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1.
Head Neck ; 45(3): 620-628, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36600471

RESUMO

BACKGROUND: To investigate the effect of nutritional status on radiation-induced acute toxicities in nasopharyngeal carcinoma (NPC) patients before radiotherapy. METHODS: Nutritional status of 228 patients with NPC who received intensity-modulated radiotherapy was retrospectively analyzed by modified nutrition index (m-NI). Cumulative grading score of six common acute toxicities were defined as total score for acute toxicities. RESULTS: M-NI ≤6 is a risk factor for xerostomia (p = 0.016, OR = 0.208, 95% CI 0.058-0.743), oral mucositis (p = 0.016, OR = 0.287, 95% CI 0.104-0.793), dysgeusia (p = 0.001, OR = 0.028, 95% CI 0.004-0.217), and dysphagia (p = 0.015, OR = 0.251, 95% CI 0.083-0.764) as well in patients with NPC. Total score of radiation-induced acute toxicities of patients with malnutrition (13.6 ± 1.7) was significantly higher than that of patients with normal nutrition (12.0 ± 2.4) (t = -5.464, p < 0.001). CONCLUSIONS: NPC patients with malnutrition before radiotherapy develop more serious dysgeusia, oral mucositis, dysphagia, and xerostomia after intensity-modulated radiotherapy.


Assuntos
Carcinoma , Transtornos de Deglutição , Desnutrição , Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Estomatite , Xerostomia , Humanos , Carcinoma Nasofaríngeo/radioterapia , Carcinoma Nasofaríngeo/complicações , Estado Nutricional , Carcinoma/radioterapia , Estudos Retrospectivos , Transtornos de Deglutição/complicações , Disgeusia/complicações , Neoplasias Nasofaríngeas/patologia , Radioterapia de Intensidade Modulada/efeitos adversos , Estomatite/etiologia , Desnutrição/etiologia , Xerostomia/etiologia
3.
Health Technol Assess ; 26(46): 1-172, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36484364

RESUMO

BACKGROUND: Oral mucositis is a debilitating and painful complication of head and neck cancer irradiation that is characterised by inflammation of the mucous membranes, erythema and ulceration. Oral mucositis affects 6000 head and neck cancer patients per year in England and Wales. Current treatments have not proven to be effective. International studies suggest that low-level laser therapy may be an effective treatment. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of low-level laser therapy in the management of oral mucositis in head and neck cancer irradiation. To identify barriers to and facilitators of implementing low-level laser therapy in routine care. DESIGN: Placebo-controlled, individually randomised, multicentre Phase III superiority trial, with an internal pilot and health economic and qualitative process evaluations. The participants, outcome assessors and therapists were blinded. SETTING: Nine NHS head and neck cancer sites in England and Wales. PARTICIPANTS: A total of 87 out of 380 participants were recruited who were aged ≥ 18 years and were undergoing head and neck cancer irradiation with ≥ 60 Gy. INTERVENTION: Random allocation (1 : 1 ratio) to either low-level laser therapy or sham low-level laser therapy three times per week for the duration of irradiation. The diode laser had the following specifications: wavelength 660 nm, power output 75 mW, beam area 1.5 cm2, irradiance 50 mW/cm2, exposure time 60 seconds and fluence 3 J/cm2. There were 20-30 spots per session. Sham low-level laser therapy was delivered in an identical manner. MAIN OUTCOME MEASURE: The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks following the start of irradiation. Higher scores indicate a worse outcome. RESULTS: A total of 231 patients were screened and, of these, 87 were randomised (low-level laser therapy arm, n = 44; sham arm, n = 43). The mean age was 59.4 years (standard deviation 8.8 years) and 69 participants (79%) were male. The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks was 33.2 (standard deviation 10) in the low-level laser therapy arm and 27.4 (standard deviation 13.8) in the sham arm. LIMITATIONS: The trial lacked statistical power because it did not meet the recruitment target. Staff and patients willingly participated in the trial and worked hard to make the LiTEFORM trial succeed. However, the task of introducing, embedding and sustaining new low-level laser therapy services into a complex care pathway proved challenging. Sites could deliver low-level laser therapy to only a small number of patients at a time. The administration of low-level laser therapy was viewed as straightforward, but also time-consuming and sometimes uncomfortable for both patients and staff, particularly those staff who were not used to working in a patient's mouth. CONCLUSIONS: This trial had a robust design but lacked power to be definitive. Low-level laser therapy is relatively inexpensive. In contrast with previous trials, some patients found low-level laser therapy sessions to be difficult. The duration of low-level laser therapy sessions is, therefore, an important consideration. Clinicians experienced in oral cavity work most readily adapt to delivering low-level laser therapy, although other allied health professionals can be trained. Blinding the clinicians delivering low-level laser therapy is feasible. There are important human resource, real estate and logistical considerations for those setting up low-level laser therapy services. FUTURE WORK: Further well-designed randomised controlled trials investigating low-level laser therapy in head and neck cancer irradiation are needed, with similar powered recruitment targets but addressing the recruitment challenges and logistical findings from this research. TRIAL REGISTRATION: This trial is registered as ISRCTN14224600. FUNDING: This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 46. See the NIHR Journals Library website for further project information.


Around 9 out of 10 head and neck cancer patients undergoing treatment experience pain, swelling and sores in their mouth (oral mucositis). This can lead to weight loss, painful ulcers, difficulty talking, eating and drinking, and even hospitalisation. Current care includes helping patients to keep their mouth and teeth clean, encouraging them to have a healthy diet and prescribing mouthwashes, painkillers and mouth-coating gels. However, these treatments give limited help in preventing or treating this condition. The LiTEFORM trial looked at whether or not low-level laser therapy could be used to prevent and treat oral mucositis. Patients were allocated to one of two arms at random: active laser or fake (sham) laser. Neither the patients nor the hospital staff knew which laser was being used. Eighty-seven people joined the study during the time allowed (44 received low-level laser therapy and 43 received sham treatment); however, this was a smaller number than the planned target of 380 people. As a result, no meaningful conclusion can be drawn from the results about whether the therapy is beneficial or cost-effective. People receiving the low-level laser therapy reported slightly more soreness in their mouth than those receiving the sham laser, but this could be down to chance. The number of participants is too small to draw conclusions about whether or not the low-level laser is helpful. Some patients found the laser treatment sessions to be difficult. Setting up a new service delivering laser therapy at the same time as cancer treatments was more complicated than originally anticipated. Problems included the scheduling of appointments, finding suitable rooms and having enough trained staff with time to deliver laser therapy. However, this study has provided us with knowledge on how best to set up a laser therapy service in the NHS as part of the cancer treatment pathway and the costs involved. These findings could help future studies looking into low-level laser therapy for those with head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço , Estomatite , Humanos , Adulto , Masculino , Pessoa de Meia-Idade , Feminino , Inglaterra , Estomatite/etiologia , Estomatite/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , País de Gales , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
PLoS One ; 17(12): e0278102, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36480513

RESUMO

BACKGROUND: Oral mucositis (OM) is a common side effect of chemotherapy and radiotherapy in patients with cancers. The prevention or treatment of OM in cancer patients is crucial in the treatment of cancer. METHODS: We searched PubMed, Embase, and Cochrane Library for the randomized control trials (RCTs) of interventions for preventing and treating OM. Network meta-analysis (NMA) was performed to estimate odds ratios (ORs) and 95% confidence intervals (CI) from both direct and indirect evidence. The prespecified primary efficacy outcome was the treatment effect of moderate to severe oral mucositis with 12 interventions. The outcome was moderate to a severe grade of OM. RESULTS: This study included 55 RCTs with 3,552 participants. The results showed that honey significantly lowered the risk of chemo/radiotherapy-induced moderate to severe oral mucositis than placebo (OR: 0.01, 95%CI 0.00 to 0.45), followed by lignocaine (OR: 0.07, 95%CI 0.00 to 0.95). The surface under cumulative ranking curve (SUCRA) values for honey were 0.95, followed by lignocaine (SUCRA, 0.81) and benzydamine (SUCRA, 0.78). CONCLUSIONS: The honey is effective for patients with cancer undergoing chemotherapy or radiotherapy-induced oral mucositis.


Assuntos
Neoplasias , Estomatite , Humanos , Metanálise em Rede , Estomatite/etiologia , Estomatite/prevenção & controle , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia
5.
Support Care Cancer ; 31(1): 31, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36517616

RESUMO

PURPOSE: Considering the complex pathobiology of oral mucositis, especially in oral cancer patients, the prevention and treatment of oral mucositis in patients undergoing radiotherapy remains an essential and clinically crucial unmet need. The present study aims to investigate and compare the effects of synbiotic mouthwash with normal saline mouthwash on the prevention and control of radiotherapy-induced oral mucositis in oral cancer patients. METHODS: Double-blind, randomized clinical trial (RCT) performed on 64 oral cancer patients who underwent radiotherapy (IRCT20201106049288N1, registration date: 2020-12-23). Patients were divided randomly into the case (32 subjects) and control (32 subjects) groups. All patients underwent intensity-modulated radiotherapy and received 6000 cGY of radiotherapy in 34 fractions. All patients received the usual treatment for mucositis, but in the case group, synbiotic mouthwash was prescribed and in the control group, normal saline mouthwash was prescribed from a day before the start to the end of radiotherapy treatment. Patients were monitored every session for 6 weeks to check the progression, oral involvement severity, and mucositis grade. RESULTS: The case group showed a significant reduction in the oral mucositis severity. The mucositis grade in the case group from the 7th session of oral examination was significantly lower than the control (p < 0.05), and this significant difference persisted until the last session of oral examination. Incidence rates of severe oral mucositis (grade 3) during the treatment period were 11.59% in the case and 36.45% in control (p < 0.001). CONCLUSION: Synbiotic mouthwash significantly reduces and prevents oral mucositis intensity in oral cancer patients undergoing radiotherapy.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Mucosite , Estomatite , Simbióticos , Humanos , Antissépticos Bucais/uso terapêutico , Mucosite/tratamento farmacológico , Solução Salina/uso terapêutico , Estomatite/etiologia , Estomatite/prevenção & controle , Estomatite/tratamento farmacológico , Neoplasias Bucais/tratamento farmacológico , Método Duplo-Cego , Neoplasias de Cabeça e Pescoço/complicações
6.
J Fam Pract ; 71(9): 413-415, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36538779

RESUMO

We initially suspected primary herpetic gingivostomatitis. But the patient's lab work, persistent fever, and cough led us in a different direction.


Assuntos
Estomatite Herpética , Estomatite , Criança , Humanos , Estomatite Herpética/diagnóstico , Estomatite Herpética/tratamento farmacológico , Estomatite/diagnóstico , Estomatite/etiologia , Estomatite/terapia
7.
BMC Med ; 20(1): 377, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36324139

RESUMO

BACKGROUND: Oral mucositis (OM) in patients receiving cancer therapy is thus far not well managed with standard approaches. We aimed to assess the safety and effectiveness of methylene blue (MB) oral rinse for OM pain in patients receiving cancer therapy. METHODS: In this randomized, single-blind phase 2 clinical trial, patients were randomized to one of four arms: MB 0.025%+conventional therapy (CTx) (n = 15), MB 0.05%+CTx (n = 14), MB 0.1%+CTx (n = 15), or CTx alone (n = 16). Intervention groups received MB oral rinse every 6 h for 2 days with outcomes measured at days 1-2; safety was evaluated up to 30 days. The primary outcome measured change in the pain numeric rating scale (0-10) from baseline to day 2. Secondary outcome measured change in oral function burden scores from baseline to day 2, World Health Organization OM grades, morphine equivalent daily doses, and adverse events. The trial was registered with ClinicalTrials.gov ID: NCT03469284. RESULTS: Sixty patients (mean age 43, range 22-62 years) completed the study. Compared with those who received CTx alone, those who received MB had a significant reduction of pain scores at day 2 of treatment (mean ± SD); 0.025%: 5.2 ± 2.9, 0.05%: 4.5 ± 2.9, 0.1%: 5.15 ± 2.6) and reduction of oral function burden scores (0.025%: 2.5 ± 1.55, 0.05%: 2.8 ± 1.7, 0.1%: 2.9 ± 1.60). No serious adverse events were noted, but eight patients reported burning sensation of the oral cavity with the first dose, and this caused one patient to discontinue therapy. CONCLUSIONS: MB oral rinse showed significant pain reduction and improved oral functioning with minimal adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03469284.


Assuntos
Neoplasias , Dor Intratável , Estomatite , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Dor Intratável/complicações , Dor Intratável/tratamento farmacológico , Azul de Metileno/efeitos adversos , Método Simples-Cego , Método Duplo-Cego , Estomatite/tratamento farmacológico , Estomatite/etiologia , Neoplasias/complicações , Analgésicos/uso terapêutico
8.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 40(6): 721-726, 2022 Dec 01.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-36416327

RESUMO

Radiation-induced oral mucositis is an oral mucosal injury caused by radiation ionizing radiation, which often manifests as oral mucosal congestion, erosion, and ulcers. Radiation-induced oral mucositis manifesting as vascular proliferative changes in the oral mucosa has not been reported. We report a case of oral mucosal atypical vascular proliferation after radiotherapy for a malignant maxillofacial tumor. We discussed the mechanism and treatment of aty-pical vascular proliferation in the oral mucosa secondary to radiotherapy, including diagnosis, treatment, and previous literature.


Assuntos
Neoplasias , Lesões por Radiação , Estomatite , Humanos , Estomatite/etiologia , Estomatite/patologia , Estomatite/terapia , Mucosa Bucal , Neoplasias/complicações , Proliferação de Células
9.
Support Care Cancer ; 30(12): 10179-10190, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36350380

RESUMO

PURPOSE: Oral mucositis affects up to 80% of children and young people (CYP) receiving chemotherapy. This can result in pain, reduced oral intake and, in severe cases, hospitalisation for parental nutrition and pain relief. Photobiomodulation is recommended by multiple bodies for mucositis management for those undergoing cancer treatments. The current use of photobiomodulation within the UK, and the barriers and facilitators to implementation is unknown. METHOD: An online mixed-methods survey was administered to representatives from the Children's Cancer and Leukaemia Group (CCLG) between October 2021 and March 2022. This explored: use of photobiomodulation, planned future use, barriers and facilitators to implementation and dental assessment. Quantitative data underwent descriptive statistics. Barriers and facilitators to the implementation of photobiomodulation were analysed using the Theoretical Domains Framework (TDF). RESULTS: All UK CCLG centres responded (n = 20, a response rate of 100%). Two units in Scotland were delivering photobiomodulation. A further four units were planning to implement a service. Most units, 65% (n = 13) utilised specialist Paediatric Dentistry services for dental assessment. In the TDF analysis, five domains were most frequently populated: knowledge, skills, environmental context and resources, social influences, and social/professional role and identity. CONCLUSION: Photobiomodulation was only available in Scotland in two children's cancer units. Lack of knowledge and skills, and insufficient environmental resources were identified as barriers. Collaboration with paediatric dental services was identified as a facilitator. The establishment of a national network of Paediatric Dentists and Oncologists would promote collaboration to standardise protocols and to address the identified barriers to wider implementation of photobiomodulation.


Assuntos
Neoplasias , Estomatite , Humanos , Criança , Adolescente , Estomatite/etiologia , Estomatite/terapia , Inquéritos e Questionários , Dor , Reino Unido , Neoplasias/complicações , Neoplasias/radioterapia
10.
Support Care Cancer ; 30(12): 10285-10290, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36239800

RESUMO

PURPOSE: During head and neck radiotherapy, backscatter from metallic dental restorations (MDRs) causes oral mucositis. Currently, two MDR handling methods are used: the replacement of MDRs with provisional restorations (MDR removal) and fabrication of dental spacers before radiotherapy. We compared the effects of these two methods on the incidence of oral mucositis during head and neck radiotherapy. METHODS: We enrolled 76 patients with MDRs who underwent radiotherapy for head and neck cancer between April 2016 and March 2020. We set grade 2 oral mucositis as an outcome. After adjustment of all covariates using the propensity score (PS), we analyzed the data using a Cox proportional hazards model. In addition, subgroup analysis was performed by stratifying the data into quintiles based on the PS. RESULTS: For the incidence of grade 2 oral mucositis due to head and neck radiotherapy, the hazard ratio for the MDR removal group relative to the dental spacer group was 0.344 (95% confidence interval, 0.121-0.980; P = 0.046). Subgroup analysis showed that the hazard ratio for the MDR removal group was 0.339 (95% confidence interval, 0.122-0.943; P = 0.038). CONCLUSION: The results suggest that MDR replacement is superior to dental spacer fabrication in reducing the incidence of oral mucositis during head and neck radiotherapy, although MDR removal carries several associated risks.


Assuntos
Neoplasias de Cabeça e Pescoço , Estomatite , Humanos , Estomatite/epidemiologia , Estomatite/etiologia , Estomatite/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/complicações , Radioterapia/efeitos adversos
11.
J Opioid Manag ; 18(4): 309-316, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36052929

RESUMO

Oral mucositis (OM) pain is an anticipated complication of immunosuppressive therapies for hematological malignancies. Opioids are effective for OM-associated pain and dysfunction that is refractory to simple measures. At the study institution, parenteral opioids are preferentially prescribed for the treatment of complicated OM. This audit explores the efficacy of opioids for the management of OM pain using morphine, oxycodone, and fentanyl patient-controlled analgesia (PCA). Pain scores, opioid consumption, resumption of oral intake, and the duration of admission were retrospectively analyzed from patient records over an 18-month period. Two-thirds of included patients had ceased PCA therapy by day 6, by which time there was a meaningful 35.4 percent reduction in pain scores, with very few side effects reported. Interagent comparison demonstrated no significant differences in mean daily pain scores; however, a larger sample size would facilitate an investigation of clinically significant nuances in treatment differences, if they exist.


Assuntos
Neoplasias Hematológicas , Estomatite , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Neoplasias Hematológicas/induzido quimicamente , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Morfina/efeitos adversos , Dor/tratamento farmacológico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos , Estomatite/diagnóstico , Estomatite/tratamento farmacológico , Estomatite/etiologia
12.
Oral Oncol ; 134: 106116, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36115328

RESUMO

This study identified the scientific literature comparing the influence of different times in which dental procedures were performed before the oncological treatments (radiotherapy and/or chemotherapy) on the risk of oral complications development. MEDLINE/PubMed and Embase databases were searched, and articles were selected by title, abstract and full-text assessment. The search identified 2,356 articles and three retrospective observational studies were included. Data were collected and analyzed according to the dental procedure, the time before oncological treatment, and oral complications. Risk of bias (ROBINS) and certainty of evidence (GRADE) were evaluated. Pairwise meta-analyses were performed from dental extractions (Exo) data according to the time which were performed and ORN development using a random-effect model (RR and 95 % CI, p < 0.05). meta-analyses showed a higher risk of ORN development in patients with Exo performed < 2 weeks before oncological treatment than in those who Exo was performed > 2 weeks ≤ 1 month before oncological therapy (RR 1.29; 95 % CI 1.12-1.48; p < 0.01). There was a higher prevalence of oral mucositis (OM) in patients who received periodontal treatment ≤ 3 weeks before oncological therapy than those who received dental procedures > 3 weeks ≤ 6 months before. Although the risk of bias ranged from serious to critical, with very low certainty of evidence, the findings suggest that dental extractions should be performed within > 2 weeks before oncological treatment to avoid ORN complications. More studies are needed to conclude the appropriate time to perform dental procedures to decrease other associated oral complications. (CRD42021272652).


Assuntos
Estomatite , Assistência Odontológica , Humanos , Estudos Retrospectivos , Estomatite/etiologia
13.
J Clin Periodontol ; 49(12): 1357-1365, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36054620

RESUMO

AIM: To evaluate the clinical outcome and the associated factors of a treatment protocol for peri-implant mucositis. MATERIALS AND METHODS: Patients were evaluated 30 months after a treatment protocol including professional mechanical debridement and modification of the prosthesis contours to improve access for biofilm control. Clinical performance was assessed by means of probing with an electronic pressure-calibrated periodontal probe. The possible impact of implant- and patient-level factors on the changes in peri-implant mucosal inflammation measured with the modified bleeding index (mBI) was evaluated. RESULTS: Twenty patients and 61 implants were included in the analysis. At the final visit, 50% of the patients presented bleeding on probing, with a mean mBI of 0.22 (SD 0.27). The adjusted linear regression model showed a significant association between patient's compliance with supportive care visits (p = .006) and mucosal inflammation. Similarly, at the implant level, modified plaque index (p < .001) and an irregular use of interdental brushes (p = .017) had a significant impact on final mBI. CONCLUSIONS: Prosthesis modification when needed in association with non-surgical treatment may be an important intervention in the treatment of peri-implant mucositis. Compliance with supportive care visits and the regular use of inter-dental brushes were identified as important factors to achieve mucosal inflammation control.


Assuntos
Implantes Dentários , Mucosite , Peri-Implantite , Estomatite , Humanos , Mucosite/etiologia , Mucosite/terapia , Desbridamento , Seguimentos , Estomatite/etiologia , Estomatite/terapia , Implantes Dentários/efeitos adversos , Peri-Implantite/terapia , Inflamação
14.
Support Care Cancer ; 30(11): 9141-9149, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36008731

RESUMO

PURPOSE: Oral mucositis is a common complication during haematopoietic stem cell transplantation (HSCT). This study aimed to assess the incidence of severe mucositis in patients undergoing different HSCT regimens. METHODS: This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected. RESULTS: Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI)-based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced-intensity fludarabine/melphalan (FluMel) (43%) and carmustine/etoposide/cytarabine/melphalan (BEAM) autologous HSCT (41%). In contrast, grade 3-4 oral mucositis was less common in reduced-intensity haploidentical regimen melphalan/fludarabine/TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high-dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. CONCLUSIONS: Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Estomatite , Humanos , Melfalan/efeitos adversos , Estudos Retrospectivos , Incidência , Metotrexato/efeitos adversos , Condicionamento Pré-Transplante/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Estomatite/epidemiologia , Estomatite/etiologia , Estomatite/prevenção & controle , Ciclofosfamida
15.
Oral Surg Oral Med Oral Pathol Oral Radiol ; 134(4): e256-e260, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35987735

RESUMO

Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the digestive tract, and they involve systemic inflammatory diseases known as extra-intestinal manifestations (EIMs). Timely and correct diagnosis of mucocutaneous EIMs could assist with detecting and monitoring IBD. We present a case of 52-year-old male patient of ulcerative colitis with 2 rare EMIs together at the same time: pyostomatitis vegetans in the oral cavity and Sweet syndrome on the skin. They presented as multiple small white or yellow pustules on the surface of the hyperemic fragile oral mucosa and abrupt appearance of painful, swollen, and erythematous papules on the skin, respectively. The final diagnosis was made based on clinical manifestations, skin and oral tissue biopsies, and the ulcerative colitis history. This rare case report may remind dentists of rare mucocutaneous EIMs of IBD that might be overlooked. Dentists and dermatologists could contribute to the early diagnosis and management of systematic diseases.


Assuntos
Colite Ulcerativa , Gengivite Ulcerativa Necrosante , Doenças Inflamatórias Intestinais , Estomatite , Síndrome de Sweet , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/complicações , Masculino , Pessoa de Meia-Idade , Compostos Orgânicos , Estomatite/diagnóstico , Estomatite/etiologia , Síndrome de Sweet/complicações , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamento farmacológico
16.
Ann Hematol ; 101(10): 2325-2336, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35922679

RESUMO

Oral mucositis is one of the worst effects of the conditioning regimens given to patients undergoing hematopoietic stem cell transplantation. It is characterized by dry mouth, erythema, mucosal soreness, ulcers, and pain, and it may impact patient outcomes. Bovine colostrum and Aloe vera contain a wide variety of biologically active compounds that promote mucosal healing. A non-randomized phase II study was designed to assess the safety and efficacy of a combined bovine colostrum and Aloe vera oral care protocol to prevent and to treat severe oral mucositis in transplant patients. Two commercially available products were given to patients in addition to the standard protocol: Remargin Colostrum OS® mouthwash and Remargin Colostrum Gastro-Gel® taken orally. Forty-six (78.0%) patients experienced oral mucositis, 40 (67.8%) developed mild-moderate forms, and 6 (10.2%) severe ones. Comparing the study group's outcomes with those of a homogeneous historical control group, severe oral mucositis decreased significantly (10.2% vs. 28.4%; P < 0.01), as did its duration (0.5 ± 1.9 vs. 1.5 ± 3.0 days; P < 0.01). Febrile neutropenia episodes (69.5% vs. 95.1%; P < 0.01) and duration (4.0 ± 4.7 vs. 6.2 ± 4.5 days; P < 0.01) also decreased. These findings show that the experimental protocol seems effective in preventing severe forms of oral mucositis. However, a randomized controlled trial is necessary to confirm this.


Assuntos
Aloe , Colostro , Estomatite , Aloe/efeitos adversos , Animais , Bovinos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Gravidez , Estomatite/etiologia , Estomatite/prevenção & controle , Condicionamento Pré-Transplante/efeitos adversos
17.
Support Care Cancer ; 30(11): 8819-8829, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35915339

RESUMO

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.


Assuntos
Neoplasias , Estomatite , Criança , Humanos , Incidência , Estomatite/epidemiologia , Estomatite/etiologia , Estomatite/prevenção & controle , Educação em Saúde
18.
Int Dent J ; 72(6): 735-745, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35931559

RESUMO

The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], -0.36; 95% confidence interval [CI], -0.88 to 0.16; P = .18) or bleeding on probing (MD, -0.71; 95% CI, 1.58-0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well-designed RCTs are still needed.


Assuntos
Implantes Dentários , Mucosite , Peri-Implantite , Estomatite , Humanos , Peri-Implantite/cirurgia , Lasers Semicondutores/uso terapêutico , Estomatite/etiologia , Estomatite/radioterapia
19.
J Cell Mol Med ; 26(16): 4556-4565, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35810384

RESUMO

Radiation-induced oral mucositis is a common and dose-limiting complication of head and neck radiotherapy with no effective treatment. Previous studies revealed that sildenafil, a phosphodiesterase 5 inhibitor, has anti-inflammatory and anti-cancer effects. In this study, we investigated the effect of sildenafil on radiation-induced mucositis in rats. Two doses of radiation (8 and 26 Gy X-ray) were used to induce low-grade and high-grade oral mucositis, separately. A control group and three groups of sildenafil citrate-treated rats (5, 10, and 40 mg/kg/day) were used for each dose of radiation. Radiation increased MDA and activated NF-κB, ERK and JNK signalling pathways. Sildenafil significantly decreased MDA level, nitric oxide (NO) level, IL1ß, IL6 and TNF-α. The most effective dose of sildenafil was 40 mg/kg/day in this study. Sildenafil also significantly inhibited NF-κB, ERK and JNK signalling pathways and increased bcl2/bax ratio. In addition, high-dose radiation severely destructed the mucosal layer in histopathology and led to mucosal cell apoptosis in the TUNEL assay. Sildenafil significantly improved mucosal structure and decreased inflammatory cell infiltration after exposure to high-dose radiation and reduced apoptosis in the TUNEL assay. These findings show that sildenafil can improve radiation-induced oral mucositis and decrease the apoptosis of mucosal cells via attenuation of inflammation and oxidative stress.


Assuntos
NF-kappa B , Estomatite , Animais , Apoptose , NF-kappa B/metabolismo , Estresse Oxidativo , Ratos , Citrato de Sildenafila/farmacologia , Citrato de Sildenafila/uso terapêutico , Estomatite/tratamento farmacológico , Estomatite/etiologia , Estomatite/metabolismo
20.
Hu Li Za Zhi ; 69(4): 52-63, 2022 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-35893337

RESUMO

BACKGROUND: The majority of patients with oral cavity and nasopharyngeal cancer experience severe oral mucositis during concurrent radiochemotherapy. The effectiveness of routine nursing education remains limited. PURPOSE: To evaluate the effect of a simple home-based oral care regimen on oral mucositis. METHODS: A double-group quasi-experimental design was adopted in this study. The participants were all newly diagnosed patients with oral cavity and nasopharyngeal cancer who were scheduled to receive concurrent radiochemotherapy in a northern medical center. A total of 31 patients in the experimental group and 32 patients in the control group were enrolled as participants. The control group received routine care, while the experimental group received an additional six- to seven-week two-way interactive home-based oral care regimen. The measurement tools included a plaque record and oral assessment guide (OAG) implemented twice during the study period. Study data were collected at 8 time points, including before treatment, at 1-5 weeks of treatment, at the end of treatment, and at one-month post-treatment. Data analysis was performed using two-way repeated measures ANCOVA. RESULTS: After controlling for OAG score, nutrition, age, living habits, and oral hygiene, the development of mucositis was found to be significantly slower in the experimental group than in the control group during the traumatic phase (effect of group: F = 11.1, p < .01; effect of group x time: F = 3.5, p = .01). However, both groups reported a statistically similar rate of improvement during the repair phase (effect of group and group x time: F = 0.19, p = .67). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The simple home-based oral care regimen introduced in this study may be used to improve traumatic oral mucositis in patients with oral cavity and nasopharyngeal cancer. It is recommended that even after the completion of radiotherapy, medical staffs should continue to strengthen patients' execution of proper oral care to maintain the positive effect until the mucositis has abated.


Assuntos
Mucosite , Neoplasias Nasofaríngeas , Higiene Bucal , Estomatite , Quimiorradioterapia , Humanos , Neoplasias Nasofaríngeas/terapia , Higiene Bucal/métodos , Estomatite/diagnóstico , Estomatite/etiologia , Estomatite/terapia
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