Onkolojik tedavi gören çocuklarda ağız ve diş sağlığı

Year 2013, Volume: 30 Issue: 1, 39 - 43, 11.03.2013

Aslı Evren Delilbaşı

Abstract

Günümüzde kanser hastalarının sayısı ve buna bağlı olarak kanserden ölüm oranı gittikçe artmaktadır. Bilimin ve teknolojinin ilerlemesiyle kanser tedavisinde ilerleme sağlanmış ve yeni kemoterapi ajanları ve radyoterapi teknikleri kullanıma girmiştir. Bu yeni buluşlar, hastalığın yayılmasının önlenmesi ve tedavisinde etkin olarak kullanılmalarına rağmen, halen sistemik ve lokal bir takım ciddi komplikasyonlara ve yan etkilere sebep olmaktadır. Kanser hastalarında mevcut hastalığa veya tedaviye bağlı olarak yaşam kalitesini düşüren sonuçların görülmesi bu dönemde hasta bakımı ve takibini ön plana çıkarmaktadır. Çocuklarda görülen kanser türleri ve hastalığın prognozu yetişkinlerden farklıdır. Onkolojik tedavi gören çocuklarda sağlık sorunlarının ve tedavi komplikasyonlarının yetişkinlere göre daha ağır olduğu bilinmektedir. Kemoterapinin yan etkileri daha kısa süreli ve geçicidir; ancak, radyoterapi daha uzun süreli ve kalıcı yan etkilere sahiptir. Bu yan etkilerden başlıcaları; mukozitis, ağız kuruluğu, radyasyon çürükleri, fırsatçı enfeksiyonlar ve osteoradyonekrozdur. Primer kanser odağı ağız dışında olsa bile onkolojik tedavinin sistemik yan etkileri orofasiyal bölgede komplikasyonlara yol açarak çocuğun yaşam kalitesini düşüren sağlık sorunlarına sebep olabilir. Çocuk hastalarda kemoterapi ve radyoterapinin orofasiyal yapılar üzerine olumsuz etkilerinin azaltılması veya tedavisinde pedodontistlere önemli görevler düşmektedir. Bu nedenle onkolojik tedavi bir takım çalışması şeklinde planlanmalı ve pedodontistler tedavi başlamadan önce, tedavi sürecinde ve tedavi bittikten sonra ağız ve diş sağlığının sürdürülmesinde belirleyici rol oynamalıdırlar. Bu derlemenin amacı, onkolojik tedavi gören çocuk hastalarda oral komplikasyonların tartışılması ve bu komplikasyonların önlenmesi ve tedavisi için alternatif yöntemlerin ele alınmasıdır.

Keywords

Ağız Sağlığı, Çocuk, Kemoterapi, Onkolojik Tedavi, Radyoterapi

Oral and dental health in children receiving oncological therapy

Abstract

Today, the number of cancer patients and consequently the death rate from cancer is gradually increasing. With the progress of science and technology, improvement has been achieved in cancer treatment and new chemotherapy agents and radiotherapy techniques have been introduced. Despite the use of these new discoveries in the treatment and in the prevention of the spread of the disease, they still cause systemic and local complications as well as a number of serious complications. Decrease in quality of life in cancer patients due to existing disease or treatment underline the importance of care and follow-up during this period. The types and prognosis of cancer differ in children and adults. Even if primary cancer focus is outside the mouth, systemic side effects of the oncological treatment may lead to complications and can cause health problems decreasing the life quality of child. Health problems and complications in children receiving oncological treatment are known to be more severe than that of adults. Chemotherapy has short-term and transient side effects, whereas radiotherapy has more long-term and permanent side effects. The main side effects are: mucositis, xerestomia, radiation caries, opportunistic infections and osteoradionecrosis. Pediatric dentists undertake an important role for decreasing side effects of chemotherapy and radiotherapy in orofacial structures. Therefore, oncological treatment should be planned as a team work, and before, during and after treatment, pediatric dentists should play a decisive role in maintaining the oral and dental health. The aim of this review is to discuss oral complications in children receiving oncological treatment and to highlight alternative methods for treatment.

Keywords

Chemotherapy, Child, Oncological Therapy, Oral Health, Radiotherapy

References

• 1. Barberia E, Hernandez C, Miralles V, Maroto M. Paediatric patients receiving oncology therapy: review of the literature and oral management guidelines. Eur J Paediatr Dent 2008;9:188-94.
• 2. Belfield PM, Dwyer AA. Oral complications of childhood cancer and its treatment: current best practice. Eur J Cancer 2004;40:1035-41.
• 3. Hogan R. Implementation of an oral care protocol and its effects on oral mucositis. J Pediatr Oncol Nurs 2009;26:125-35.
• 4. Otmani N. Oral and maxillofacial side effects of radiation therapy on children. J Can Dent Assoc 2007;73:257-61.
• 5. Delilbasi Ç. Kemoterapi Hastalarında Ağız Bulguları. Diş Hekimliği Klinik Dergisi 2004;18:119-21.
• 6. Aguiar GP, Jham BC, Magalhaes CS, Sensi LG, Freire AR. A review of the biological and clinical aspects of radiation caries. J Contemp Dent Pract 2009;10:83-9.
• 7. Cetiner S, Alpaslan C. Long-term effects of cancer therapy on dental development: a case report. J Clin Pediatr Dent 2004;28:351-3.
• 8. Marec-Berard P, Azzi D, Chaux-Bodard AG, Lagrange H, Gourmet R, Bergeron C. Long-term effects of chemotherapy on dental status in children treated for nephroblastoma. Pediatr Hematol Oncol 2005;22:581-8.
• 9. Oguz A, Cetiner S, Karadeniz C, Alpaslan G, Alpaslan C, Pinarli G. Long-term effects of chemotherapy on orodental structures in children with non-Hodgkin's lymphoma. Eur J Oral Sci 2004;112:8-11.
• 10. Epstein JB, Chow AW. Oral complications associated with immunosuppression and cancer therapies. Infect Dis Clin North Am 1999;13:901-923.
• 11. Hong CH, Napenas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, et al. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 2010;18:1007-21.
• 12. Maciel JC, de Castro CG, Jr., Brunetto AL, Di Leone LP, da Silveira HE. Oral health and dental anomalies in patients treated for leukemia in childhood and adolescence. Pediatr Blood Cancer 2009;53:361-5.
• 13. Farrington M, Cullen L, Dawson C. Assessment of oral mucositis in adult and pediatric oncology patients: an evidence-based approach. ORL Head Neck Nurs 2010;28:8-15.
• 14. Meraw SJ, Reeve CM. Dental considerations and treatment of the oncology patient receiving radiation therapy. J Am Dent Assoc 1998;129:201-5.
• 15. Cho SY, Cheng AC, Cheng MC. Oral care for children with leukaemia. Hong Kong Med J 2000;6:203-8.
• 16. Kostler WJ, Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin 2001;51:290-315.
• 17. Sonis ST. Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol 1998;34:39-43.
• 18. Stokman MA, Spijkervet FK, Wymenga AN, Burlage FR, Timens W, Roodenburg JL, et al. Quantification of oral mucositis due to radiotherapy by determining viability and maturation of epithelial cells. J Oral Pathol Med 2002;31:153-7.
• 19. Xavier AM, Hegde AM. Preventive protocols and oral management in childhood leukemia--the pediatric specialist's role. Asian Pac J Cancer Prev 2010;11:39-43.,
• 20. Simchowitz B, Shiman L, Spencer J, Brouillard D, Gross A, Connor M, et al. Perceptions and experiences of patients receiving oral chemotherapy. Clin J Oncol Nurs 2010;14:447-453.
• 21. Moursi AM, Fernandez JB, Daronch M, Zee L, Jones CL. Nutrition and oral health considerations in children with special health care needs: implications for oral health care providers. Pediatr Dent 2010;32:333-42.
• 22. Özsaran Z, Yalman D, Yıldırım G, Parvızı M, Esassolak M, Haydaroğlu A. Baş-boyun kanseri tanısı ile radyoterapi gören olgularda geç yan etkilerin değerlendirilmesi. Türkiye Klinikleri J Med Sci 2003;23:195- 9.
• 23. Cheng KK, Chang AM. Palliation of oral mucositis symptoms in pediatric patients treated with cancer chemotherapy. Cancer Nurs 2003;26:476-484.
• 24. Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws--a current overview--Part 2: dental management and therapeutic options for treatment. Oral Maxillofac Surg 2010;14:81-95.
• 25. Watts NB, Marciani RD. Osteonecrosis of the jaw. South Med J 2008;101:160-5.
• 26. Glenny AM, Gibson F, Auld E, Coulson S, Clarkson JE, Craig JV, et al. The development of evidence-based guidelines on mouth care for children, teenagers and young adults treated for cancer. Eur J Cancer 2010;46:1399-412.
• 27. Allen G, Logan R, Gue S. Oral manifestations of cancer treatment in children: a review of the literature. Clin J Oncol Nurs 2010;14:481-90.
• 28. Chin DW, Treister N, Friedland B, Cormack RA, Tishler RB, Makrigiorgos GM, et al. Effect of dental restorations and prostheses on radiotherapy dose distribution: a Monte Carlo study. J Appl Clin Med Phys 2009;10:2853.
• 29. da Fonseca MA. Dental and oral care for chronically ill children and adolescents. Gen Dent 2010;58:204-9.
• 30. Koga DH, Salvajoli JV, Alves FA. Dental extractions and radiotherapy in head and neck oncology: review of the literature. Oral Dis 2008;14:40- 4.
• 31. Shipway L. Providing nutritional support for patients during cancer treatment. Paediatr Nurs 2010;22:20-5.