Cryotherapy Prevention and Treatment

examining the dental health of children with cancer found that 43 of patients had untreated decay and only 35 had been seen by a dentist since diagnosis. Their study exemplifi ed the lack of dental preventive care for pediatric oncology patients and stressed the need to continue to pro- vide primary oral hygiene during pediatric cancer therapy Clarkson and Eden 1998 . A European multidisciplinary group, in collaboration with the United Kingdom Childhood Cancer Study Group UKCCSG and the Paediatric Oncology Nurses Forum PONF, was established in 2001 princi- pally to produce comprehensive, evidence-based guidelines on mouth care for children and adoles- cents being treated for cancer. The potential ben- efi ts of such guidelines include improved patient care, consistency of care, the promotion of inter- ventions of proven benefi t and a reduction in use of ineffective or potentially harmful practices Glenny et al. 2010 . The UKCCSG-PONF Mouth Care for Children and Young People with Cancer guidelines used the agreed-upon methodology of SIGN Scottish Intercollegiate Guidelines Network to aid them in their development of evidence-based guidelines Glenny et al. 2010 . A consensus approach was utilized to establish the scope and basic structure of the guidelines. Three key areas were identifi ed and covered by the guidelines: 1 dental care and basic oral hygiene, 2 methods of oral assess- ment, and 3 drugs and therapies Glenny et al. 2010 . The group conducted a systematic review of the literature to examine these three key areas and, where no evidence existed, a consensus opin- ion on best practice was determined Glenny et al. 2010 . Additionally, the American Academy of Pediatric Dentistry AAPD has published guide- lines on the dental management of pediatric patients receiving chemotherapy, HSCT or radia- tion AAPD 2013 . The overarching purpose of these guidelines is to recognize that the pediatric dental professional plays an important role in the care of pediatric oncology patients. The AAPD guidelines focus on basic oral hygiene and dental care for pediatric oncology patients before, during and after cancer therapy. The AAPD and UKCCSG-PONF guidelines make recommendations in fi ve areas, as summarized in Table 11.3 : 1 orodental care at the time of can- cer diagnosis, 2 oral hygiene at diagnosis and dur- ing cancer treatment, 3 orodental care during cancer treatment, 4 orodental care after cancer therapy, and 5 prevention and treatment of xero- stomia Glenny et al. 2010 . The UKCCSG-PONF guidelines emphasize the importance of oral assessment throughout cancer treatment utilizing the discussed oral assessment tools. Frequency of oral assessment should be determined on an individual basis and should be increased if oral complications arise Glenny et al. 2010 . The AAPD describes the importance of identifying and stabilizing, or elim- inating, existing and potential sources of infection or local irritants in the oral cavity. Emphasis on the education of patients and parents on the importance of oral care should occur throughout therapy as well as in regard to the potential short- and long-term effects of therapy. The AAPD fur- ther elaborates on care when the use of radiation will affect the orofacial region with the goal of reduction of radiation to healthy oral tissue through consultation with the radiation oncologist and utilization of lead-lined stents, prostheses and shields to spare structures such as the salivary glands. Patients who receive radiation therapy involving the masticatory muscles should be edu- cated on daily oral stretching exercises to decrease the potential of trismus AAPD 2013 . Finally, for patients that experience xerosto- mia, the AAPD recommends fl uoride rinses and gels for the prevention of caries as well as the use of humidifi cation for symptomatic relief.

11.6 Oral Infections

Patients experiencing OM are predisposed to infections of the oral cavity. Viral, fungal and bac- terial infections may arise with incidence depen- dent on the use of prophylactic anti- infective regimens, oral status prior to chemotherapy, and secondary to the duration and severity of neutro- penia. The most frequent documented source of sepsis in the immunocompromised cancer patient is the mouth Allen et al. 2010 . In adults, chemo- therapy and radiotherapy in patients with head