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rev port estomatol med dent cir maxilofac . 2019;60(3):118-124 119

Manifestações orais em pacientes com diferentes comportamentos
de saúde oral submetidos a quimioterapia: estudo preliminar

r e s u m o

Palavras-chave: Objetivo: Este estudo observacional, tem como objetivo avaliar as manifestações orais e os
Quimioterapia sintomas durante a quimioterapia em 49 pacientes adultos com patologia onco-hematoló-
Saúde oral gica e investigar se os hábitos de saúde oral influenciam a experiência de manifestações e
Hábitos de saúde oral sinais na cavidade oral e a qualidade de vida destes pacientes.
Manifestações orais Métodos: O estudo decorreu no Instituto Português de Oncologia Francisco Gentil de Lisboa,
Qualidade de vida no Hospital de Dia, em pacientes dos Serviço de Hematologia e Clínica de Mieloma. Os dados
foram recolhidos por questionário e por exame clínico oral. Foram utilizados testes Mann
Whitney e Kruskal Wallis para verificar possíveis associações entre o número de manifes-
tações orais com ciclos e duração da quimioterapia, frequência de consultas de medicina
dentária e qualidade de vida.
Resultados: Os resultados obtidos demonstram que 89,8% dos sintomas orais sendo os mais
frequentes a xerostomia (71,7%) e disgeusia (47,8%). Cerca de um quarto dos pacientes re-
portaram pior qualidade de vida durante a CT (p=0,001) com associação a um maior núme-
ro de manifestações orais (p=0,002) Não foram encontradas associações entre o uso de
serviços dentários antes ou durante a quimioterapia, hábitos de higiene oral e número de
ciclos da quimioterapia. Contudo, a duração da quimioterapia influenciou negativamente o
número de manifestações orais (p=0,014).
Conclusões: Este estudo demonstrou que a quimioterapia influencia a saúde oral e compro-
mete a qualidade de vida. O acompanhamento médico-dentário destes pacientes é funda-
mental para minimizar as consequências desta terapêutica. (Rev Port Estomatol Med Dent
Cir Maxilofac. 2019;60(3):118-124)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

lated manifestations in the oral cavity also compromise on-
Introduction
cology patients’ quality of life, mainly their physical and social
Nowadays, cancer is one of the most significant health prob- functions. 2,4,5
lems. Chemotherapy (CT) is one of the most used contempo- Several factors can influence the presence and severity of
1
rary treatments, by at least 70% of patients. This treatment is oral complications, such as the patient’s age, the cancer type
based on destroying or inhibiting abnormal cell growth with- and location, the nutritional status, the dental and periodontal
out any differentiation between normal and carcinogenic health, and the oral hygiene status before and after treat-
4,9
cells. CT is usually toxic to cells with high turn-over, which ment. Also, the dosage and frequency of use of the chemo-
2
entails not only cancer cells but also bone marrow and the therapeutic agents can influence the severity of oral complica-
7
gastrointestinal tract mucosa, including the oral mucosa. One tions. Currently, CT is usually given in cycles with varying
study reported the development of oral complications in 40% intensity depending on the disease and, usually, on an outpa-
of patients submitted to CT. 1 tient basis. There are specific protocols that vary in duration
It is known that CT-related oral complications can result (minutes, hours or days), frequency (weekly, bi-weekly or
from direct or indirect mechanisms. The direct effects result monthly) and number of cycles (depending on the type of can-
3,4
10
from the toxicity of the drug on oral structures and include cer and the phase of cancer treatment and follow-up). CT
mucositis, dysgeusia (usually temporary), neurotoxicity (a protocols have been changing in the past years to minimize
toothache-like severe pain not associated with a local pathol- side effects, with the use of new drugs and techniques and also
ogy), xerostomia and salivary gland dysfunction. The indirect fewer drugs, which reduces chemotherapeutic side effects, thus
side effects are based on myelosuppression and immunosup- allowing more time for normal cells to recover from damage. 11
pression and may result in a propensity for bacterial, fungal Since the oral cavity suffers so many side effects of CT, it
5
and viral infections. Sudden oral bleeding can also occur as- is relevant to inquire whether the oral health routines before
sociated with thrombocytopenia. It is evident in the literature and during CT affect oral health, CT consequences and quali-
1
that oral manifestations can be severe and serious, affecting ty of life in these patients. As reported in the literature, careful
the success of CT treatment. These oral complications can oral hygiene is effective in reducing oral complications in pa-
6,7
3
threat the patient’s survival by compromising the discontin- tients submitted to CT. In the same way, including an oral
8
uation or requiring a change in the CT protocol. The CT-re- health professional in the onco-hematology team can reduce