Journal of Medical Implants & Surgery
Open Access

Rhabdomyosarcoma; Radiation treatment; Pediatric; Osteoradionecrosis; High-pressure air; Dental care; Outpatient care; Cancer

Introduction

In operation since 2007, the dental department of the Child’s Institute at the Hospital das Clinics, Faculdade de Medicina, Universidad de So Paulo (ICr/HCFMUSP) treats cancer children from infancy to early adulthood. Patients with blood problems such congenital or acquired anaemia and platelet disorders are also cared for by this section.The danger of infection, duration of hospital stay, expense of treatment, and unfavourable influence on the course and prognosis of the disease all rise as a result of oral issues brought on by cancer treatments. The dentistry team concentrates on preventative measures and dental care before, during, and after chemo- or radiation in addition to routine ward visits. For the advancement of research, like the one described here. This retrospective study’s objective is to describe the patients seen at a paediatric cancer teaching hospital’s dental unit [1-2].

Due to the tremendous expansion of medical diagnostic and interventional procedures over the past few decades, radiation exposure to patients during medical operations is of great interest. Medical procedures were estimated to contribute roughly 50% of the total effective radiation dose received by the US population in 2006 by the National Council on Radiation Protection and Measurements (NCRP), with the remaining 50% coming from background radiation (3% terrestrial, 5% internal, 5% space, and 37% radon and thoron), 2% from consumer sources, and 0.2% from industrial and occupational sources. Compared to the around 15% of the total effective radiation dose from medical procedures in the early 1980s, the relative radiation exposure from medical procedures in 2006 increased alarmingly [3].

Materials and method

From the 367 dentistry unit patients’ medical records reviewed throughout the 14-month research period (November 2007 to December 2008), 186 had a cancer diagnosis and full clinical data; 20 had a cancer diagnosis but only partial data; and 161 had just a haematological diagnosis. The following factors were evaluated: ethnicity, gender, age, diagnosis, cancer characteristics, current cancer treatment, and dental work done [4].

12252 dental radiographic exams (4220 intraoral, 1324 cephalometric, 5284 panoramic radiographs, and 1424 CBCTs) were performed on 7150 children and young people in the paediatric population over the course of two years. CBCT group (exposed to CBCT conventional radiography) and 2D group were the two study groups (exposed only to 2D radiological examinations). Using logarithmic fit formulae for dose interpolation, the effective doses were adjusted for age at exposure and settings parameters (mA; FOV). For each group, the radiation risk, per-caput collective dose, and individual cumulative dose were computed [5].

Discussion

The newly created dentistry unit in our oncology-hematology service improved patient care, improved communication, and tight collaboration between the dental and medical teams, all of which benefited the patients and their families. In Brazilian hospitals, this specialist centre is crucial since there are more than 9,000 new cases of juvenile cancer each year. Behind accidents and violence, cancer is the third most common cause of death in this country for those aged 1 to 19. 2 Children under the age of 15 are more likely to get specific forms of cancer than adults. According to the literature, acute lymphocytic leukaemia (ALL), which accounts for 24 percent of all paediatric cancers, is the most prevalent malignancy among children. 75% of all paediatric leukemia’s occur in children ages 4-6. In terms of a gender comparison, this study and other relevant studies8 concur that males are more likely than females to have general malignancies, leukemia’s, lymphomas, and tumours of the central nervous system [6].

According to several publications, mucositis, xerostomia, bleeding, dysguesia, enlargement of the periodontal ligament gap, and infections are the most frequent side effects of paediatric cancer therapy (including bacterial, fungal and viral). These side effects lead to discomfort and agony, necessitate parental narcotic medication and prolonged hospital stays, raise expenditures, and affect the neoplasm’s prognosis and course [7].

The most frequent late side effects in children after cancer treatment are dental abnormalities, which include changes in tooth shape (microdontia, macrodontia, taurodontia), number (anodontia), and root development (root shortening, root blunting, and root stunting). Children who receive head and neck radiation therapy may have anomalies in the development and maturation of the craniofacial skeletal structures, these abnormalities can lead to severe aesthetic and functional consequences that call for surgical and orthodontic procedures. Periodic dental follow-ups are crucial in both groups to detect issues and act as early as feasible during cancer therapy since in our study, 63 percent of the patients were receiving cancer therapy and 37 percent had ended their treatment. Additionally, the unit’s orthodontic services may be required to prevent and correct the craniofacial deformities brought on by cancer treatments [8].

A decrease in blood cell count, which typically occurs 5 to 7 days after the start of each cycle and lasts for 14 days, is another adverse effect of chemotherapy. The duration of the low blood cell count varies depending on the treatment plan. To avoid potential infectious foci and dental infections, all children patients’ oral cavities should be examined before the start of cancer therapy if feasible. Priorities for treatment should include infections, extractions, periodontal maintenance, and sources of irritation when there is not enough time for dental work before cancer treatment. Given the poor health of the participants throughout the 14-month research period, restorative therapy, preventative operations, and the removal of infectious foci were the most frequent dental procedures of the patients before cancer therapy [9].

Results

Only fourteen of the 2201 publications that were screened were chosen for data extraction. There were 22 patients in total. Six malignant pathologies, benign pathologies, and one undescribed pathology were present. In twenty-one cases, hemi-mandibulectomy was done; in one case, entire mandibulectomy was done. In five instances, Condyle was kept, whereas it was taken out in nine. Nineteen cases involved single-stage reconstruction, and the other three involved second-stage reconstruction. Thirteen cases involved fibular graft reconstruction; while others with varying follow-up times used CCG. Even though there were a few minor side effects, fibula or CCG graft regeneration was successful in every patient, as measured by either function or growth .

Conclusion

There are important distinctions that healthcare professionals should be aware of even if therapy and prevention of dental caries in paediatric cancer survivors do not differ considerably from those in healthy children. Primary care physicians will be held more and more accountable for lowering the risks of problems that arise as a result of oncologic treatment as children cancer survivorship rates raise. Background information about the most frequent cancer treatment options for children.

Everyone should be aware of the fundamental distinctions between adults and children in terms of damage pattern, screening indications, and radiation exposure hazards while assessing paediatric trauma patients. When young children have vague results and a history that does not match the clinical presentation, medical professionals must always have a high degree of suspicion that the injury was done on purpose.

Acknowledgehment

None

Conflict of interest

None

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