Investigation of the Effect of Oral Care With Coconut Oil on the Degree of Oral Mucositis in Pediatric Oncology Patients
Condition: Oral Mucositis
MeSH terms: Mucositis; Stomatitis
Study type: Interventional

Summary: 
      Oral mucositis is characterized by ulcerative and inflammatory changes in the oral mucosa and
      is frequently seen in pediatric oncology patients receiving chemotherapy. Oral mucositis
      negatively affects the child's daily life functions, nutrition and quality of life. Pain is
      the most commonly reported side effect in mucositis. Pain impairs patients' ability to chew,
      swallow and speak, leading to inadequate fluid/nutrient intake, malnutrition and
      communication problems. Weight loss, dehydration, mucosal ulceration, fluid-electrolyte
      imbalance may develop in patients who cannot be fed adequately, and total parenteral
      nutrition (TPN) can be started. Other important complications of oral mucositis are oral
      bleeding and infection. The ulcerated oral mucosa creates an entrance gate for
      microorganisms, increasing the risk of bacterial/fungal/viral infections. Infections may be
      limited only to the oral mucosa, as well as systemic infection and septicemia. As a result,
      the length of hospital stay of the patients increases, the treatment costs increase and their
      quality of life deteriorates. Therefore, early diagnosis of oral mucositis, planning and
      implementation of oral care are important. Responsibility of nurses in the management of oral
      mucositis; monitoring the oral cavity for symptoms, diagnosing mucositis, providing
      appropriate oral care, and educating patients.

      In this context, it is extremely important to prevent oral mucositis, to evaluate the oral
      mucosa using a scale, and to reduce the degree of oral mucositis, that is, to perform
      appropriate oral care for its recovery, in terms of preventing other health problems and
      ensuring the well-being of the child. The aim of this thesis is to determine the effect of
      oral care with coconut oil on the degree of oral mucositis in pediatric oncology patients.
    

Detailed description: 
      Cancers have an important place among the childhood health problems. Although deaths in
      childhood cancers have decreased in recent years, it has been reported that the incidence of
      cancer has increased. Although the incidence of childhood cancers is lower than that of adult
      cancers, 0.5% of all cancer cases are children under the age of 15. Treatments such as
      chemotherapy, radiotherapy, surgical treatment, and bone marrow transplantation are applied
      alone or in combination in cancer treatment. Chemotherapy, which is one of the most used
      treatment methods in childhood cancers, destroys cancer cells, can prevent the spread of
      cancer cells in the body and the recurrence of the disease by 60-70%. Chemotherapy can cause
      complications by affecting normal cells and tissues as well as cancer cells. Among these
      complications, anemia, alopecia, dermatitis, thrombocytopenia, mucositis, nausea-vomiting and
      pain are the most common complications. Oral mucositis is one of the most common
      complications after chemotherapy and is seen in approximately 52% to 80% of children
      receiving treatment. Oral mucositis can directly affect the individual's quality of life by
      causing major problems such as shedding of the oral mucosal skin, ulceration, bleeding, pain,
      bacterial, fungal and viral infections in sick individuals. These problems make it difficult
      for the child to eat, drink, swallow and speak, and may lead to the development of
      biopsychosocial problems such as changes in comfort, decrease in body image and self-esteem,
      and increase in hospitalization time and hospital cost. It is important to prevent and manage
      mucositis in order to increase the quality of life of these children and reduce their stress
      levels. Proper oral hygiene and care practices are effective in the prevention and management
      of mucositis. Oral care provided by nurses is very important. Nurses, who play a primary role
      in patient care, are responsible for oral care and the prevention of mucositis. In order to
      prevent the development of mucositis, nurses need to have sufficient knowledge and skills,
      comply with practice protocols, take part in research that will form the basis of evidence,
      and follow the results of these studies. The aim of basic oral care is to reduce the effect
      of oral microbial flora and to prevent opportunistic infections. Basic oral care; It consists
      of brushing teeth with a soft-bristled toothbrush, cleaning between teeth with dental floss,
      rinsing the mouth using sterile water, saline or sodium bicarbonate. In basic oral care, it
      is recommended that the platelet (PLT) number be above 50,000 mm3 and the white blood cell
      (WBC) count over 1,000 mm3 for brushing and flossing. There is insufficient evidence that any
      component of basic oral care in the evidence-based practice guidelines fully prevents oral
      mucositis. However, there is evidence that it reduces the severity and duration of oral
      mucositis. To prevent and treat mucositis, saline, sodium bicarbonate, granulocyte colony
      stimulating factor (G-CSF), granulocyte-macrophage colony stimulating factor (GM-CSF), zinc
      sulfate, cryotherapy, sucralfate suspension, amifostine, prostaglandi E2 (PGE2) ),
      hydroxypropyl cellulose film, mucous sealants such as polyvinylpyrrolidone/sodium
      hyaluronate, topical application of vitamins A and E, parenteral application of β-carotene,
      low-dose laser therapy, glutamine, royal jelly, honey, aloe vera solution, omega-3 fatty
      acid, andiroba oil, black mulberry molasses and black mulberry syrup are used. In his study
      in 2020, Chadayan used coconut oil in his oral care to heal oral mucositis, and it was found
      that rinsing the mouth with coconut oil reduced the degree of oral mucositis. Studies have
      found that coconut oil has an effect on plaque formation and plaque-related gingivitis.
      Coconut oil is an edible oil and is consumed as part of the staple diet in many tropical
      countries. Coconut oil differs from most other dietary fats in that the predominant
      composition of coconut oil is a medium-chain fatty acid, while the basic building blocks of
      most other oils are almost entirely long-chain fatty acids. This is the physical and affect
      its chemical properties. Coconut oil contains 92% saturated acids, about 50% of which is
      lauric acid. Breast milk is the only other naturally occurring substance that contains such a
      high concentration of lauric acid. Lauric acid has proven anti-inflammatory effects and
      antimicrobial effects. These include Candida species and various viruses, including
      Helicobacter pylori, Staphylococcus aureus, Escherichia vulneris, Enterobcater and Candida
      glabrata, Candida albicans, Candida stellatoidea, Candida parapsilosis, Candida tropicalis,
      and Candida krusei. This study was planned to determine the effect of oral care with coconut
      oil on the degree of oral mucositis in pediatric oncology patients.
    

Intervention name(s): coconut oil
Intervention type(s): Other
Intervention description(s): • The patient's mouth is evaluated using the World Health Organization Mucositis Classification and the International Child Mucositis Evaluation Scale (ChIMES) on days 0, 7, and 14, and after each assessment, the frequency of oral care is determined and applied for 21 days. The final assessment is made on Day 21.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled experimental design
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: oral mucositis; child; cancer; Oral care; Nursing; coconut oil