Management of oral complications associated with cancer therapy in pediatric patients

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Brian Schmid Date: 1/22/10
Article title: Management of oral complications associated with cancer therapy in pediatric patients
Author(s): Anne R Simon, Michael Roberts
Journal: Journal of Dentistry for Children
Month, Year: 1991
Major topic: cancer therapy-related oral complications
Type of Article: Review
Findings: Cancer is the second most cause of childhood morbidity in the US. Increased and often successful therapies have also increased the related morbidities such as oral complications. These problems are especially important for children with increased nutritional needs, also oral complications from cancer therapies is 3x more common in children than adults. The complications are due to a combination of factors including size, location and intensity of radioactive dose.

MUCOSITIS: the most common oral complication of cancer therapy. It is closely related to toxicity of chemotherapeutic agents and their effect on the rapidly multiplying basal epithelial cells. The nadir of the neutrophil count also coincides with the most extreme mucositis. Symptoms include: burning sensation, dryness, tingling of the lips and severe pain. This can lead to malnutrition, dehydration and premature cessation of cancer therapy. The most common treatment is “Magic Mouthwash” whose original recipe included hydrocortisone, tetracycline, nystatin and diphenhydramine, although many variations are also used. Chlorhexidine is now widely used but contains no analgesic agent.

INFECTIONS: Oral fungal infections, such as Candida, occur most commonly on the buccal mucosa, tongue, gingiva and pharynx. This is treated with antifungals such as Nystatin, clotrimidazole etc which may come in mouthrinse, lozenge or pill form. Chlorhexidine has also shown success but should NOT be used in conjunction with Nystatin; this combination will inactivate both substances. The troches and pastilles often contain cariogenic substrates and their use should always be followed by excellent oral hygiene instruction. Oral bacterial infections are often secondary to severe mucositis and should be cultured before antibiotics are prescribed. Herpes simplex virus is the most common viral infection correlated with chemotherapy and bone marrow transplant. Acyclovir is the treatment of choice, IV for the more serious cases.

XEROSTOMIA: Temporary or permanent salivary gland destruction is common when radiation is directed at the head and neck. Synthetic salivary substitutes and stimulation of normal salivary flow are essential.

BLEEDING COMPLICATIONS: The amount of bleeding is directly related to the amount of thrombocytopenia and is exacerbated by poor oral hygiene. Platelet infusions are required when topical techniques fail.

Key points/Summary: The oral health care needs of the pediatric cancer patient are broad, read up.

Assessment of article: A nice summation of oral health complications but more detail is needed if you’re going to be treating any patients in this population.