Head and neck cancer patients – information for the general dental practitioner

Abstract

Salivary gland damage is the most common adverse effect associated with radiation therapy to the head and neck. A combination of hyposalivation and dietary changes, with a reduced emphasis on oral hygiene practices can contribute to a massive increase in a person’s caries risk status. This can be further complicated by limited mouth opening. To enable optimal dental care for head and neck cancer patients before, during and after radiation therapy, patients must be informed and educated about the potential risks of dental caries and the preventive strategies available. All patients should receive a pre-radiotherapy dental assessment by a Restorative Dentistry Consultant. This information will be delivered to the patient, often at an emotionally charged time, and can be lost amongst all the information related to other aspects of his/her cancer management. General Dental Practitioners (GDPs) are therefore in a pivotal position to reiterate this information post radiation therapy and ensure compliance with preventive strategies, with the overall aim to improve quality of life and avoid the need for future extractions and the resulting risk of osteoradionecrosis. Clinical relevance: This article highlights the GDP’s role in the shared management of head and neck cancer patients who have received radiotherapy as part of their cancer treatment. The critical issue of dental caries, one of the late effects of radiation-induced hyposalivation, will be focused upon. Other side-effects, such as trismus and osteoradionecrosis, will also be discussed. This article aims to supply GDPs with accurate information to provide to their patients with post radiation therapy, whilst highlighting what treatment is within their remit and when it may be appropriate to refer.

Oral pH value predicts the incidence of radiotherapy related caries in nasopharyngeal carcinoma patients

“…Changes in the oral microenvironment are related to the radiation dose received by the parotid and submandibular glands 19 – 22 . Limiting the radiation dose to the parotid and submandibular glands can significantly reduce the risk and extent of xerostomia, while also protecting the oral microenvironment 20 , 23 .…”

Reabilitação de paciente pós câncer de cabeça e pescoço com overdenture inferior sobre dentes: relato de caso

“…Buscar estratégias de prevenção da cárie relacionada à radiação é crucial para a saúde oral do paciente e sucesso do tratamento reabilitador (Kawashita et al, 2020;Palmier et al, 2020). O ambiente oral permanece alterado mesmo após o término do tratamento radioterápico, sendo a diminuição da saliva o principal fator de risco de desenvolvimento da cárie, além da dificuldade de higienização e a estrutura dental que se encontra comprometida pela radiação de forma definitiva (Bhandari et al, 2020;Kawashita et al, 2020;Lu et al, 2019;Miranda et al, 2019;Moore et al, 2020;Noone et al, 2017;Rodrigues et al, 2018). Desta forma, a diminuição do fluxo salivar associada à estrutura dental afetada pela radiação ionizante aumentam a progressão da cárie (Lopes et al, 2021).…”

“…Portanto, o acompanhamento periódico destes pacientes é muito importante para a avaliação e manutenção dos dentes (Noone et al, 2017;Moore et al, 2020;Palmier et al, 2020). A aplicação de flúor é uma estratégia eficiente para aumentar a resistência à cárie relacionada à radiação, fornecendo benefícios na prevenção e remineralização da estrutura dental (Kawashita et al, 2020;Lopes et al, 2018;Noone et al, 2017;Palmier et al, 2020) Além do risco de ocorrência da cárie, é importante atentar-se à adaptação adequada da prótese e qualidade dos retentores, para evitar traumas à mucosa que é um fator de risco à osteorradionecrose (Petrovic et al, 2018). Desta forma, o acompanhamento destes pacientes deve ser realizado ao longo de sua vida, mesmo após o término do tratamento antineoplásico, sendo imprescindível para evitar insucessos.…”

Oral pH Value Predicts the Incidence of Radiotherapy Related Caries in Nasopharyngeal Carcinoma Patients

“…Changes in the oral microenvironment are related to the radiation dose received by the parotid and submandibular glands [19][20][21][22] . Limiting the radiation dose to the parotid and submandibular glands can signi cantly reduce the risk and extent of xerostomia, while also protecting the oral microenvironment [20,23].…”