The management of periodontal disease in patients who have received radiation therapy for head and neck cancer

Osteoradionecrosis is a common, serious sequela of radiation therapy for oral cancer. Patients who are to receive radiation therapy should have preradiation dental evaluation and treatment, oral hygiene instruction, and close dental follow-up during and after radiation therapy. Teeth with significant periodontal disease should be extracted before radiotherapy. After radiation treatment, advancing periodontal disease can be initially managed with conservative treatment, scaling and root planing, tetracycline, and good oral hygiene. Periodontal disease is a possible source of infection and may therefore predispose a patient to osteo-radionecrosis.     

Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment

BACKGROUND: There is a widespread belief among dental practitioners and physicians that oral anticoagulation therapy in which patients receive drugs such as warfarin sodium must be discontinued before dental treatment to prevent serious hemorrhagic complications, especially during and after surgical procedures. OVERVIEW: The authors examine the scientific basis for properly managing the dosage of anticoagulants for dental patients who are receiving anticoagulation therapy. The authors review the appropriate laboratory test values to which dentists should refer when evaluating for dental treatment patients who are receiving anticoagulation therapy. The authors also review clinical studies, published within the past five years, that focus on the frequency and degree of hemorrhagic and related complications among dental patients who are receiving anticoagulation therapy orally to prevent thromboembolic events. CONCLUSIONS AND CLINICAL IMPLICATIONS: The scientific literature does not support routine discontinuation of oral anticoagulation therapy for dental patients. Use of warfarin sodium as it relates to dental or oral surgical procedures has been well-studied. Some dental studies of antiplatelet therapy are consistent with the findings in warfarin sodium studies. Dental therapy for patients with medical conditions requiring anticoagulation or antiplatelet therapy must provide for potential excess bleeding. Routine discontinuation of these drugs before dental care, however, can place these patients at unnecessary medical risk. The coagulation status--based on the International Normalized Ratio--of patients who are taking these medications must be evaluated before invasive dental procedures are performed. Any changes in anticoagulant therapy must be undertaken in collaboration with the patient's prescribing physician.     

An oral disease prevention program for patients receiving radiation and chemotherapy

Thirteen years of treating more than 2,950 patients at the National Institute of Dental Research clinic have shown that a variety of potential oral sequelae associated with cancer therapy can be prevented, reduced in severity, or palliatively alleviated when the dental team has an opportunity to participate in the patient's care. The keystone of this success is based on early referral of the patient for dental consultation, treatment before the initiation of cancer therapy, and a well-defined orientation program to inform patients and their families about the difficulties they may experience. Meticulous attention to oral microbial control, prophylactic use of fluoride gels, and palliative treatment of soft tissue lesions may significantly reduce the oral morbidity associated with radiation and cytotoxic chemotherapy. Diligent personal oral health care and frequent dental recall appointments are recommended for the remainder of the patient's life. It has been our experience that patients who are not followed closely after irradiation therapy have an increased incidence of caries as a result of noncompliance with preventive regimens. The ethical and medicolegal responsibility to fully inform the patient of these recommendations lies with both the medical and dental personnel at the facility providing the radiation-chemotherapy service. The general dentist shares the responsibility for continuity of long-term oral health care.     

Oral cancer: enduring characteristics and emerging trends

Oral cancer is arguably the most serious condition that dental providers may encounter in their practice. The relatively poor prognosis associated with oral cancer highlights the importance of the dental team's awareness of the disease. While many characteristics of oral cancer have endured over time, new research is revealing trends that are changing the way we approach its screening, diagnosis and treatment. In this report, we provide a translational overview of oral cancer, including risk factors, signs and symptoms, clinical management, as well as our recent findings on the role of chronic inflammation in the development of the disease. In addition, our recent genetic profiling approach in both cancer cell lines and in patients has identified potential biomarkers, molecular pathways and therapeutic drugs for oral squamous cell carcinomas. This comprehensive review should be of interest to all dental professionals.     

Oral cancer: enduring characteristics and emerging trends

Oral cancer is arguably the most serious condition that dental providers may encounter in their practice. The relatively poor prognosis associated with oral cancer highlights the importance of the dental team's awareness of the disease. While many characteristics of oral cancer have endured over time, new research is revealing trends that are changing the way we approach its screening, diagnosis and treatment. In this report, we provide a translational overview of oral cancer, including risk factors, signs and symptoms, clinical management, as well as our recent findings on the role of chronic inflammation in the development of the disease. In addition, our recent genetic profiling approach in both cancer cell lines and in patients has identified potential biomarkers, molecular pathways and therapeutic drugs (Velcade and Aspirin) for oral squamous cell carcinomas. This comprehensive review should be of interest to all dental professionals.     

Foci of infection and oral supportive care in cancer patients

Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.     

Bacterial endocarditis of dental origin: report of case.

Although appreciated by most practitioners, the fact that dental infection may be the source of bacteremia without a history of recent dental procedures is occasionally overlooked. The case reported here illustrates what we feel is an example of such a phenomenon. The eradication of the oral foci of infection enhanced the patient's response to therapy and prompted his ultimate recovery.     

Current practice in dental oncology in the U.K

The clinical management of cancer patients, particularly where it affects the head and neck, may result in short- and long-term complications. Specialist management of the dental sequelae of cancer is often recognized nowadays by the term'Dental Oncology' Members of the dental team play a vital role in preventing and promptly managing such complications and all dental professionals should have a sound understanding and knowledge of the oral implications of cancer therapy and their management, and the contribution of this to the patient's quality of life. CLINICAL RELEVANCE: This article offers the dental team an overview of the impact of cancer therapy and strategies for preventing and managing the oral side-effects of cancer therapy prior to, during, and beyond cancer treatment.     

The need for dental treatment in a group of patients undergoing treatment for malignancies other than of the head and neck

This paper reports the findings of an audit carried out to estimate the dental needs of patients undergoing oncology therapy for malignant disease at various sites of the body. All of the subjects were in-patients on an oncology ward. Over fifty percent of the patients had dental, periodontal or mucosal disease. It was concluded that there is a need to increase the dental service provided to cancer patients to allow further co-ordination between medical, dental and nursing staff for the prevention, management and resolution of oral complications of cancer therapy.     

Oral management of the patient with cancer in the head and neck region

Cancer therapies--including surgery, radiation, and chemotherapy--may unfavorably affect the oral/dental health of patients. Existing dental problems can also result in serious complications that may be prevented by dental intervention prior to cancer therapy. This paper will be limited to a discussion of the detrimental effects of radiation therapy on the oral cavity and salivary glands and appropriate dental management.     

Tobacco or oral health: past progress, impending challenge

BACKGROUND AND OVERVIEW: A number of significant events and research findings during the past 15 years have led to the dental profession's growing involvement in tobacco-use intervention activities. The author presents an overview of events and people responsible for the progress in furthering the cause of dentistry's activism in tobacco-use prevention and control. CLINICAL IMPLICATIONS: Dentistry has led the health professions in establishing a protocol for the prevention of tobacco use, a health behavior that causes or contributes to various oral diseases and adverse conditions. Dentists practicing in the 21st century cannot ignore patients' tobacco use. Treatment prognoses for periodontal therapy, wound healing, dental implants, cosmetic treatments and cancer therapy all are compromised by patients' tobacco use. Dentists must know what to do and say to prevent patients' tobacco use and aid patients in its cessation.     

Self-reported medical conditions and drug use among elderly dental patients

There is a paucity of data describing the prevalence of systemic conditions and drug use in elderly dental patients. In this study, the charts of all patients, 65 years of age and older who were accepted for dental treatment at the University Dental Clinic in Saskatoon, Canada, during the period from January 1986 to April 1988 were reviewed. Data was obtained from a self-administered questionnaire and an oral history sheet. Cardiovascular diseases (27 per cent), orthopedic problems (24 per cent), and endocrine disorders (16 per cent), were the most commonly reported systemic conditions. Approximately 15 per cent of these patients were taking three or more medications at the time of examination. Dentists should be aware of alternate approaches for treating the medically compromised elderly patient. These findings emphasize the importance of obtaining an adequate drug history prior to commencing dental treatment. Guidelines are required to enable dental clinicians to make informed decisions, in order to provide the most appropriate therapy for this growing segment of our population.     

Cowden syndrome—a case report emphasizing the role of the dental surgeon in diagnosis

Cowden syndrome or multiple hamartoma syndrome, is a rare genetic condition inherited in an autosomal dominant pattern characterized by cutaneous manifestations, polyps, thyroid gland neoplasias, and macrocephaly. This report presents the case of a 36‐year‐old patient who looked for dental treatment for a gingival nodule. Current and past medical history and oral and facial manifestations led to the diagnosis of Cowden syndrome. This case report emphasizes the role of the dental surgeon in the diagnosis of this systemic disease, based on the analysis of medical history and manifestations in the oral cavity.     

Attitudes and lifestyle factors in relation to oral health and dental care in Sweden: a cross-sectional study

Objective: The aim of the present study was to investigate attitudes to and perceptions of dental treatment and costs, self-assessed personal oral health status and dental self-care in an adult Swedish population, with special reference to potential associations between these factors and periodontal status.

Material and methods: The study population comprised 1577 subjects who had undergone radiographic dental examination. The subjects were grouped by severity of periodontitis, based on extent of bone loss, as none, mild/moderate or severe. Subjects answered a questionnaire about socioeconomic factors, oral care habits and attitudes to dental treatment. Other questions covered medical history, smoking and other life style factors. Associations were tested using the Chi-squared test and a logistic regression model.

Results: Compared to subjects with no periodontitis, those with mild/moderate or severe periodontitis were less likely to afford (p?<?.001), more often refrained from treatment due to costs (p?<?.001) and in the past year had experienced dental problems for which they had not sought treatment (p?<?.001). They also reported more anxiety in relation to dental appointments (p?=?.001). Regarding caries prevention, the severe periodontitis group used least fluoride products (p?=?.002).

Conclusions: Swedish adults regard their oral health as important, those with periodontitis have a more negative perception of their oral health and are less prone to seek help. These discouraging findings suggest the need for targeted measures, which focus on improving the care of this group of patients.     

Periodontal considerations of the removable partial overdenture

1. An overdenture, whether complete or partial, is an excellent mode of treatment in the mutilated dentition for the preservation of the residual ridge. 2. Selection of patients for an overdenture should be based on past history of dental neglect, the status of the teeth and their periodontium, including present oral hygiene status, and patient motivation. The patients with a history of dental neglect, poor oral hygiene, and lack of motivation in having the teeth and the periodontium restored to health as well as strict compliance to a home-care regimen and recall schedule are not good candidates for treatment with an overdenture. 3. The choice of teeth or roots to serve as overdenture abutments must include their periodontal evaluation, which should consist of a detailed periodontal examination, diagnosis, prognosis, and treatment when this is indicated, including chemical protection (fluoride gel) and an oral hygiene regimen tailored to individual needs. 4. The knowledge and expertise in the selection and implementation of appropriate periodontal treatment modalities is of paramount importance in restoring optimum periodontal health to the overdenture abutments before overdenture fabrication. 5. The maintenance phase of the overdenture abutments as well as of the existing natural teeth is of critical importance in the preservation of health of these abutments and teeth. This maintenance phase should consist of periodic recalls based on individual needs; a detailed periodontal evaluation, including patient's motivation and status of oral hygiene and denture hygiene; and detection of caries. If necessary, appropriate periodontal and/or restorative therapy should be performed, and oral hygiene measures reinforced. This will ensure longevity of both abutment teeth or roots and of the existing natural teeth resulting in a long-term success of an overdenture. 6. Because there is evidence of high incidence of periodontal disease and dental caries in overdenture wearers, and because this evidence is attributed mainly to lack of motivation and compliance of adequate oral hygiene as well as to frequency of recall visits, patients should be made aware of the importance of their role in the maintenance phase of treatment and in the factors that lead to ultimate success of overdenture therapy. 7. With (a) proper selection of the patient and the abutment teeth, (b) adequate periodontal and restorative health and treatment to ensure optimum health prior to RPOD construction, (c) a well-designed home-care regimen and frequency of recalls, and (d) proper execution of maintenance care, changes for long-term success of overdenture therapy will be much improved.     

Dietary and nutritional needs of patients after therapy for head and neck cancer

BackgroundThe number of cancer survivors in the general population is increasing. Oral and dental status affects patients' quality of life and oral function, which, in turn, may affect nutritional intake and general health. The authors review the importance of oral health and the role of the oral health care provider in supporting dietary intake and providing nutritional guidance.MethodsThe authors provide a brief review of oral complications of therapy and nutritional guidelines for patients with head and neck cancer.ResultsOral adverse effects of head and neck cancer treatment include salivary gland dysfunction, taste change, orofacial pain and mucosal sensitivity, oral infection, tissue defects and necrosis, trismus and fibrosis, progressive dental and periodontal disease, and problems with prosthesis function.ConclusionsManaging oral adverse effects of treatment may have an impact on dietary and nutritional intake, as well as on quality of life. Dietary modifications may be needed because of the patient's oral function and may include modification of food texture and flavor, as well as the use of dietary supplements.Clinical ImplicationsAs part of the patient's health care team, dental care professionals should be aware of the oral adverse effects of cancer therapy, as well as their role in recognizing and treating the resulting oral conditions. In addition, they should provide guidance to patients to support their oral dietary and nutritional intake.     

Oral fungal infections

Candidiasis is the most common oral fungal infection diagnosed in humans. Candidiasis may result from immune system dysfunction or as a result of local or systemic medical treatment. Because oral candidiasis is generally a localized infection, topical treatment methods are the first line of therapy, especially for the pseudomembranous and erythematous variants.Patients with dental prostheses should also be advised to disinfect the prosthesis routinely during the candidal treatment period, because the prosthesis may serve as a source of reinfection. Additionally, patients should be advised that oral hygiene aids, such as toothbrushes and denture brushes, may also be contaminated and should be discarded or disinfected. A disinfecting solution of equal parts of hydrogen peroxide and water may be used. Likewise, 2% chlorhexidine gluconate solution may be used asa disinfecting solution for dental prostheses and oral hygiene aids. Occasionally the clinician encounters a more resistant form of oral candidiasis such as the hyperplastic variant or a variant that does not respond to topical therapy. Appropriate systemic therapy should be employed for the treatment of these infections. Additionally, a biopsy should be undertaken in individuals with the hyperplastic variant of Candida because there is some degree of risk for malignant transformation. Deep fungal infections should be managed in association with appropriate medical specialists to rule out other systemic involvement. The dental health care provider plays an important part in the diagnosis and management of fungal disease, and therefore clinicians should be aware of the presenting signs and symptoms or oral fungal disease.     

Is dental care utilization associated with oral cavity cancer in a large sample of community‐based United States residents?

Abstract – Objectives: Cancer of the oral cavity and pharynx remains one of the 10 leading causes of cancer deaths in US. Besides smoking and alcohol consumption, there are no well‐established risk factors. While poor dental care had been implicated, it is unknown if lack of dental care, implying poor dental hygiene predisposes to oral cavity cancer. This study aimed to assess the relationship between dental care utilization during the past 12 months and the prevalence of oral cavity cancer. Methods: A cross‐sectional design of the National Health Interview Survey of Adult, noninstitutionalized US residents (n = 30 475) was used to assess the association between dental care utilization and self‐reported diagnosis of oral cavity cancer. Chi‐square statistic was used to examine the crude association between the explanatory variable, dental care utilization and other covariates, while unconditional logistic regression was used to assess the relationship between oral cavity cancer and dental care utilization. Results: There were statistically significant differences between those who utilized dental care during the past 12 months and those who did not with respect to education, income, age, marital status, and gender (P < 0.05), but not health insurance coverage (P = 0.53). In addition, those who utilized dental care relative to those who did not were 65% less likely to present with oral cavity cancer, prevalence odds ratio (POR), 0.35, 95% confidence interval (CI), 0.12–0.98. Further, higher income, advanced age, people of African heritage, and unmarried status were statistically significantly associated with oral cavity cancer (P < 0.05), but health insurance coverage, alcohol use, and smoking were not, P > 0.05. After simultaneously controlling for the relevant covariates, the association between dental care and oral cavity cancer did persist but imprecise. Thus, when compared with those who did not use dental care, those who did were 62% less likely to be diagnosed with oral cavity cancer, adjusted POR, 0.38, 95% CI, and 0.13–1.10. Conclusions: Among US adults residing in community settings, use of dental care during the past 12 months was marginally statistically significantly associated with oral cavity cancer, but clinically relevant in assessing oral cavity cancer prevalence in this sample. However, because of the nature of our data, which restricts temporal sequence, a large sample prospective study that may identify modifiable factors associated with oral cavity cancer development, namely poor dental care is needed.