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rev port estomatol med dent cir maxilofac . 2019;60(3):118-124 123

infections, neurotoxicity, and temporomandibular dysfunc- for proper counseling, treatment of existing problems and pro-
tion, which usually occur with high prevalence and severe vision of appropriate preventive measures. 19
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forms. One of the reasons why a low number of oral manifes- Some authors emphasize that all patients should be seen
tations were observed in this study is probably the high num- by a dental professional before starting CT treatment. Fewer
ber of patients that were in the maintenance phase, where a oral manifestations are found in patients with better oral
2
total recovery of the cells can happen. The type of the tumor, health conditions and satisfactory oral hygiene. This idea is
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the dose of the drugs, the number of cycles, the duration of CT, reinforced by other authors that believe in the importance of
the patients’ age and their level of oral hygiene before and oral health for the prevention and reduction of oral complica-
3
after therapy are factors that determine the severity of oral tions of cancer treatment. Dental interventions should be
complications. It would be important to collect data related done before starting CT to improve the quality of life. Because
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to CT protocols and tumor type but, unfortunately, these data it is known that a systemic infection can lead to septic epi-
were not available to the researchers. sodes in immunocompromised patients, it is essential to eval-
Regarding the DMFT index, the results of patients doing CT uate oral health before CT to reduce infectious outbreaks, such
were similar to those reported in healthy adults, although the as removal of carious lesions and extensive restorations, treat-
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decayed element was lower. However, the DMFT in this study ment of periodontal disease and even tooth extractions in
2
was higher than the post-CT DMFT in a previous study. In- cases of teeth that require prolonged treatment. However, in
14
versely, the debris index was lower than that of the same the current study, it was not possible to see if oral health rou-
study. 14 tines influenced the patients’ experience of oral manifesta-
Most patients only received recommendations for a soft tions and symptoms and their quality of life, maybe because
diet. These patients did not receive any advice about cold diet, of the small sample.
non-spicy diet, acid diet or avoiding tobacco and alcohol. Diet There were several limitations to this study. First of all, the
recommendations are essential to prevent exacerbation or sample size was small, precluding the generalization of re-
emergence of oral symptoms. Tobacco and some drinks and sults. Nevertheless, this was a preliminary study that allowed
foods have to be avoided, such as alcohol, coffee, tea and spicy some valid conclusions and insights for future studies. Anoth-
food, and a non-cariogenic diet should be followed. 21,22 er limitation was the patients’ perception of oral diseases. Pa-
Considering all the oral health problems, oral changes can tients perceive oral complications as inevitable consequences
induce a decrease in quality of life. Xerostomia, which can of the cancer treatment, so they do not report them nor do
contribute to speech difficulty, causing oral discomfort and something to change or prevent them. Moreover, this study
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mouth soreness and affecting the quality of life, was referred relies on self-reported data, which can be another limitation.
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by almost all of the patients. A previous study had reported It is equally important to note that we had some problems
7
a much lower prevalence of xerostomia. Dysgeusia, which with comparing directly some results found in this study with
was indicated by almost half of the sample, was an expected those of other studies because studies about oral manifesta-
finding due to the likely direct effect of CT in the taste buds. tions in onco-hematology adults are rare and use different
Unfortunately, this change also affects the quality of life neg- methodologies. 29
atively, as it leads to loss of appetite and affects nutrition. 21,23 When the study took place, all the patients were in different
However, patients from this study reported difficulty in feeding phases of CT, with a different number of cycles, different dura-
less frequently than a healthy population. 20 tions of treatment and different types of treatment protocols,
Several studies have reported that CT affects oral health-re- and all these can influence oral manifestations frequency. Fu-
lated quality of life. 5,22 In the present study, three-quarters of ture studies should take into account these aspects, given that
the sample reported that oral symptoms influenced their life different protocols induce different oral complications.
somehow. This prevalence was higher than in another study
5
where one-fifth of patients was affected. In this study, we also
found that patients who had their quality of life more affected Conclusions
had a higher number of oral manifestations.
The duration of the CT treatment was positively correlated Based on this investigation, it is possible to infer that CT, one
with the number of oral manifestations. The same was ob- of the most used therapies by cancer patients, affects the oral
served in other studies where the dose of the chemotherapeu- cavity of these populations.
tic drugs and the frequency of administration were correlated Many oral manifestations, such as xerostomia, dysgeusia,
with the dimension of toxicity on normal tissues. 23 dental hypersensitivity, mouth ulcers and loss of appetite were
Regarding oral hygiene habits, almost all patients brushed noticed. Gingival changes, inflammation and hemorrhage
their teeth at least twice a day, which is better than reports by were also present in these patients.
people without cancer and oncological patients before starting CT patients with a higher number of oral manifestations
CT. 20,24 Interdental means of plaque removal were used by a have their quality of life more affected. The integration of an
quarter of the sample, with dental floss being the most used, oral health professional into the oncology team could contrib-
and this prevalence is also higher compared to healthy peo- ute to preventing many oral manifestations through observa-
20
ple. According to some authors, 22,23,25,26 patients doing CT tion of the oral cavity and treatment of those diseases and
must follow an oral care plan, including the utilization of den- symptoms before starting the CT treatment. This integration
tal services. More than half of the study sample visited an oral could help CT patients achieve a better quality of life and com-
health professional before starting CT. This visit would allow fort before, during and after oncology therapy.