Impacto da educação em saúde bucal na incidência e gravidade de mucosite oral em pacientes oncopediátricos

Abstract

Oral health education is among the main preventive measures for oral mucositis (OM), which favors patients' self-care in the absence of the multi-professional team. The impact of educational interventions in oral health on the incidence and severity of OM in oncopediatric patients was evaluated, through a systematic literature review and meta-analysis (chapter 1) and a quasi-experimental study (chapter 2). The systematic review aimed to synthesize and qualify the scientific evidence on this topic available in the literature until August 2020. Searches were carried out in the main national and international databases, by two independent examiners. Primary studies were sought with samples composed of oncopediatric patients aged 0-19 years, who underwent oral health education, with the outcome MO. The evaluation of the quality of the studies was conducted with the ROBINS-I instrument and a qualitative and quantitative synthesis (meta-analysis, α=5%) was performed. Six articles were selected for qualitative synthesis and three for meta analysis. Despite the methodological heterogeneity of the six studies, all tended to an oral health education positive impact on OM. The meta-analysis demonstrated a lower chance of the outcome occurring in a group submitted to the intervention, compared to the control group (p=0.01). The quasi-experimental study, of the controlled historical cohort type, evaluated the effectiveness of an Educational and Preventive Program on the Oral Health (EPPOH) in reducing the incidence and severity of OM. Two paired groups of previously assisted oncopediatric patients were compared: submitted and not submitted to EPPOH, each with 14 individuals. Both groups were examined for six weeks using the modified Oral Assessment Guide (OAG), by calibrated examiners (k>0.8). The incidence of OM and its severe form in the groups were compared using the Chi-square test (α=5%). The relative risk and effectiveness of the EPPOH were calculated, with a power of 0.97. The difference between the total OAGs of the groups was measured by the Mann-Whitney test (α=5%). There was a higher incidence of OM in patients not submitted to the program (p<0.005) and a lower risk of being affected by OM by patients undergoing the intervention (RR 0.73; CI 0.60 - 0.92). EPPOH reduced the risk of patients developing OM by 1.4 times, with an effectiveness of 27%. There was a difference between the total OAG values (p=0.041). It was concluded that the EPPOH was effective in reducing the incidence of OM. This dissertation allows us to suggest that educational strategies in oral health are implemented in pediatric oncology centers in order to reducing the incidence and severity of OM.