DEPENDENCE OF CHANGES IN THE HYGIENIC CONDITION OF THE ORAL CAVITY AND PERIODONTIUM IN CHILDREN WITH MALIGNANT TUMORS ON THE DURATION OF POLYCHEMYTHERAPY AND QUANTITIES OF CYTOSTATIC DRUGS
It is known that the course of cancer and chemotherapy adversely affect the components of homeostasis of the oral cavity, which causes stomatotoxicity. However, scientific publications have not yet provided generalized results of research on the pathogenetic mechanisms of the dental pathology formation during chemotherapy, which constitutes the relevance of this publication.
The aim of the research was to study the effect of different regimens of the second course of chemo- therapy on the hygienic condition of the oral cavity and periodontium in children with malignant tumors of the abdominal cavity.
The dissatisfaction with our results obtained after the first course of chemotherapy on various regimens prompted us to further research. A survey of two previously formed clinical groups was performed. All of them resumed the treatment in the oncohematology department of the Poltava Children's City Clinical Hospital following a 3-4 week break between courses. Each patient was treated according to an individual program but in the absence of dental care.
The dental status was assessed using the Green-Vermillion, Papillary-Marginal-Alveolar (PMA), and Pa- pilla Bleeding Index.
The study of cytograms from the surface of the gingival margin of the frontal part of the mandible was carried out taking into account the methodology developed by our department's staff. The calculation was per- formed in 10 visual fields. Statistical processing was performed according to standard conditions.
Research results and their discussion. It should be noted that in the comparative aspect, the indexes of Green-Vermillion, PMA, and RВI at the end of the first year were 1,8, 1,3, and 1,6 times worse than in the second observation group which received more cytostatic drugs.
At the end of the second course of chemotherapy, the dryness of the mucous membrane accompanied by a decrease in oral fluid, which became viscous, was observed in 14 children (70,0%) of the first and 18 of the second group (85.7%). In addition, 15 people in the first group (75,0%) and 19 in the second one (90,4%) complained of pain and bleeding gums, which worsened when eating. At the same time, all children noted pain in the muscles that are adjacent to the lower jaw and involved in articulation.
On external examination, only 2 children of the first (10,0%) and 1 of the second group (5%) had a red normal-coloured lip border, while the rest had exfoliation, cracks, and angular cheilitis. The oral mucosa mostly looked pale and pasty, except for 7 people of the second group (35,0%), who had manifestations of erythema. Localized erosions covered with fibrinous plaque were detected in 4 of these patients (20,0%) on the background of erythema. In addition, 12 children (60,0%) of the first group and 19 children of the second one (85.7%) showed swelling and redness of the gingival marginal edge, and the probing of the gingival sulcus provoked bleeding in all children of both groups.
Green-Vermillion indexes increased by 1,5 and 1,7 times in the first and second groups, PMA increased by 1,4 times in both groups, and RВI was 1,4 and 1,5 times higher in the respective compared groups.
The examination of cytograms revealed more pronounced changes in the second group where the epithelium with signs of intermediate stages of the differentiation prevailed. There was increased desquamation of the superficial layer of the gums and the increased number of peripheral blood elements, especially destroyed neutrophils.
Thus, the generalization of the results obtained at the end of the second course of chemotherapy showed that the Green-Vermillion index was 1,8 times higher, and PMA and SВI indices were 1,4 times higher in the second observation group which received more cytostatics. That is, the severity of the manifestations of dental status disorders is directly proportional to the severity of the regimen.
Conclusion. The prolongation of the second course of chemotherapy in children with abdominal malignant tumors provoked a significant deterioration of dental status. Major changes occurred in the group of children who received more cytostatic drugs simultaneously, which requires a balanced approach to designing differentiated treatment plans and prevention measures depending on the complexity of antitumor therapy regimens.
Prospects for further research. The obtained results indicate the need to develop a set of differentiated
treatment and prevention measures aimed at eliminating or improving changes in children that occur in the oral cavity under the influence of polychemotherapy.
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