Dodd M J, Miaskowski C, Shiba G H, Dibble S L, Greenspan D, MacPhail L, Paul S M, Larson P
Department of Physiological Nursing, University of California, San Francisco, USA.
Cancer Invest. 1999;17(4):278-84. doi: 10.3109/07357909909040598.
Oral mucositis is one of the dose-limiting toxicities of several chemotherapy (CTX) agents. There are suggested risk factors that could influence the development of mucositis. The presence of dental appliances, history of oral lesions, or smoking have the potential to irritate the oral mucosa and produce breaks in the integrity of the mucosa. The purposes of this study were to determine if there were differences in the incidence, severity, and time to onset of CTX-induced mucositis in oncology outpatients who wore dental appliances, had a history of oral lesions, had varying oral hygiene/care practices, and had a history of smoking and those who did not. Patients who were initiated a course of CTX that included stomatotoxic agents were followed for three complete cycles of CTX. They were instructed on how to examine their mouths for mucositis, to contact, and then visit their outpatient settings if it occurred. Clinicians corroborated the presence of mucositis, and the Eiler's Oral Assessment Guide was used by clinicians to determine the severity. Of 332 outpatients, almost half (46%) wore some type of dental appliance, 32% had a history of oral lesions, 10% were currently smoking, and 63% had a history of smoking. Oral hygiene/care practices varied: 81% brushed their teeth two or more times a day, 29% flossed at least daily, 11% had visited their dentist within 2 months of beginning CTX, and 10% had their teeth professionally cleaned within two months of beginning CTX. There was a 31% (n = 104) incidence of CTX-induced mucositis. No significant differences were found in the incidence between patients who wore dental appliances, had a history of oral lesions, had a history of smoking, and practiced different hygiene/care and patients who did not. Of 104 patients who developed mucositis, the average severity rating was 13.05 +/- 2.88 (+/-SD) (a normal mouth is rated at 8) and the average time to onset was 22.3 +/- 21.46 days. There were no significant differences found in severity or time to onset of mucositis between patients who wore dental appliances, had a history of oral lesions, had a history of smoking, and practiced different dental hygiene/care and patients who did not. Although not significant, there were interesting differences in the time to onset across the suggested risk factors (e.g., patients who had visited a dentist or who had their teeth professionally cleaned within 2 months before beginning before CTX developed mucositis 7.4 and 10.6 days sooner, respectively, than patients who did not). These findings suggest that risk factors for the development of CTX-induced mucositis are not as simple and direct as clinicians may believe.
口腔黏膜炎是几种化疗药物的剂量限制性毒性反应之一。有一些提示的风险因素可能会影响黏膜炎的发生。使用牙齿矫治器、有口腔病变史或吸烟有可能刺激口腔黏膜并导致黏膜完整性受损。本研究的目的是确定在接受化疗的肿瘤门诊患者中，使用牙齿矫治器、有口腔病变史、有不同的口腔卫生/护理习惯、有吸烟史的患者与没有这些情况的患者在化疗引起的口腔黏膜炎的发生率、严重程度和发病时间上是否存在差异。开始接受包含口腔毒性药物的化疗疗程的患者接受了三个完整周期的化疗随访。他们被告知如何检查口腔是否出现黏膜炎，如果出现应联系并前往门诊就诊。临床医生证实黏膜炎的存在，并使用艾勒口腔评估指南来确定严重程度。在332名门诊患者中，近一半（46%）使用某种类型的牙齿矫治器，32%有口腔病变史，10%目前吸烟，63%有吸烟史。口腔卫生/护理习惯各不相同：81%的患者每天刷牙两次或更多次，29%的患者至少每天使用牙线，11%的患者在开始化疗后2个月内看过牙医，10%的患者在开始化疗后2个月内接受过专业牙齿清洁。化疗引起的口腔黏膜炎发生率为31%（n = 104）。在使用牙齿矫治器、有口腔病变史、有吸烟史、有不同卫生/护理习惯的患者与没有这些情况的患者之间，未发现发生率有显著差异。在104名发生黏膜炎的患者中，平均严重程度评分为13.05 +/- 2.88（+/-标准差）（正常口腔评分为8分），平均发病时间为22.3 +/- 21.46天。在使用牙齿矫治器、有口腔病变史、有吸烟史、有不同口腔卫生/护理习惯的患者与没有这些情况的患者之间，未发现黏膜炎的严重程度或发病时间有显著差异。虽然不显著，但在所提示的风险因素之间，发病时间存在有趣的差异（例如，在开始化疗前2个月内看过牙医或接受过专业牙齿清洁的患者发生黏膜炎的时间分别比未看过牙医或未接受过专业牙齿清洁的患者早7.4天和10.6天）。这些发现表明，化疗引起的口腔黏膜炎的风险因素并不像临床医生认为的那么简单直接。
