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1Addah R.S. Freire; 2André L. Carvalho; 3Bruno C. Jham; 1Marco M. Buso.

1 CETTRO, Brasilia, Brazil.

2 Head and Neck Surgery Service, Barretos Cancer Hospital, Barretos, Brazil.

3 Midwestern University, College of Dental Medicine - Illinois, USA.



          Diseases of odontogenic origin are risk factors for septicemia in patients undergoing chemotherapy for hematologic malignant diseases. Several studies show the importance of removing oral infectious foci prior to starting oncologic treatment.1,2,3 The identification of cancer patients’ oral needs should be an evaluation aspect of all cancer treatment centers.

           The goal of this study was to compare the demographics and the oral health situation of patients undergoing chemotherapy between pre- and post- the introduction of a standard protocol for prevention of oral side effects due to chemotherapy.



           This was a retrospective study of 100 charts from a private oncology center in Brasilia (Centro de Cancer de Brasília – CETTRO) between 2011 and 2012. All charts had been completed by a dentist, with specialization in oncology, when patients had been referred by physicians for dental evaluation. Following extra- and intra-oral examination, radiographic examination (periapical, interproximal and/or panoramic) was conducted. After clinical and radiographic evaluation, patients were instructed, when appropriate, to undergo dental treatment (aimed at removing infectious foci), ideally prior to starting the oncologic treatment. This led to the development of a protocol where all cancer patients would be evaluated by a dentist with the objective of diagnosing and removing infectious foci prior to starting oncologic treatment. A clinical chart was developed with patient data and  descriptive statistical analysis conducted.         



           Patients in the post-protocol period were more likely to be female (28.0% vs. 42.0%, p=0.038), but with similar age (p=0.871). The previous oral health was worse in the post-protocol group (p=0.031) (figures 1,2,3). The frequency of patients able to be evaluated prior to the treatment beginning was similar among groups (p=0.428); however, the reason for not getting the evaluation was different among the groups, being mostly related to the referral in the pre-protocol phase, and being related to the patient in the post-protocol period (p=0.043). In the end, the oral health of the patients at the time of chemotherapy was better in the post-protocol period, but not significantly (76.5% vs. 65.0%, p=0.075)



           The demographics of the patients changed along the periods. The main issue for evaluating oral health was the absence of the patient for the dental appointment on the latter period, stressing the necessity of a better referral and the importance of this evaluation for the patient.



Akashi M., et al. Myelosuppression grading of chemotherapies for hematologic malignancies to  facilitate communication between medical and dental staff: lessons from two cases experienced  odontogenic septicemia. BMC Oral Health 2013,13:41:2-7.

2. Epstein JB., et al. Advances in hematologic stem cell transplant: an update for oral health care  providers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009, 107:301–312.

3. Kashiwazaki H., et al. Professional oral health care reduces oral mucositis and febrile neutropenia in  patients treated with allogeneic bone marrow transplantation. Support Care Cancer 2012,20:367–373.

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