The prevention and treatment of oral mucositis in oncohematology pediatric patients receiving chemotherapy: a literature review.

Introduction. Childhood cancer and its aggressive treatment cause painful symptoms. Oral mucositis (OM) or stomatitis, is the most frequent side effect of chemotherapy. Therefore, the prevention of OM is very important for children's quality of life and for their compliance to chemotherapy. Methods. A literature review was performed in the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ISI Web of Knowledge, National Guidelines Clearinghouse, and Royal College of Nursing. Articles published until July 2010 were searched to identify evidences to prevent or treat OM. We identified 222 documents, of which only 31 were relevant and met the inclusion criteria. Results. Several studies have been retrieved that evaluated the effectiveness of the available interventions: low-dose laser both for prevention and treatment, light-emitting diodes, vitamin E, chewing gum, cryotherapy and propantheline, glutamine, Tumor Growth Factor-Beta, sucralfate, miconazole and fluoride, iseganan, chlorhexidine gluconate at 0.12%, prostaglandins, amifostine, homeopathic remedies. The retrieved evidences are not sufficient to support or reject the effectiveness of one specific intervention above another. These results are not widely generalizable because of the small sample sizes of the studies. Despite the widespread interest for the prevention and treatment of OM, a truly effective treatment strategy is still missing. Discussion. The retrieved evidences are insufficient to support important changes in OM management, although all studies emphasize the need for oral hygiene and for pain management. Oral care is an integral part of nursing that can provide children with comfort and can prevent complications, that in turn improves children quality of life. Guidelines indicate oral care protocols, that include patient/family education for a systemic cleansing of teeth and mucous membranes using non-traumatic solution, together with regular monitoring of the oral cavity, as the best current practice to reduce adverse events and to limit opportunistic infections arising in the damaged mucosa.