Saito, H., Watanabe, Y., Sato, K., Ikawa, H., Yoshida, Y., Katakura, A., ... Sato, M. (2014). Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis. Supportive Care in Cancer, 22, 2935–2940. 

DOI Link

Study Purpose

To assess the usefulness of prophylactic professional oral health (POHC) care done by dentists and dental hygienists for preventing mucositis in patients undergoing chemotherapy

Intervention Characteristics/Basic Study Process

Patients were randomly assigned to either the self-care or POHC group.
 
Self-care group: Day 1 of chemo, patients were educated regarding adverse oral reactions due to chemotherapy. Patients were assessed and received brushing, nutrition, and lifestyle guidance.
 
POHC group: Patients were given instructions on brushing, nutrition, and lifestyle. In addition, patients received weekly POHC consisting of scaling and polishing. The status of the oral cavity was determined and further guidance was given on the basis of the determination. Reassessment was done in the second week after chemotherapy in both groups.
 
In the self-care group, if the oral cavity exhibited symptoms of oral mucositis while the patient was on chemotherapy, POHC was instituted from that time on.

Sample Characteristics

  • N = 26  
  • MEDIAN AGE = 58 (+/– 9.8) years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Patients with breast cancer receiving chemotherapy
  • OTHER KEY SAMPLE CHARACTERISTICS: No significant differences existed between the two groups with regard to age, BMI, or number of teeth.

Setting

  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Department of Surgery at Tokyo Dental College, Ichikawa General Hospital

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Randomized controlled trial

Measurement Instruments/Methods

  • National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (NCI-CTCAE)
  • Eiler’s Oral Assessment Guide (OAG)
  • Evaluation of oral hygiene using plaque control records (PCR)
  • Evaluation of dry mouth and oral moisture using the Saxon test and oral moisture checking device (MUCUS) 
  • Gustatory measurements using an electrogustometer

Results

No adverse dental events, such as dental infections, were observed. All patients completed chemotherapy, and no mortality was observed during the study period. In the POHC group, OAG score was improved or unchanged in 11 patients and one patient’s score worsened (p = 0.005). No patients had grade I or higher oral mucositis (p = 0.044). PCR showed numerical improvement in 11 patients and deterioration in 1. In the self-care group, five patients showed improvement or no change, nine patients showed deterioration in the OAG score, three patients had grade I mucositis, and one patient scored grade II on CTCAE. On the PCR, six patients showed improvement and eight patients showed deterioration (p = 0.012). 
 
There was no significant differences between the two groups on the Saxon, MUCUS, or electrogustometer.

Conclusions

Further studies are needed to investigate the addition of professional oral care along with self-care. In this study, oral mucositis was not improved or made worse by professional oral care. There is a definite role for better education regarding self-care and adherence to self-care with oral hygiene. Patients need to understand how their oral care can affect the side effects they may experience from the medication.

Limitations

  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)
  • Risk of bias (sample characteristics)
  • Findings not generalizable
  • Other limitations/explanation: Single gender study and single diagnosis

Nursing Implications

Patients undergoing chemotherapy are at risk for oral mucositis. Good dental hygiene is a key component in overall health and well-being and an essential part of oral health. Reinforcing good oral care is essential to nursing; teaching and follow-up should be done at every chemo visit. Professional oral health care may provide extra help to maintain the integrity of the oral mucosa before, during, and after treatment.
 
Larger sample size is needed to establish the efficacy.