Oral health status of 207 head and neck cancer patients before, during and after radiotherapy

Abstract

The aim of this retrospective study was to describe the oral health status of patients before, during, and after radiotherapy (RT) for the treatment of head and neck cancer (HNC). Before RT, the following data was collected: presence of unrecoverable teeth, residual roots, unerupted teeth, use of dentures, periodontal alterations, caries, candidiasis, and xerostomia. Mucositis, candidiasis, and xerostomia were evaluated during RT. Patients continued to be followed after RT for evaluation of mucositis, candidiasis, xerostomia, radiation caries, and osteoradionecrosis. For statistical analysis, 95% confidence intervals (CI) were determined using sample size, population, and percentages. Before RT, 120 (57.9%) patients presented with alterations in the oral cavity namely, 85 (41.0%) with periodontal disease, 44 (21.2%) with residual roots, 25 (12.0%) with caries, 15 (7.2%) with candidiasis, and 12 (5.8%) had an unerupted tooth present. Xerostomia was a complaint of 19 patients (9.1%). Restorations were indicated for 33 patients (15.9%), whereas extraction was indicated for 104 (50.2%) patients. During RT, mucositis was found in 80 (61.7%) patients, candidiasis in 60 (45.8%), and xerostomia was a complaint of 82 patients (62.6%). After RT, mucositis persisted in 21 patients (19.2%), candidiasis was identified in 23 patients (21.1%), and xerostomia was reported by 58 patients (53.2%). Radiation caries developed in 12 patients (11.0%), whereas six patients (5.5%) developed osteoradionecrosis. The demographic profile herein presented will be useful as baseline data to provide additional epidemiological information and to determine future measures for prevention and treatment of RT-induced complications and sequelae.

Preradiotherapy dental extractions and health-related quality of life

“…This is in keeping with the literature showing head and neck cancer patients present with high dental needs and unmanaged risk factors, poor oral health literacy and low engagement with the dental profession, often persisting post-treatment [4,15,16]. 15.5% (20) of those having pre-RT dental extractions went on to have post-RT dental extractions, with only 10 participants having post-RT extractions alone.…”

“…At this visit, the oral status is assessed and appropriate dental treatments are completed. The dental needs of patients diagnosed with HNC are often quite high, and patients frequently present with periodontal disease and caries [4]. Initial screening and elimination of oral foci of infection has been shown to reduce post-radiotherapy complications such as osteoradionecrosis [5].…”

Saúde oral, capacidade mastigatória e estado nutricional de indivíduos pós-tratamento de câncer de cabeça e pescoço

“…Além disso, a radioterapia na região de cabeça e pescoço também pode induzir a doença periodontal, uma vez que alterações no fluido gengival e saliva são vistas, levando a quedas de imunoglobulinas circulantes, prejudicada resposta imune do hospedeiro, alterações da vascularidade, e diminuição da capacidade de reparação e remodelação do periodonto (SCHUURHUIS et al, 2011). A literatura descreve média de doença periodontal em pacientes pós-câncer de cabeça e pescoço de 23,9% (DUARTE et al, 2014) a 67,9% (JHAM et al, 2008), estando os resultados deste estudo dentro destes valores (56,5%).…”

“…dos pacientes tem mucosite, 45,8% candidíase e 62,6% xerostomia, e após 3 meses a mucosite persiste em 19,2% dos pacientes, candidíase em 21,1% e xerostomia em 53,2%, visto que 11,0% destes desenvolvem cárie de radiação, enquanto 5,5% evoluem para osteorradionecrose (JHAM et al, 2008).…”

Experiência da mulher com câncer de boca em relação à radioterapia

“…O fluxo salivar diminuido pode resultar em aumento da colonização pelo fungo Candida albicans (SIMÕES; CASTRO;CAZAL, 2011;JHAM et al, 2008). A osteorradionecrose é uma das complicações mais severas.…”