Impacto da terapia periodontal na mucosite oral e identificação de microrganismos orais prevalentes

Abstract

Background: Periodontal disease (PD) and oral mucositis (OM) are immunoinflammatory conditions that can be characterized by the constant presence of systemic inflammation and bacteremia. Objective: Evaluate the impact of periodontal therapy in oral mucositis and investigate the occurrence of putative periodontal pathogens in patients undergoing chemotherapy for solid tumors and scheduled for hematopoietic stem cell transplantation (HSCT). Methods: This study included an evaluation of demographic data, data chemotherapy and comorbidities, and global systematic dental assessment. These were obtained prior and between 7- 14 days after initiated chemotherapy in periodontal health group (PH group). The Periodontal disease Group (PD Group) was evaluated during 7 to 14 days after of chemotherapy. The oral mucosa also was examined for scoring of chemotherapyinduced oral mucositis. Furthermore clinical tests for dysphagia diagnosis and evaluation of xerostomia and quality of life related to oral health; socio-economic class of patients was determined. Subgengival samples were collected by inserting sterile paper points for both groups, for same periods described above. Total number of bacterial cells and cells from each species determined by FISH (fluorescence in situ hybridization). Results: Fifty-one patients with solid tumors and scheduled for HSCT were assessed to evaluate the impact of periodontitis in OM. Mean age was 51.12, 38(74.5%) were female and socio-economic Class C 22(43.1%) was prevalent. The primary tumor site was most commonly breast cancer 21(41.1%) and prevalent chemotherapeutic agent was doxorubicin 22(43.1%). The prevalent morbidity associated was hypertension 20(39.2%). PH Group included 33 patients and PD Group enrolled 18 patients. Statistical analyses revealed that the distributions of patients with incidence of OM did not differ between both groups. The majority incidence of grade 1 chemotherapy-induced OM was observed. Sixteen(31%) patients developed oral mucositis, 9(56.2%) in patients undergoing conditioning regimen prior HSCT, and 7(43.7%) in patients undergoing common chemotherapy for solid tumors. Patients with oral complications showed a mean OHIP-14 index of 1.36, while those who did not develop oral complications had a mean OHIP-14 of 0.56, after chemotherapy for solid tumors. Conclusion: This study demonstrated that oral health, could affect experience and incidence of chemoinduced OM. When only patients periodontally healthy undergoing conditioning regimen of therapy and conventional chemotherapy were observed, was noted a lower incidence of oral mucositis, when compared with scientific evidences. The need of inclusion of patients with severe periodontitis to evaluate this relationship hampers such trial.