الفهرس 
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Abstract
Leukemia is the most common childhood cancer. Untreated leukemia results in death from infections or hemorrhage. The primary treatment of ALL is chemotherapy. Chemotherapy is usually associated with number of side effects among of them is oral mucositis (stomatitis) .It is one of the most debilitating complications following chemotherapy treatment administration. These lesions may produce discomfort and pain which interfere with eating and patient compliance to treatment and potential risk of oral infection. Good and consistent oral hygiene is one of the basic role of the pediatric nurse to prevent and reduce the complication of oral mucositis and oral infection. It includes oral assessment before initiation of chemotherapy treatment and daily during its administration followed by creating an oral care plan. Chlorhexidine gluconate is effective in prevention of oral lesion and in decreasing the severity of stomatitis. The aim of the present study was to determine the effect of using chlorhexidine gluconate in the prevention of oral lesions in leukemic children receiving chemotherapy.
Materials and method
This study was conducted at the Haematology Unit of Alexandria University Children`s Hospital at EL-Shatby and Oncology department at Health Insurance Student Hospital in Alexandria. The studied subjects included 50 child of both sex with acute lymphoblastic leukemia. All cases had fulfilled the following criteria:
• Free from any other disease.
• Free from any oral lesion.
• Age ranged from 2-16 years.
• Children were taken in the first day of starting chemotherapy either during induction or intensification phase.
The subjects of the study were divided into two groups by simple randomization:
group I
It Included 25 children with acute lymphoblastic leukemia under chemotherapy who received oral hygiene by 0.12% chlorhexidine gluconate two times per day 30 minute after breakfast and the second time 30 minute after the last meal time.
group II
It included 25 children with acute lymphoblastic leukemia under chemotherapy who received routine hospital care of oral hygiene.
Tool
It was consisted of:
Part I:
• Children’s Socio-demographic data, such as age, sex, and area of residence.
• Children’s Medical data, such as: type of ALL , platelets (PLT) count, White blood cells (WBCs) count, clinical manifestation as Hepatomegaly, Splenomegaly, Hepato-splenomegaly, Protocol of treatment and stage of chemotherapy.
• Oral assessment guide (OAG)
It was developed by Eilers et al. (1988) to assess the condition of oral cavity and degree of stomatitis.
Oral assessment guide tool consists of 8 items:
Voice
Swallow.
Lips and angle of the mouth
Tongue.
Saliva.
Mucus membrane.
Gingiva.
Teeth.
Each of the eight items of oral assessment guide was scored as 1, 2 or 3; where
• Score 1 for normal findings.
• Score 2 for mild abnormality without compromise of either mucosal integrity or loss of function.
• Score 3 for severe abnormality with compromise of either mucosal integrity or loss of function.
The eight subscale scores of oral assessment guide are summed to obtain an overall assessment score (8-24).
The total assessment score was categorized as follow:
- If an overall assessment score was 8 or less than 9, it denotes healthy oral cavity.
- If an overall assessment score ranges from 9-16, it denotes moderate mucositis.
- If an overall assessment score ranges from 17-24, it denotes severe mucositis.
The data collection was done during the period from November 2008 to August 2009.
The study results showed that:
• Fifty fore percent of the subjects were in the preschool age i.e. age between 2 to less than 6 years and 20% of subjects were in the adolescencs age i.e. age between 12 to less than 16 years. The mean age of the sample was 6.94±4.474.
• Two thirds of studied subjects (66%) were boys, while the rest of them were girls.
• It was found that less than two third of the studied subjects (60%) were from urban area and (40) % of them were from rural area.
• Equal percentage (80%) of treated and controlled group had B.ALL while the rest of them had T.ALL.
• Equal percentage (92%) of treated and controlled groups had WBCs count <50.000.
• Treated group had more normal oral assessment concerning most of their oral assessment categories than that of the controlled group after 10 days from chemotherapy administration.
• After 10 days chemotherapy oral assessment more than three quarter of the treated group (76%) had healthy oral cavity (OAG score=8) compared to 24% of the controlled group. On the other side, 16% of the controlled group had severe mucositis (OAG score from17-24) compared to none of the treated group. The difference was statistically significant between both groups.
• In controlled group half of adolescence (50%) had healthy oral cavity compared to 20 % of preschool. However, near three quarter (73.3%) suffered from moderate mucositis compared to 25% of adolescence.
• All girls who received chlorhexidine gluconate had healthy oral cavities compared to 70% of boys. On the other hand, none of the girls had moderate or severe mucositis compared to 30% of boys who had only moderate mucositis.
• All children of treated group who had WBCs count ≥50.000 had healthy oral cavity compared to 73.9% of children who had WBCs count <50.000.
• Eighty percent of children of treated group who received high risk protocol of treatment had healthy oral cavity compared to 73.3% of children who received standard risk protocol of treatment.
• Over three quarter (76.5%) of children of treated group had healthy oral cavity during induction phase while three quarter (75%) were during intensification phase.
• Near half (46.15%) of boys of controlled group had healthy oral cavities compared to no one of girls. On the other hand 7.7% of boys had severe mucositis compared to 25% of girls and statistically significant difference was found between boys and girls.
Based on the finding of the present study the following recommendation should be considered:
• Responsibility of the nurses toward all children being treated from leukaemia and receiving chemotherapy is preventing and decreasing oral complication of chemotherapy through assessing oral cavity by using standardized grading system as an oral assessment guide (OAG) tool prior to the initiation of chemotherapy and at least daily following the administration of it.
• Creating an oral care plan to each child individually involving cleaning the teeth by using a mouth wash with Chlorhexidine gluconate is an important recommendation in preventing oral complications and decreasing severity of oral mucositis and treating gingivitis (swelling, redness and bleeding of the gums).
• Leukemic children receiving chemotherapy and their mothers should be taught about the possible oral complications of chemotherapy, how to detect and decrease the incidence of mucositis, and how to maintain oral hygiene.
• Direct family involvement in children oral care should be encouraged for maximum treatment compliance of their leukemic children.