Neoplastic diseases in a pediatric population: of the incidence of oral complications

A survey of 186 pediatric patients with neoplastic disease at Riley Children’s Hospital in Indiana was conducted to determine the distribution, frequency, and types of oral problems encountered during their hospitalization. Thirty-one per cent of the patients had some form of oral complications during the course of their hospitalization. Ten per cent of the patient population had existing dental treatment needs prior to cancer treatment. The oral problems most frequently seen were mucositis, fungal or candidal infections, gingival bleeding, herpetic lesions, and apthous ulcerations. Different frequencies of oral complications were found to exist between differing types of malignancy and the types of therapy. Not all patients receiving chemotherapy developed oral complications. The pediatric dentist should therefore be aware of the different clinical and biological characteristics of each neoplastic disease, and the various types and phases of treatment in the assessment of his patients. Neoplastic diseases in children occur with a frequency of about 10 in 100,000 and are the second leading cause of death in children younger than 14 years of age (Silverberg and Lubera 1987). The leukemias and lymphomas constitute approximately 40% of pediatric neoplastic diseases, with solid tumors making up the remaining percentages (Tubergen 1984). Pain, oral infection, mucositis, gingival bleeding, ulcers, stomatitis, and caries have been reported as the result of the direct toxicity of antineoplastic drugs on the mucosal epithelium or secondary to the effects of immunosuppression. 1 The goal of cancer therapy is to increase patient comfort, longevity, and ultimately cure the patient. With current advances in early diagnosis and therapy, more than 40% of children with cancer now survive for at least five years after treatment (Silverberg 1986; Krakoff 1987). ’ DelRegato 1939; King et al. 1968; Dreizen 1974; Dreizen et al. 1975; Bruya and Madeira 1975; Rotman et al. 1977; Braham 1977; Sonis et al. 1978; Epstein 1986. a survey Treatment of pediatric neoplastic disease is multidisciplinary and ideally involves the pediatric dentist in the supportive care of oral complications. The oral mucosa can become a major site of systemic infection and pain in cancer patients. Knowledge and understanding of the multiplicity and the incidence of oral complications is essential in facilitating appropriate dental management. Prevention and early detection of existing dental needs are important in providing optimum care. Materials and Methods A retrospective analysis of pediatric oncology patient records was undertaken. Oncology pediatric patients admitted to James Whitcomb Riley Hospital for Children, Indianapolis, Indiana, were surveyed from July, 1985, to October, 1986. During the 14 months of the study, 186 pediatric oncoIogy patients were foIIowed during their hospitalization by the pediatric dental residents on service with the hematology/oncology department. Patients on service varied from initial diagnosis and treatment to maintenance and consolidation therapy. There were 96 males (52%) and 90 females (48%). The mean age was seven years with a range of 10 months to 20 years. There were 27 different clinical diagnoses of neoplastic disease made in the survey group. Information concerning the patients was obtained by pediatric dental residents making rounds with the hematology/oncology physicians. The dental resident, as part of the oncology team, completed a "pediatric oncology patient profile" on each patient on the service. Data for the profile were obtained by bedside visual examination, cultures as necessary, information supplied by the attending physicians, and the hospital patient chart. The patient profile contained specific information: name, sex, date of birth, diagnosis, date of diagnosis, treatment protocol, oral conditions (baseline), date of observation, vital signs, and laboratory results, medications and chemotherapy drugs given, comments and oral problems. PEDIATRIC DENTISTRY: MARCH, 1988 -VOLUME 10, NUMBER 1 25