Oral manifestations such as stomatitis, gingival hyperplasia, local hemorrhage and ulceration are seen as onset symptoms or during treatment in children with malignant tumors. Such oral lesions disturb swallowing and eating and seriously affect general health. It is, therefore, very important to prevent oral lesions in pediatric patients. For this purpose, we performed oral examinations and microbiological examination of Candida species at the pediatric clinic of Niigata Cancer Center Hospital between June 2003 and September 2004.
Materials and Methods: Fifty-four patients (22 with acute lymphoblastic leukemia,12 with acute myeloblastic leukemia,7 with malignant lymphoma,4 with neuroblastoma and 9 with other malignant tumors) were examined. The patients consisted of 33 males and 21 females. Their ages ranged from 6months to 15 years 1 month. All of the patients were undergoing remission induction therapy, consolidation therapy, maintenance therapy or radiation therapy and all were given antifungal therapy orally (Amphotericin B syrup) and povidine iodine solution as a mouthrinse. Oral examination was carried out 1-11 times per child (ay.5.6 times) at the bedside using a dental miller and explorer under a small light every 2 or 3 weeks. Coating samples taken from the dorsal surfaces of the tongues were cultured on CHROMagar Candida plate medium. After incubation, Candida colonization was confirmed.
Results and conclusion: Oral lesions were present in 32 patients (59%). These consisted of gingival swelling and redness in 13 patients, stomatitis in 10 patients, hairy tongue in 7 patients, oral cadidiasis in 4 patients, petechia in 3 patients, erosion or ulcer in 2 patients, graft versus host disease in 2patients and aphtha in 1 patient. Stomatitis appeared after 5 or 7 days due to the chemotherapy. Candida was positive in 9 patients (17%) and 4 were diagnosed with oral candidiasis. Candida was positive several times in two of four patients with oral candidiasis. A periodical Candida screening test and oral examination are therefore important. Six of nine patients had untreated caries teeth. After beginning of the cancer therapy, dental treatment is very difficult for them. Dental examination prior to cancer therapy and dental care during treatment are very important.