A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 2

Abstract

The incidence of head and neck cancer is on the rise. Radiation therapy is one of the major treatment modalities for the management of oral malignancies. As with any treatment modality, radiation therapy is associated with various complications. The second part of this series is a review of the oral changes that occur during and after radiotherapy and the oral management of head and neck oncology patients before, during and after radiotherapy. Dental practitioners will encounter patients who have been affected by cancer or who are current cancer patents. General dental practitioners (GDPs) have a vital and proactive role in supporting such patients. The aim of this article is to review the oral management of these patients during and after radiotherapy, and gives practical advice for GDPs and their teams in the long-term care of these patients.

Cancer and orofacial pain

“…The quality of life for these patients gets severely diminished since for some of them it is too painful to eat, so an adequate nutrition is compromised. In addition, xerostomia can be present making them more susceptible to rampant caries and also they are more susceptible to candidiasis and herpetic infections (59,61,62). …”

“…Management involves anticonvulsants, antidepressants, NMDA antagonists, opioids, cannabinoids, topical agents and local anesthetics (63). For oral mucositis, management also includes mouthwashes with antimicrobial, analgesic, anesthetic and anti-inflammatory properties, as well as oral mucosal protectants, to create a protective shield against irritation (59,61). The WHO analgesic ladder has shown these approaches to be successful in achieving adequate pain control in 80-90% of patients, but there is not enough data about the control of orofacial pain independent of oral mucositis (non-mucositis pain) (64).…”

“…Myofascial pain can be present as trismus, contracture, fibrosis and scarring of the muscles of mastication and TMJ ligaments (61,65-67) compromising daily life activities such as eating because they can cause severe limitations of mouth opening. Therefore, it is recommended that the patient begins a physical therapy protocol before and after the procedure to maintain an optimal mouth opening.…”

Pharmaceuticals: Antibiotics and vegetarians

“…2 If, therefore, our patients feel strongly enough to opt for this, even when there is no ingestion of the medication, then is it not our duty to inform them that certain antibiotic prescriptions (which are swallowed and absorbed), may not be aligned with their values?…”

Orthodontic extrusion of nonrestorable teeth to prevent the development of osteoradionecrosis in patients with head and neck cancer postradiotherapy

“…Therefore, it is highly recommended to extract nonrestorable teeth with poor prognosis, if they are included in the field of radiation prior to treatment with radiotherapy; hence, preradiotherapy dental assessment is crucial. However, some HANC patients do not have an opportunity to visit their dental care providers prior to treatment with radiotherapy due to the limited time between cancer diagnosis and treatment with radiotherapy . Thereby, some HANC patients required dental extraction during the postradiotherapy period.…”