Chemotherapy Oral Manifestations and Dental Awareness Among Parents

Childhood cancer is defined here as cancer in children aged 0-14 years and it only accounts for a small portion of the worldwide cancer burden .with an estimated 13.7 million additional cases of cancer in children globally between 2020 and 2050.

Childhood malignancies continue to be a leading source of morbidity and death in children. Cancer is the leading cause of disease-related mortality among children in developed, high-income countries, such as the United States.

With advances in healthcare access and a drop in communicable disease mortality, paediatric cancer is projected to become a significant cause of death even in developing, low- and middle-income nations. Furthermore, because children make up a significant proportion of the population in these countries, the scope of the problem is exacerbated, potentially resulting in a greater burden of childhood malignancy for the healthcare system to address.

Leukaemia accounted for the greatest share of classified childhood cancer burden globally, followed by brain and nervous system cancers.

The Children's Cancer Hospital in Egypt (CCHE) is the country's largest paediatric cancer hospital, enrolling about 3000 children under the age of 18 annually, accounting for an estimated 50% of juvenile cancer cases in a country with a population of around 100,000,000.

The primary mode of treatment for malignancies in children is antineoplastic chemotherapy, either alone or in conjunction with surgery and/or radiation according to the type of neoplasm.

Childhood cancers tend to respond well to chemotherapy as they are fast-growing and thus more susceptible to chemotherapy.This mechanism of treatment usually associated with severe side effects. Moreover, general adverse events that are common among patients treated by chemotherapy include reduced immunity, pancytopenia, muscle atrophy, skin manifestations, hair loss and others.

Chemotherapy includes the administration of injectable pharmaceuticals, which suppresses the immunity .Approximately 15 days after the chemotherapy session, patients usually show immunosuppression. As a result, any change in the integrity of the oral mucosa, carious processes, or outbreaks of odontogenic infection pose a significant risk for the development of additional oral and systemic illnesses.

Complications might be acute (occurring during therapy) or chronic (occurring after therapy) (developing months to years after therapy) Oral problems result from both direct injury to oral tissues as a result of chemotherapy and indirect damage as a result of regional or systemic toxicity.

One of the most common adverse effects of chemotherapy antineoplastic therapy is oral mucositis, which appears as mucosal inflammation followed by tissue degradation caused by chemotherapeutic drug stomatotoxicity. Oral mucositis occurs five to seven days after the start of antineoplastic therapy and lasts for the duration of the treatment.

Also, infections (viral- fungal- bacterial), salivary gland dysfunction, taste impairment, and discomfort are the most frequent oral problems associated with cancer treatments. Secondary problems such as dehydration, dysgeusia, and malnutrition might result from these issues. The mouth cavity can potentially be a source of systemic infection in myelosuppressed cancer patients. Fungal infections and ulceration can be observed with patient on chemotherapy.

Parents of children receiving cancer treatment, particularly chemotherapy, who are in a phase of acute immunosuppression usually neglect dental care. The parents are more concerned about the concurrent disease than the dental care of their kid, as they appeared anxious when presented with a cancer diagnosis, and they inquired about the impact of oral hygiene on cancer therapy and may not see it as a high priority.