were distributed in the analysis units "waiting room", "clinic" and "laboratory". The main potentialities were related to the reduction of the biological risk of transmission of pathogens and the adaptation of physicalspaces in more ergonomic learning environments. As for the weaknesses, there are increased costs for students and institutions and reduced number of visits. There are challenges to be considered to comply with the new biosafety protocols in the return of practical activities in Dentistry Courses during the COVID-19 pandemic (AU).

ABCG2 polymorphism, age and leukocyte count may contribute to oral mucositis in oncopediatric patients.

The study investigated the relationship between genetic polymorphisms and the development of oral mucositis in pediatric patients undergoing chemotherapy involving methotrexate. A longitudinal study was conducted with 64 patients, and oral mucositis was evaluated by the modified Oral Assessment Guide, which aims to diagnose and classify oral mucositis. Epithelial cells were obtained by mouthwash and DNA was extracted. The polymorphisms MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) and ABCG2 (rs2231142) were analyzed by PCR-RFLP method. Demographic, hematological and biochemical data were collected from medical records. Statistical analysis was performed using the SPSS software adopting a p-value of 0.05. Male sex predominated (56.2%), and the mean age was 10.8 years (± 4.9). Oral mucositis affected 65.6% of the patients, of which 61.9% developed the severe form of the disease. For the ABCG2 gene (rs2231142), the rare A allele and CA genotype were more frequent in individuals with mucositis (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). The severity of the disease was mainly observed in younger patients (median = 9 years; p=0.02). Patients with severe oral mucositis presented lower leukocytes count (median = 2.150 mm3) compared to patients with the mild/moderate form (median = 4.200 mm3; p=0.03). Female patients and each 10,000-platelet increase were protective factors against the onset of oral mucositis (p=0.02). It is concluded that rs2231142 polymorphism increases the likelihood of oral mucositis and younger patients and patients with low leukocytes counts are more likely to develop severe form.

The effectiveness of an oral health education and prevention program on the incidence and severity of oral mucositis in pediatric cancer patients: a non-randomized controlled study.

PURPOSE: To investigate the effectiveness of an Oral Health Education and Prevention Program (OHEPP) on the incidence and severity of oral mucositis (OM) in pediatric cancer patients. The OHEEP was a ludic strategy for promoting oral health and monitoring the oral health condition. METHODS: We compared the incidence and severity of OM in patients who attended the OHEPP against those under similar conditions who did not receive educational interventions. Both groups were examined for 6 weeks by calibrated examiners (k > 0.8) using the modified Oral Assessment Guide (OAG). A total of 14 patients aged 2 to 18 years were included in each group and matched for sex, age, tumor type, and treatment modality. The incidence and severity of OM were compared using the chi-squared test (α = 5%), and the relative risk and effectiveness of the OHEPP were calculated with a statistical power of 0.97. Differences in total OAG scores between the groups were determined by the Mann-Whitney test (α = 5%). RESULTS: There was a higher incidence of OM in patients who did not attend the OHEPP (P = 0.005), and the relative risk of developing OM was significantly lower in OHEPP attendants (RR: 0.73; CI 0.60-0.92). No difference in the occurrence of severe OM was observed. OHEPP reduced the risk of developing OM by 1.4-fold, with an effectiveness of 27%. There was a difference in total OAG scores (P = 0.041). CONCLUSION: Participation in OHEPP was an effective measure to reduce the incidence of OM in pediatric cancer patients.

ABCG2 polymorphism, age and leukocyte count may contribute to oral mucositis in oncopediatric patients

Abstract The study investigated the relationship between genetic polymorphisms and the development of oral mucositis in pediatric patients undergoing chemotherapy involving methotrexate. A longitudinal study was conducted with 64 patients, and oral mucositis was evaluated by the modified Oral Assessment Guide, which aims to diagnose and classify oral mucositis. Epithelial cells were obtained by mouthwash and DNA was extracted. The polymorphisms MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) and ABCG2 (rs2231142) were analyzed by PCR-RFLP method. Demographic, hematological and biochemical data were collected from medical records. Statistical analysis was performed using the SPSS software adopting a p-value of 0.05. Male sex predominated (56.2%), and the mean age was 10.8 years (± 4.9). Oral mucositis affected 65.6% of the patients, of which 61.9% developed the severe form of the disease. For the ABCG2 gene (rs2231142), the rare A allele and CA genotype were more frequent in individuals with mucositis (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). The severity of the disease was mainly observed in younger patients (median = 9 years; p=0.02). Patients with severe oral mucositis presented lower leukocytes count (median = 2.150 mm3) compared to patients with the mild/moderate form (median = 4.200 mm3; p=0.03). Female patients and each 10,000-platelet increase were protective factors against the onset of oral mucositis (p=0.02). It is concluded that rs2231142 polymorphism increases the likelihood of oral mucositis and younger patients and patients with low leukocytes counts are more likely to develop severe form.

Resumo O presente estudo investigou a relação entre cinco polimorfismos genéticos e o desenvolvimento de mucosite oral em pacientes pediátricos recebendo quimioterapia com metrotexato. O estudo longitudinal foi conduzido com 64 pacientes e a mucosite oral avaliada pelo Oral Assessment Guide modificado, que tem como objetivo diagnosticar e classificar a mucosite oral. Células epiteliais bucais foram obtidas por bochecho e o DNA foi extraído. Os polimorfismos MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) e ABCG2 (rs2231142), foram analisados pela técnica de PCR-RFLP. Dados demográficos, hematológicos e bioquímicos foram coletados a partir de registros médicos. Análise estatística foi realizada utilizando o software SPSS adotando um valor de p=0,05. Observou-se que, o sexo masculino foi predominante (56,2%), e a idade média foi de 10,8 anos (± 4.9). A mucosite oral acometeu 65,6% dos pacientes, dos quais, 61,9% desenvolveram a forma grave da doença. Para o gene ABCG2 (rs2231142), o alelo raro A e o genótipo CA foram mais frequentes em indivíduos com mucosite (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). A gravidade da doença foi observada principalmente em pacientes mais jovens (mediana = 9 anos; p=0.02). Além disso, os pacientes com mucosite oral grave apresentaram menor contagem de leucócitos (mediana = 2150 mm3) em comparação aos pacientes com a forma leve/moderada (mediana = 4200 mm3; p=0.03). Pacientes do sexo feminino e aumento a cada 10.000 plaquetas foram fatores de proteção contra o aparecimento de mucosite oral (p=0.02). Concluiu-se que a presença do polimorfismo rs2231142 aumenta o risco de o paciente desenvolver a mucosite oral, bem como pacientes mais jovens e menor contagem de leucócitos contribui com a severidade.