Abstract
Aims: The aim of this study were to estimate the percentage of general and oral complications among patients receiving chemotherapeutic agents and correlate the oral complications with the age of the patients and with the drugs either used singly or in combination with the other chemotherapeutic agent and the effect of xylitol chewing gum on oral dental hygiene in patients having malignant diseases. Materials and Method: In this clinical trial, 70 patients with ages ranging between 7–65 years treated with different cancer chemotherapy for a duration from 3 months to 3 years. The patients were selected from those who treated in Hazim Al–Hafith center for treatment cancer in Mosul City. General and oral complications of chemotherapeutic agents were recorded and the agent recorded either used singly or in combination with the other chemotherapeutic agent. Twenty patients from those who had oral com-plications were examined and the plague and gingival indices were measured according to Silness and Loe (1963) at the base line. Then those patients were instructed to take xylitol chewing gum (4 grams/day); four times immediately after eating. The plague and gingival indices were measured again after 3 weeks of using the chewing gum. Results: The results of this study revealed that approximately half of the patients have general and oral complications while the others either had only general com-plications or had no complications (48.57%, 27.14%, 24.29% respectively). The incidence of oral com-plications correlated with the increasing in patients' age (P<0.01). The distribution of general and oral complications were correlated with the agent used either singly or in combination, where 100% of pa-tients medicated with single therapy had general and oral complications while the patients medicated with multiple therapy 70.69% of them had general and oral complications and 29.13% had no signifi-cant complications. The patients who had taken xylitol chewing gum had a significant reduction in pla-gue index while there is no significant reduction in gingival index (p<0.01). Conclusions: the study concluded that the general and oral complications arising in cancer patients can be attributed to the various modalities of cancer chemotherapy. Routine oral hygiene and elimination of preexisting dental disease and sources of mucosal irritation with a giving of salivary substitutes like xylitol reduce the incidence and severity of a number of oral complications of chemotherapy.
Highlights
Cancer chemotherapeutic agents are used clinically to destroy and suppress the growth and spread of malignant cells.[1,2] Most chemotherapeutic agents have common adverse effects include, nausea, vomiting, diarrhea, alopecia, fever and allergic reaction. [3,5,7]Oral complications are frequently encountered in patients receiving chemotherapy include, mucositis, infection, hemorrhage and xerostomia.[4]
Oral complications always occur as a consequence of treatment for head and neck cancer and may be unpleasant and even life
Oral infections associated cancer therapy can be caused by fungal, viral and bacterial organisms.[4]. These infections can cause tissue damage directly or increase the damage due to secondary infection of oral mucositis.[15]. The effects of chemotherapy on bone marrow and oral flora coupled with the patients immunosuppressed state and altered oral microbial flora predispose these patients to oral mucositis, infection and hemorrhage.[16]. In addition to that, chemotherapeutic agents may secondarily induce thrombocytopenia which is the usual cause of intra oral hemorrhage.[17]
Summary
Cancer chemotherapeutic agents are used clinically to destroy and suppress the growth and spread of malignant cells.[1,2] Most chemotherapeutic agents have common adverse effects include, nausea, vomiting, diarrhea, alopecia, fever and allergic reaction. [3,5,7]Oral complications are frequently encountered in patients receiving chemotherapy include, mucositis, infection, hemorrhage and xerostomia.[4]. Threatening complications.[6,7] Several factors play a role in the development of these problems include, the type of malignancy, patient age, type and dosage of chemotherapy and oral hygiene level before and during therapy.[8,9]. Mammdoh JK expenses.[11] Xerostomia is a common complication in patients receiving cancer chemotherapy and radiation therapy.[12] Cancer chemotherapy can cause decrease in salivary secretion which is usually much less sever and transient.[13] dry mouth result in tissue with reduced barrier function which is contributes to increased mucosal irritation and infections.[14]. The benificial effects of xylitol on oral health it reduces the quantity of plague and the number of bacteria that cause tooth decay.[21,22,23,24] sugar free gum has a beneficial means of saliva stimulation for people suffering from Xerostomia.[25]
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