Hutton, Alison (2008)
M.Phil. thesis, University of Birmingham.
The survival rate of children with solid tumours is increasing. As a consequence the late effects of cancer therapy have become an important issue requiring further research. The oral health of an individual is central to their general health, level of nutrition and quality of life. This study therefore set out to investigate: • Whether or not the effects of cancer therapy resulted in a reduced level of oral health during and after treatment. • The need for dental input in comparison with the general population. • If patients had knowledge of the effects of cancer therapy on the oral cavity. • If the oral health care needs of patients differed according to tumour type and treatment regime undertaken. The study group consisted of 120 patients aged 0-17 years, attending the solid tumour follow up clinic at Birmingham Children’s Hospital from July 2006-February 2007. The complete study group was investigated and analysed, with stratification according to tumour diagnostic group and medical treatment regime. The results were compared with national data from the 2003 office of national statistics Child Dental Health Survey. The study had two main parts. Part A included a dental examination, and part B included a questionnaire completed by the parent/guardian. Demographic information was collected about each subject, cancer diagnosis, date of diagnosis, type of cancer therapy and time since completion of therapy. Part A recorded the current oral health of each subject. Caries prevalence, enamel opacities and gingivitis were recorded. Part B utilised a questionnaire to assess the reported experience of the family regarding oral health care prior to, during and after cancer therapy. The parents/guardians perceived level of oral health input from the dental services and level of knowledge about the effects of cancer therapy on the oral cavity were also investigated. The results of this study demonstrated that the neuroblastoma diagnostic group and the high dose chemotherapy with stem cell rescue (HDCSCR) therapy group had greater oral health needs compared to the remaining study group and 2 general population. The level of decay in the primary dentition was increased in the neuroblastoma and HDCSCR groups. Microdont teeth were found in children who had received chemotherapy under the age of 3.5 years. There was a statistically significant relationship between the age at receipt of chemotherapy and the presence of microdont teeth. Thirty seven percent of the study group reported problems involving the oral cavity during cancer therapy with 40% demonstrating limited knowledge of potential future oral health complications. This study concludes that oral health input is important for all patients suffering from a solid tumour. The possible adverse sequelae on the oral cavity are significant and arise both during and after cancer therapy. Children receiving chemotherapy under the age of 3.5 years should be warned of the possibility of microdontia in the permanent dentition. Extra attention should be directed towards those with a neuroblastoma or who are receiving HDCSCR. Clinical protocols and care pathways should be created for the oral health care of those patients suffering from a solid tumour. Specific and separate care pathways for neuroblastoma patients and those patients receiving HDCSCR should also be considered.
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