Dental implications in oral cancer patients

Abstract

Objectives. A study is made of the dental implications of oral cancer, with a view to avoiding the complications that appear once oncological treatment is started. Patients and Methods. The study comprised a total of 22 patients diagnosed with oral cancer according to clinical and histological criteria in the Service of Ma�illofacial Surgery (Dental Clinic of the University of Barcelona, Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona. Results. Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12 subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could not be located; these subjects were thus e�cluded from the analysis. All of the smokers had abandoned the habit. The most common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularly before the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried out in 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperative radiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, �erostomia or speech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergo regular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50% had active periodontal disease. Conclusions. Protocols are available for preventing the complications of oral cancer treatment, and thus for improving patient quality of life. However, important shortcomings in the application of such protocols on the part of the public health authorities make it difficult to reach these objectives.

Periodontal therapy for patients before and after radiotherapy: A review of the literature and topics of interest for clinicians

“…The most important late complication is ORN, which is characterized by an aseptic necrosis of the irradiated bone and loss of regenerative capacity of the osteogenic tissue. The soft tissue covering the bone becomes altered, and together with other stimuli, leads to lesions that do not heal ( 32 ).…”

Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis

“…In a study of patients enrolled on EORTC trials from 1980 to 1995, those 65 years of age and older had higher grade 3–4 mucositis during radiation than younger patients, but there was no difference in late toxicities including trismus, xerostomia, or dysphagia . However, other series have reported no difference in acute oral complications for elderly and younger patients undergoing radiotherapy . Additionally, higher hospitalization rates for elderly patients and unplanned treatment breaks have been reported in some series, but this appears more commonly due to infectious or renal complications rather than oral complications.…”

“…Patients are at increased risk of dental caries following RT primarily due to hyposalivation . Saliva has essential functions in maintaining tooth structure due to control of pH, remineralization and antimicrobial and tooth cleansing effects .…”

“…The mandible is more commonly affected than the maxilla. While most ORN cases develop in the first three years after completion of RT , it can occur at any time following RT.…”

Patología oral asociada a la sequedad bucal

“…La ausencia del efecto tampón de la saliva con respecto al pH, no ayuda al problema permitiendo la colonización por gérmenes especialmente cariogénicos (5,(10)(11)(12)(13). El problema se agrava de forma especial en los pacientes irradiados (14)(15)(16)(17).…”