Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including prophylactic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1%) patients developed radiation caries and 5 out of 23 cases (21.3% - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental conditions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.     

Oral complications associated with the treatment of pediatric neuroblastoma: a case study

The treatment for pediatric cancer can have serious oral complications that adversely affect prognosis. Dental intervention to pediatric cancer patients is crucial in influencing side effects of therapy. This case study will demonstrate the role for oral intervention prior to and during cancer chemotherapy, as well as demonstrate the overall success achieved with interdisciplinary care.     

Dental considerations for head and neck cancer: A clinical review

IntroductionRadiotherapy is one of the treatment modalities for the treatment of head and neck cancer (HNC). However, it leads to the development of chronic and acute side effects. These side effects impact negatively on the patient’s quality of life and oral functioning. This clinical review aims to provide basic information about HNC, understand the impact of radiotherapy on oral health, and explain the role of dental care providers for HNC patients during the pre-and post-radiotherapy time.Materials and MethodsElectronic databases (i.e., PubMed, Scopus, and Google Scholar) were searched using defined keywords. The main inclusion criteria were any studies describing “dental management of patients with head and neck cancer” and “dental management of patients treated with radiotherapy.”ResultsThematic analysis was used to summaries the findings of the included studies (n = 102) into main headings and subheadings. All studies were published between 1970 and 2023.ConclusionThe number of HNC patients is increasing. This necessitates the need for raising the awareness of dental care providers to the side-effects of HNC therapy which includes treatment with radiotherapy, chemotherapy, and/or surgery. Dental care providers should understand the common side-effects and their treatments besides their role in the pre- (i.e., dental extraction of teeth with poor prognosis and maintaining good oral hygiene) and post- (i.e., oral rehabilitation and post-HNC dental care) radiotherapy dental care.     

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.     

Survey of the oral health needs of institutionalised elderly patients in Western Australia

An epidemiological survey of the oral health needs of 1144 elderly patients was conducted in hospitals and nursing homes in Western Australia. Patients were categorised as being either totally dependent (requiring intensive nursing care) or partially dependent (requiring nursing supervision). Of all patients the mean age was 80.2 yr, 70% were women, 74% were edentulous, and 70% needed some form of prosthetic care. Of all dentate patients 56% needed dental scaling (and 17% needed complex periodontal treatment), 47% needed some restorative treatment (with a mean need per patient of 1.1 coronal restorations and 0.4 radicular restoration), and 29% needed one or more dental extractions (with a mean need of 1.4 extractions per patient). Partially dependent patients had statistically significant higher needs for prosthetic work than did totally dependent patients, while the converse applied to extraction needs, but in all other aspects the needs of the two categories of patient did not differ significantly.     

Oral care of chemotherapy patients

About 65 to 75% of all cancer patients will receive antineoplastic chemotherapy during some part of the course of their disease. With about 700,000 cases of cancer in the United States, it is more likely that dentists will be called on to treat an oral complication of chemotherapy than an oral cancer, which represents only 5% of all cases of cancer. The diagnosis and treatment of stomatitis, oral infections, and hemorrhage are discussed here, and a program of oral evaluation and care before, during, and after chemotherapy is presented.     

Dental care for cancer patients: a survey of Texas dental school graduates

A survey of recent Texas dental school graduates regarding their preparedness for addressing the oral health care needs of cancer patients in their practices suggests several trends. Many graduates (26%) do not feel adequately prepared to manage and provide oral care for cancer patients. Over 95% of the dentists surveyed expressed interest in locally sponsored continuing education courses on the oral health care of cancer patients. Clearly, both predoctoral and postdoctoral dental education must recognize the need for formalized instruction on the oral cre of cancer patients if general dentists are to provide high-quality, comprehensive dental care for these patients.     

热灌注化疗对口腔颌面部恶性肿瘤患者NO及T淋巴细胞的影响

目的: 探讨热灌注化疗对口腔颌面部恶性肿瘤患者NO及T淋巴细胞的影响。方法: 选取汉堡大学休伯特斯·沃尔德癌症中心2017年12月—2019年12月收治的口腔颌面部恶性肿瘤患者60例,按照随机数字表法分为热化疗组(30例)与常规化疗组(30例),常规化疗组患者给予单纯静脉化疗,热化疗组患者在静脉化疗的基础上给予热化疗。比较2组患者的治疗效果、NO及T淋巴细胞数量、生存质量以及毒副反应之间的差异。采用SPSS 22.0软件包进行数据统计。结果: 热化疗组的治疗有效率及疾病控制率显著高于常规化疗组。治疗后,热化疗组患者NO含量显著高于常规化疗组,CD4⁺、CD4⁺/CD8⁺显著高于常规化疗组,热化疗组患者体力功能、情感功能、社会功能等功能性指标及综合生存质量评分显著高于常规化疗组,疲劳、疼痛、便秘等症状性指标显著低于常规化疗组,差异均具有统计学意义(P<0.05)。2组患者的毒副作用比较差异无统计学意义(P>0.05)。结论: 热化疗可显著提高口腔颌面部恶性肿瘤患者的治疗效果及NO含量,改善患者的免疫功能,提高生存质量,且安全性较高。     

Cancer treatment-induced oral mucositis: a critical review

Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.     

Radiotherapy-induced oral morbidities in head and neck cancer patients

The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects have a strong, negative influence on the oral functions and are responsible for a drastic reduction in the oral-health-related quality of life of the cancer survivors. In a significant deviation to the earlier approach of advising extraction of all remaining teeth before RT, the concept of preserving a maximum number of teeth in a state of health and for better oral functions postcancer cure has been globally accepted and is adhered to. The effects of radiation and their impact on the general well-being of the patients underscore the relevance of understanding the sequelae of radiation therapy on healthy oral tissues, preexisting oral diseases and their progression, impact on oral treatment needs, limitations in performing the indicated treatment, and shortcoming in treatment outcomes. It is vital for the professionals involved in head and neck cancer care to follow a well-devised referral system for oral care before and after RT and educate patients for a life-long follow-up     

Prevalence of oral herpes simplex virus reactivation in cancer patients: a comparison of different techniques of viral detection

Background:  Oral reactivation of latent Herpes simplex virus (HSV) infection may easily occur in cancer patients. Virus reactivation can cause oral mucosa damage, worsen already existing lesions caused by stomatotoxic effect of cancer therapy and, whether symptomatic or asymptomatic, ample spreading and promote viral transmission.
Methods:  Polymerase chain reaction (PCR), cell-culture and direct immunofluorescence have been used to determine the frequency of oral HSV reactivation in 60 patients undergoing chemotherapy for different malignancies.
Results:  By means of PCR, the presence of viral DNA was detected in 71.7% of patients prior to chemotherapy and in 85.0% after chemotherapy. 33.3% of patients before and 40.0% after chemotherapy were viral-culture positive, while 3.3% of patients before and 11.7% after chemotherapy were positive as shown by direct immunofluorescence. No significant difference in HSV-1 reactivation was found before and after chemotherapy. In addition, no significant difference was found when comparing HSV-1 reactivation in patients with and without mucositis. HSV-2 was not detected in any of the patients.
Conclusions:  Reactivation of latent HSV is exceptionally frequent in cancer patients. The results of this study suggest that virus reactivation occurs independently of cancer chemotherapy. The potential role of HSV reactivation in oral mucosa damage remains unclear.     

Incidence of oral complications and application of a preventive protocol in children with acute leukemia

This prospective, controlled study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL). During a 13-month period, 96 children from one to 16 years of age with a diagnosis of ALL were evaluated. When the study was initiated, 60 patients already undergoing chemotherapy received palliative treatment for complications (Group I). Thirty-six children (Group II) with newly diagnosed ALL received a daily preventive protocol consisting of: (1) elimination of bacterial plaque; (2) application of a mouthwash with a non-alcoholic solution of chlorhexidine 0.12% and (3) topical application of lodopovidone, followed by "swish and swallow" with nystatin 500,000 units. Children in both groups were examined every 7 to 14 days by our pediatric dentistry team. We found a significant improvement in oral hygiene (p = 0.001) and a significant decrease in the incidence of mucositis grade 2 (p = 0.0013) and oral candidiasis (p = 0.009) in the Group II children. These findings show that the systematic application of a preventive protocol significantly reduces the incidence of oral complications. The results of this study identify a need to include a pediatric dentist in a multidisciplinary team which provides oral care for cancer patients.     

重组人p53腺病毒联合放疗治疗晚期口腔癌的护理

目的探讨重组人p53腺病毒（tAd-p53）联合放射治疗晚期口腔癌患者的护理。方法对2009年1月至2012年4月在中国人民解放军总医院接受rAd-p53注射联合放射线治疗晚期口腔癌的患者,治疗前给予心理护理及健康指导．注射过程中做好护理配合．严密观察治疗后病情变化,及时处理发热、局部肿胀、疼痛、胃肠道反应等不良反应,做好放疗后皮肤护理、口腔护理及饮食护理,观察疗效并总结各项护理要点。结果22例患者均顺利完成rAd-p53联合放射治疗,其中部分缓解10例（45．5％）、稳定8例（36．4％）、进展4例（18．1％）。全部病例均无并发症及严重不良反应的发生。结论正确合理的护理是rAd-p53瘤内注射联合常规放疗治疗晚期口腔癌的重要环节,可有效减少不良反应的发生,减轻患者痛苦,达到提高治疗效果和生活质量的目的。     

光动力治疗口腔黏膜癌及癌前病变的临床进展

口腔癌是发生在口腔的恶性肿瘤之总称,严重影响人类生命和生活,发病率高,致残率和病死率高.许多口腔癌由癌前病变发展而来,最常见的是口腔黏膜白斑、扁平苔藓等.目前针对口腔癌一线治疗方案分为:手术切除、放射线治疗、化学治疗以及联合治疗.特别是高龄口腔癌症患者,传统治疗尚有一定的局限性和毒副作用.针对癌前病变常用药物和手术治疗...     

基于德尔菲法构建老年口腔癌患者围术期口腔护理方案

目的 构建老年口腔癌患者围术期口腔护理方案。方法 在前期指南内容分析、医护患相关人群深入访谈的基础上,根据老年口腔癌患者的临床特点、治疗阶段,结合PDCA循环,构建老年口腔癌患者围术期口腔护理方案初稿,采用德尔菲法对16位相关领域专家进行2轮函询,以确定方案。采用Excel 2016、SPSS 25.0软件包进行统计描述和统计分析。结果 2轮专家咨询回收率均为100%,整体专家权威系数为0.84。经过2轮专家咨询,各指标的变异系数为0~0.240,整体协调系数为0.171,形成了术前、术后、放化疗时期3个阶段的口腔护理方案。术前阶段包括4个维度,12个一级条目,56个二级条目;术后阶段包括4个维度,18个一级条目,102个二级条目;放化疗阶段包括4个维度,13个一级条目,35个二级条目。结论 老年口腔癌患者围术期口腔护理方案符合老年口腔癌围术期患者特点,能够满足该群体的口腔护理需求,方案构建具有可靠性,能为临床实践提供参考。     

The effect of olive leaf extract in decreasing the expression of two pro-inflammatory cytokines in patients receiving chemotherapy for cancer. A randomized clinical trial

BackgroundOral mucositis is the most common side effects of chemotherapy of all cancer with intensive treatments regimen, and is the most common side effects of head and neck radiation therapy. For steam cell transplantation, its also regarded as the most debilitating side effects.Aims of the studyThe objectives of this study were to assess the effect of a mouth rinse containing olive leaf extract (OLE) in preventing severe oral mucositis in patients receiving chemotherapy, and to estimate its effect in decreasing pro-inflammatory cytokine production after chemotherapy.Materials and methodsThis study utilized a placebo-controlled, randomized, double-blind, and cross-over design. Twenty-five patients undergoing intensive chemotherapy were randomly assigned to receive a mouth wash containing OLE, benzydamine hydrochloride, or placebo in 3 different cycles of chemotherapy. Oral mucositis severity was assessed using the World Health Organization criteria and Oral Mycositis Assessment Scale. Patients were evaluated weekly until 15 days after chemotherapy for each cycle. Salivary levels of interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) were evaluated by enzyme-linked immunosorbant assay.ResultsOral mucositis rates and severity after 2 weeks were significantly lower in the OLE and benzydamine groups compared to the placebo group. The IL-1β and TNF-α levels were significantly decreased in the OLE group compared to the other groups.ConclusionPreliminary findings indicate that OLE is effective in reducing IL-1β and TNF-α levels after chemotherapy and exert a therapeutic effect and prevent development of severe oral mucositis.     

氮芥术中动脉内给药对口腔癌术后伤口愈合及近期疗效的影响

目的：探讨术中动脉内化疗的临床应用。方法：对实验组１１例口腔癌（９例舌癌,２例口底癌）患者行联合根治术及皮瓣修复术,氮芥术中舌动脉内给药（浓度为１ｍｇ／ｍｌ,剂量为５ｍｇ）,对照组１６,例口腔癌（１３例舌症,３例口底癌）患者仅行手术,并同期行皮瓣修复。术后观察患者全身和局部反应并作近期随访。结果实验组无明显全身及局部反应,１１例皮瓣全部存活,近期随访（３－１２个月）,实验组局部复发率为９．１％（１     

Treatment outcomes of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy for locally advanced oral cancer in the elderly

The aim of this study was to evaluate the therapeutic efficacy and safety of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy in elderly patients with locally advanced oral cancer. Between February 2009 and October 2019, 42 oral cancer patients aged ≥75 years were treated with this therapy. Median age was 80 years (range 75–90 years) and the median follow-up duration was 39 months (range 2–106 months). Of the 42 patients, 34 (81%) were diagnosed with stage IV cancer. The 3-year overall survival, local control, progression-free survival, and disease-specific survival rates were 56%, 69%, 32%, and 67%, respectively. Regarding acute toxicities, grade 3 neutropenia was observed in six patients (14%), anaemia in five (12%), acute kidney injury in one (2%), and oral mucositis in 18 (42%). Late toxicities of grade 3 were observed in seven patients: dysphagia in six (14%) and osteonecrosis of the jaw in one (2%). This study showed that proton beam therapy combined with retrograde intra-arterial infusion chemotherapy was effective for elderly patients with oral cancer, and toxicities were tolerable and manageable. The study findings suggest that this therapy is a potential treatment option for elderly oral cancer patients with difficulty in surgery and systemic chemotherapy.     

The oral health needs of children after treatment for a solid tumour or lymphoma

Background.  With increasing survival rates for childhood cancer, late effects are of growing importance. Oral health is central to general health, level of nutrition, quality of life, and is significant in the holistic care of children during cancer therapy.
Hypothesis.  The oral health needs of children treated for solid tumours/lymphoma will be greater than the general population, groups will differ according to tumour and treatment.
Design.  One hundred and twenty patients, 0–17 years, under follow-up from 01/07/06 to 07/02/07 were investigated for caries, opacities, microdontia, and gingivitis. Analysis was performed with stratification according to tumour and treatment. Comparisons made with the UK 2003 Child Dental Health Survey.
Results.  The neuroblastoma group and high-dose chemotherapy with stem-cell rescue (HDCSCR) therapy group had increased caries of the primary teeth. Chi-squared analysis revealed a statistically significant relationship ( P  < 0.03) between the age at receipt of chemotherapy (<3.5 years) and the presence of microdont teeth.
Conclusion.  Oral health care is important for all patients particularly those with a neuroblastoma, or who received HDCSCR. Patients should be advised about the possibility of microdontia in the permanent dentition following chemotherapy under 3.5 years.     

口腔鳞癌新辅助化疗的回顾性研究

目的 :探讨新辅助化疗在口腔鳞癌治疗中的近期和远期临床效果。方法 :对 1990 2 0 0 0年我院住院治疗的36例新辅助化疗口腔鳞癌患者和 72例术前未作任何辅助治疗的口腔鳞癌患者作回顾性分析 ,对化疗后临床肿瘤退缩程度、生存率、术后复发和转移率作比较。其中新辅助化疗组患者术前接受一个疗程的VM方案化疗后进行手术。结果 :新辅助化疗后临床完全缓解 6例 ,有 18例部分缓解 ,总有效率 6 6 .7%。在平均 4 8个月 (6 12 0个月 )的随访中 ,新辅助化疗组 12例出现复发 (33.3% )、3例 (8.3% )转移、6例 (16 .6 % )死于肿瘤 ,对照组 4 8例复发 (6 6 .7% ) ,2 0例 (2 7.8% )转移、2 8例 (38.9% )死于肿瘤 .两组差别有显著意义 (P <0 .0 5 )。结论 :新辅助化疗安全低毒、不影响手术、近期肿瘤缓解率明显、远期可减少术后复发和转移率、大大提高患者无瘤生存率