Chiyadu Padmini, and K.

Yellamma Bai (2014) conduct study Oral and

Dental Considerations in Pediatric Leukemic Patient that aim to revise
the prevention and treatment of oral and dental problem that result
from chemotherapy they use revision included a new systematic
literature search , the result from this search suggest that Acute side
effect and manifestations that develop during suppression of immune
system are mucositis, secondary candidiasis, xerostomia, gingival
bleeding, bacterial infections and herpes simplex. Ulceration of mucosa
is the most frequent oral manifestation related to chemotherapy
encountered and oral mucositis associated with low immunity so the
goal of oral management is to prevent and treat any secondary
infection and to relieve symptoms, oral mucositis is very painful side
effect so this lead to significantly effect on nutritional intake, mouth
care, and quality of life of leukemic child, Also the literature search
focus on the methods and ways to prevent and treat oral mucositis in
children thats include: pain control, nutritional support, oral
decontamination, palliation of dry mouth, and management of oral
bleeding and therapeutic interventions for oral mucositis.

Rmulo, et al. (2011) in their case report study title Chemotherapyinduced oral mucositis in a patient with acute lymphoblastic leukemia,
they mention that Oral mucositis is the most frequent and the main
complication of anticancer therapy that include chemotherapy and
radiotherapy, Mucositis is clinically manifested as erythema,
ulcerations, edema and bleeding the aim of this research is reports the
cases of a pediatric patients with leukemia, who they develop oral
mucositis resulting from chemotherapy employed for the treatment of
acute lymphoblastic leukemia, In the present case, the study include
five-year-old female patient undergoing in chemotherapy for the
treatment of acute lymphoblastic leukemia at the Santa Casa de
Misericrdia in Brazil, the girl developed oral mucositis, oral mucositis
developed on the 5th day of chemotherapy, the treatment applied the
red band with a wavelength of 630 nm, 100 mW output power and
point applications of 6.0 J/cm2 was used for of the mucositis and
cellulitis on a daily basis for ten consecutive days, the result of follow
up show On the sixth day of treatment, the pain had reduced to Grade
2 and mucositis had reduced to Grade1, LED therapy caused no pain,
as the equipment did not come into contact with the lesion. At the end
of treatment, the patient reported the alleviation of symptoms from the
lesions.

Discussion:
Chiyadu Padmini, and K. Yellamma Bai (2014) categorize prevention
and management of oral mucositis into period, the first period is Oral
Care before the Initiation of Cancer Therapy in which the dentist should
consult the oncologist to determine the current condition of the patient
and the type of treatment planned, The key to success in maintaining a
healthy oral cavity during cancer treatmen is compliance of patient so
depend on this education plan to child and parents and should be
considered include educated about the suitable preventive methods
include mainly importance of good oral hygiene practices , the most
efficient means to reduce the risk of significant bleeding and infection
in the gingiva is use of regular soft toothbrush or an electric brush at
least twice daily, Leukemic patient who have poor oral hygiene or any
problem to prevent in performing oral hygiene should use mouth rinse
such as chlorhexidine rinses, Sodium bicarbonate or saline mouthwash
three to four times a day could be used. The Sodium bicarbonate (5%)
could dilute the mucous secretion, moisten the oral mucosa, increase
the oral pH, and inhibit the Candida, Mouth rinses containing alcohol
should be avoided because they can dry the mucosa and aggravate
mucositis, The pain result from mucositis affects quality of life of child,
nutritional intake, oral care. To relieve pain effective methods are used such
as saline mouth rinses, ice chips, and topical anesthetic mouth rinse such as
2% lidocaine gel, Nutritional intake can be severely affected by the pain
associated with oral mucositis this result in poor nutritional intake so

parenteral nutrition should be considered in children who cannot maintain

adequate nutritional intake orally for 5 to 7 days, Oral Decontamination ill
reduce the severity of mucositis because microbes of oral lesions increase
the severity of oral mucositis, Chlorhexidine mouth rinse is effective
antimicrobial and topical protect against oral mucositis and candidiasis also
work as pain killer, dry mouth result from hyposalivation that result from
chemotherapy increase severity of mucositis so palliation of dry mouth
should be consider and this can performed by drink water as needed to
alleviate mouth dryness. Several supportive products consider use of artificial
saliva ; rinsing with a solution of 1/2 teaspoon of baking soda (and/or 1/4 or
1/2 teaspoon of table salt) in 1 cup warm water several times a day to clean
and lubricate the oral tissues and to buffer the oral environment; chewing
sugarless gum to stimulate salivary flow and using cholinergic agents as
necessary, Local bleeding resulted from oral mucositis can usually be
controlled with the use of topical hemostatic agents such as fibrin glue or
gelatin sponge.

In Rmulo case report the Pain is the manifested symptom the pain
result from the exposure of nerve endings due to mucosa breakdown.
In the case reported here, a pain scale was used to assess the intensity
of the pain associated to oral mucositis, At the time starting of
treatment, the patient has Grade 5 pain which had decreased to Grade
2 by the sixth day of LED therapy. There was also a regression in
mucositis, which went from Grade 3 at the beginning of treatment to
Grade 1 by the sixth day. This give us that, LED has a curative effect,
on mucosa lesions and accelerates the healing process, The choice of
LED was based on the characteristics attributed to this light source,
such as greater spreading of light, lower cost and in comparison to lowlevel laser therapy. This enables a larger tissue area to be reached and
consequently reducing the application time. These characteristics are

incentives for carrying out randomized clinical trials that can either
confirm or refute the effectiveness of the treatment instituted in the
present case, regardless of the therapeutic methods in institutions to
treat oral mucositis, educate the patients and parents about the
importance of the maintenance of oral hygiene is important part to the
prevention/treatment of complications and reduce the pain, duration
and severity of the lesions and consequently. So Education in oral
health with a focus on oral hygiene should be part of the daily routine
of patients in an oncological program.