Modern treatment of oral mucositis as a complication of chemotherapeutic treatment of patients with breast cancer. Clinical case

Abstract

Introduction. According to the latest data from the Ukrainian National Cancer Registry, an average of 137,300 oncology cases is registered inUkraine annually. As in January 1, 2019, there are 1254700 people registered.

Breast cancer of women is a serious health problem, as it accounts for 20% of malignancies. According to the National Cancer Institute, the incidence of breast cancer has increased by 30% over the past 20 years.

Patients with breast cancer receiving chemotherapy face a number of difficulties, including suffering from chronic fatigue, lack of physical shape and immune system problems. Despite the fact that breast cancer is one of the most studied areas of medicine, there are significant gaps in published data; there are no answers to questions that are important for patients and health professionals. Oral mucositis on the background of cancer therapy is an acute inflammation of the oral mucosa due to systemic chemotherapy or radiation therapy in the oral cavity.

The aim. The aim of this study is to show the features of therapeutic treatment of mucositis of patients with malignant neoplasms of the breast and to confirm the need of prevention and treatment of dental diseases before chemotherapy.

Materials and methods. The first case, Patient A, 47 years old, diagnosed with stage 2 breast cancer and receiving chemotherapy went to the clinic of theMedicalUniversity, complains of pain in the lower right jaw, discharge from the fistula, headache and weakness, which appeared few days later. It was more painful during eating. According to the patient, the pain has appeared after the second session of chemotherapy.

First of all, the face is symmetrical, and the mucous membrane is hyperemic and swollen. Second, adentia 47, 46, 45, 44, 42, 36, 37. The patient has been using a removable partial lamellar prosthesis for the lower jaw during 10 years. Where the 46^th tooth was, is inflamed. During palpation of a transitional fold edema, allocation of pus, the patient notes sharp pain. Orthopantomogram and intraoral X-ray have shown no changes in the bone structure of the alveolar sprout. The clinical and radiographic picture corresponds to the diagnosis of acute mucositis of the oral cavity caused by the beginning of chemotherapeutic treatment of breast cancer.

During the first visit, according to our proposed treatment, tactics after infiltration anesthesia, antiseptic treatment with 1% dioxidine solution and application of antibacterial and keratoplastic ointments. The patient has been instructed in how to treat the oral cavity by an antiseptic and hygienic treatment of the oral cavity for 10 days.

While the second visit. The patient complains of fever up to 37.5 - 38ºC, weakness, increased pain and increased secretion of pus. The treatment was consisted of antibiotics, antihistamines, probiotics and anti-inflammatory medications as of applications of anti-inflammatory and keratoplastic medications are prescribed twice a day for 10 days.

The third and last visit, the patient has an improvement in his well-being as positive changes. The pain during the meal decreased, no headache, nor weakness and fever.

Results. After our proposed therapeutic treatment of acute mucositis of the oral cavity, the patient's complaints decreased. There are no signs of inflammation, namely redness of the mucous membranes, fistula, edema and acute pain. The ulcer in the area of the missing 46^th tooth corresponds to the stage of proliferation and subsequent healing. The patient notes a significant improvement in general well-being.

Conclusions. The results confirm that insufficiently sanitized oral cavity of cancer patients can lead to certain dental complications during chemotherapy. It has been proven that chemotherapy can cause acute or exacerbate chronic inflammatory processes in the oral cavity. It has also been confirmed that dental complications are difficult to treat during a course of chemotherapy. This requires the joint cooperation of an oncologist and a dentist in diagnosing the disease and determining treatment tactics.