Dental therapy before and after radiotherapy–an evaluation on patients with head and neck malignancies

Abstract

The present investigation evaluates the dental care situation of patients with head and neck cancer before and after radiotherapy. The situations of these patients in 1993 and 2005 were compared to detect similarities, differences and developments. In the years 1993 and 2005, 37 and 36 patients, respectively, with head and neck cancer treated by the local departments of otorhinolaryngology and of radiotherapy were examined consecutively according to their aftercare appointments. Time points of radiotherapy treatment of the patients evaluated in 1993 varied from 1984 to 1993. The patients evaluated in 2005 had received radiotherapy between 1998 and 2005. Therefore the applied radiotherapeutic regimen differed not only between the two groups of patients, but also within each group. The information for these investigations was provided anonymously. It was evaluated with descriptive statistics. The evaluation of the data shows distinct differences with respect to preventive and therapeutic dental care measures. In 2005, 35 out of 36 patients (97.2%) had a dental consultation before radiotherapy (1993, 65%). All 27 dentate patients (100%) obtained a splint for fluoride application (1993, none). 29% fewer edentulous patients were seen than in 1993. The number of teeth destroyed decreased from 19.2% (1993) to 7.8% in 2005. Mycoses due to Candida spp. and chronic failures in wound healing were rare (5.5%). In the course of the 12 years, prophylactic measures, such as the application of splints for fluoride treatment, were intensified. However, concepts for the dental care of patients undergoing radiotherapy, especially following the radiation, should be widened to avoid ruined teeth and long delayed wound healings.

Evidence supporting pre-radiation elimination of oral foci of infection in head and neck cancer patients to prevent oral sequelae. A systematic review

“…Generally, an oral focus has been defined in the literature as 'a pathologic process in the oral cavity that does not cause major problems in healthy individuals, but may lead to severe (local or systemic) inflammation under certain circumstances' [3,4]. This definition does not indicate which pathology may lead to postradiation oral problems such as ORN.…”

“…While some adverse effects are unavoidable, others, in particular the risk of developing jaw osteoradionecrosis (ORN), are thought to be reduced by a thorough preradiation dental screening to detect oral foci of infection [1,2]. In this review we have operationalized the concept of oral focus of infection as a pathologic process in the oral cavity that does not cause major problems in healthy individuals, but may lead to severe local or systemic inflammation under certain circumstances [3,4]. A pre-radiation dental screening aims to locate and eliminate oral foci of infection, such as caries profunda, periodontal attachment loss, periapical problems and partially or completely impacted teeth [3][4][5], thus prevent radiation-related oral complications.…”

“…In this review we have operationalized the concept of oral focus of infection as a pathologic process in the oral cavity that does not cause major problems in healthy individuals, but may lead to severe local or systemic inflammation under certain circumstances [3,4]. A pre-radiation dental screening aims to locate and eliminate oral foci of infection, such as caries profunda, periodontal attachment loss, periapical problems and partially or completely impacted teeth [3][4][5], thus prevent radiation-related oral complications. Little evidence exists on the efficacy of elimination of oral foci of infection to prevent post-radiotherapy oral sequelae [5,6].…”

Oral Care

“…These are coated with fluoride gel 3 times a day, which is allowed to act on the teeth for 5 min. This procedure has to be followed throughout life because, without sufficient caries protection, the teeth rapidly develop deep caries and have to be extracted, which carries a risk of osteoradionecrosis [15].…”

Estudo clínico, bioquímico e histológico comparativo do efeito das fototerapias LED, laser de baixa e alta potência na mucosite oral e do efeito do laser na hipofunção das glândulas salivares em hamsters tratados com 5-Fluorouracil

“…Células da unidade terminal produzem uma saliva primária, isotônica em relação ao plasma, e o sistema ductal funciona como regulador eletrolítico, dando à saliva uma característica hipotônica em relação ao plasma através da reabsorção de Na + (sódio) e Cl -(cloro), e desta maneira o fluído será secretado ao meio bucal (Humphrey;Williamson, 2001;Nicolau, 2008;Katchburian;Arana-Chavez, 2012 (Nicolau, 2008;Nanci, 2013 (Nicolau, 2008;Nanci, 2013). Com isso, além de exercer suas funções de lubrificação e formação do bolo alimentar, também exerce atividade antimicrobiana, maturação e remineralização do esmalte, clearance, paladar e proteção contra estímulos mecânicos e químicos (Wang et al, 1998;Diaz-Arnold;Marek, 2002;Nicolau, 2008;Katchburian;Arana-Chavez, 2012 Nicolau, 2008;Grundmann et al, 2009;Simões et al, 2009;Simões et al, 2009a;Simões et al, 2010a;Katchburian;Arana-Chavez, 2012 (Lockhart;Sonis, 1981;Siegel, 1988a;Siegel, 1988b;Vissink et al, 2004;Jensen et al, 2010 (Jham et al, 2007;Sennhenn-Kirchner et al, 2009;Simões et al, 2010a (Takeda, 1988;Simões et al, 2009a;Simões et al, 2009b;Simões et al, 2010b). No entanto, poucos destes trabalhos são relacionados com algum tratamento antineoplásico (Cowen et al, 1997;Simões et al, 2010...…”