A randomized clinical trial to evaluate the impact of a dental care program in the quality of life of head and neck cancer patients

Objectives

A randomized clinical trial (RCT) to evaluate the impact of dental care program on the quality of life (QOL) of head and neck cancer patients under oncological treatment.

Materials and methods

The study design was a parallel RCT where 46 subjects with a diagnosis of head and neck primary neoplasy were randomly allocated to the control (CG) or test group (TG). Both groups received basic dental care but the TG received a complimentary care before and during, oncological therapy. Data related to general (WHOQOL-BREF) and specific (EORTC QLQ H&N 35) QOL were assessed before and 15 days after the conclusion of the oncological therapy.

Results

The TG showed an improvement in the general and specific QOL, while the CG showed a worsening in these indexes but without significant difference. The variation between the initial and final measures in the TG shows a tendency of significant improvement along the time. A reduction in candidiasis (p?<?0.05) and muccositis was observed in the TG.

Conclusion

In a short follow-up period, dental care was able to reduce damage from the oncological therapy especially related to muccositis and candidiasis, although the QOL was not significantly improved. However, a longer follow-up to measure the late side effects over the QOL of these patients is necessary.

Clinical relevance

Provision of continuous dental care for head and neck cancer patients can reduce deleterious side effects of the oncological treatment.     

The dental treatment needs and oral side effects of patients undergoing outpatient cancer chemotherapy

An increasing number of patients receive cancer chemotherapy on an out-patient basis. Dentists therefore need to be aware of the consequences of cancer chemotherapy. Two hundred and eighteen patients attending a specialist oncology centre were examined and the oral side effects recorded. The patients also completed a structured interview to examine the advice they had been given by health care professionals prior to starting chemotherapy. Clinical examination revealed a significant dental treatment need with 16% of patients requiring restorations and 66% requiring professional periodontal care. The commonest oral side effects were altered taste sensation (52%), xerostomia (35%) and mucositis (22%). All these side effects are unpleasant and may have a significant effect on a patient's quality of life.     

Oral symptoms of immunologic disorders. Part I. Systemic autoimmune diseases

Polysystemic autoimmune diseases often cause orofacial and stomatognathic symptoms. Inflammation of the temporomandibular joint only rarely and slightly reduces the range of mouth opening (rheumatoid arthritis), which is much more restricted in systemic sclerosis due to fibrosis of perioral soft tissues. Weakness of masticatory and pharyngeal muscles in idiopathic inflammatory myopathies results in dysphagia and dystonia. Ulcerations, petechiae, teleangiectasia, and lichenoid lesions are the characteristic symptoms of oral mucosal involvement, but drugs used in systemic treatment can also cause very similar side effects. Salivary gland hypofunction (Sj?gren's syndrome) is common, and in addition to the subjective complaints, leads to objective pathologic alterations such as oral mycotic infections, purulent sialadenitis, and increased caries prevalence. The side effects of steroid administration should be taken into account also during dental treatments. Regular dental follow-up and treatment is a basic part of the complex care of these patients in order to diagnose and cure oral abnormalities and salivary gland hypofunction in time. Impairment of hand functions (rheumatoid arthritis, scleroderma) reduces the oral hygienic activity and therefore special devices, local antiseptics and local fluoride preparations are necessary.     

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.     

Systematic review of primary osseointegrated dental implants in head and neck oncology

The aim of this paper is to provide a systematic review of articles concerning primary osseointegrated dental implants in the head and neck oncology setting. We searched MEDLINE (1950 to March 2009) and Embase (1980 to March 2009) using the terms head and neck, oral, maxillofacial, craniofacial, jaws, mandible, maxilla, zygoma, dental implants, osseointegrated implants, implants, tumour, cancer, oncology, immediate, simultaneous, and primary. Two authors independently reviewed the abstracts, and all those written in the English language that referred to the placement of primary dental implants in patients with cancer of the head neck were included. Articles that referred to craniofacial or extraoral implants were excluded. Of 892 abstracts 83 were eligible for further consideration; the full articles were evaluated, and 41 that complied fully with the inclusion criteria are presented as a tabulated summary. There are three case reports, 13 reviews, and 25 clinical studies. Eight of the clinical studies refer solely to the insertion of dental implants at the time of primary oncological resection, and only two were of a prospective design. We have concisely summarised publications concerning primary dental implants, and our findings will help to inform head and neck cancer teams, particularly oncological surgeons, restorative dentists, and maxillofacial prosthodontists of the evidence base surrounding this approach to oral rehabilitation.     

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.     

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.     

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.     

Dental abnormalities of a long-term survivor of a childhood hematological malignancy: literature review and report of a case

The treatment of haematological malignancy is multimodal and involves chemotherapy, radiotherapy and/or bone marrow transplants. With the advancement in cancer therapy, there is an increase in the survival of many children with childhood haematological malignancy. In addition, the late effect of the oncology treatment to the orofacial and dental development becomes significant in terms of the potential clinical impact that may affect the quality of life of the survivor. The severity of the long-term effects is dependent on the age of the child at initiation of treatment and whether chemotherapy is combined with radiation or not. The dental treatment may become more complex if the patient requires advanced restorative dental care and the roots malformation may complicate orthodontic treatment. Therefore these patients may require a scheduled careful preventive programme, long-term follow up, with prophylactic treatment and intervention at appropriate time to minimize the consequences of the disease and the given therapy.     

Extending Medicare coverage to medically necessary dental care

BACKGROUND: Periodically, Congress considers expanding Medicare coverage to include some currently excluded health care services. In 1999 and 2000, an Institute of Medicine committee studied the issues related to coverage for certain services, including "medically necessary dental services." METHODS: The committee conducted a literature search for dental care studies in five areas: head and neck cancer, leukemia, lymphoma, organ transplantation, and heart valve repair or replacement. The committee examined evidence to support Medicare coverage for dental services related to these conditions and estimated the cost to Medicare of such coverage. RESULTS: Evidence supported Medicare coverage for preventive dental care before jaw radiation therapy for head or neck cancer and coverage for treatment to prevent or eliminate acute oral infections for patients with leukemia before chemotherapy. Insufficient evidence supported dental coverage for patients with lymphoma or organ transplants and for patients who had undergone heart valve repair or replacement. CONCLUSIONS: The committee suggested that Congress update statutory language to permit Medicare coverage of effective dental services needed in conjunction with surgery, chemotherapy, radiation therapy or pharmacological treatment for life-threatening medical conditions. PRACTICE IMPLICATIONS: Dental care is important for members of all age groups. More direct, research-based evidence on the efficacy of medically necessary dental care is needed both to guide treatment and to support Medicare payment policy.     

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??Child dental fear??CDF??is an anxiety symptom??mainly caused by fear of pain??being unknown??and body hurt??etc. CDF may cause long-term adverse effects on physical and psychological health of children. Therefore??relieving CDF is the necessary way to ensure the effect of oral treatment and promote the healthy growth of children. The dental fear treatment methods were categorized into behavioral interventions??music therapy??bondage??general anesthesia and laughing gas. Dentists have difficulty in carrying on objective appraisal on CDF of disease and selecting individualized treatment. This paper gives a detailed introduction of the cause??evaluation method??classification and treatment methods of CDF??so as to help medical staff of oral health care to clear treatment thoughts in order to provide evidence for correct diagnosis??intervention and treatment of dental fear.     

You can treat the chemotherapy patient.

Increased numbers of cancer patients are treated with chemotherapy. Patients who receive antineoplastic agents can be at serious risk from dental infections and should be provided appropriate dental care. In many instances, indicated treatment can be accomplished by the patient's private dentist. Certain precautions, however, are necessary when treating dental patients medically compromised by chemotherapy. Dental conditions which may increase morbidity are identified and treatment recommendations are made. Guidelines for dental intervention before, during, and after chemotherapy are discussed with emphasis on the hematologic parameters necessary for safe dental care. The cyclic relationship between chemotherapy and oral complications is also reviewed.     

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.     

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.     

Study for improvement of oral health among the elderly. Present status of dental care service at elderly homes

Since the dental environment at a living place could potentially become a factor causing a need for dental care, all 33 elderly homes (27 of which responded to the survey) in Tokyo were investigated for the purpose of identifying the present status of dental care service and the problems existing at these homes. The following are the obtained conclusions. 1. The rate of homes with dental care facilities is as low as 19.2%, and cooperation by dental care institutions, including house calls, is ensured only at the low rate of 11.1%. As a result, usually patients visit the dental institutions. 2. The involvement of the dental staff, including part-time, was 44.4%, less than half of the homes surveyed. The homes wishing to employ or receive service from dental staff accounted for 76.9%. The homes also expected them to be engaged in the activities of overall oral hygiene, including not only dental treatment, but also participation in the planning of oral hygienic management. However, 23.1% of the respondents did not wish to employ any dental staff or receive any such service. 3. Specific programs for the guidance and management of oral hygiene were not observed. Homes that conducted dental examination periodically and those that carried out activities related to oral hygiene during Dental Health Week were also lacking. In addition, the homes which had assigned personnel responsibility for oral hygiene represented only 12.0%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sleep disorders and oral devices.

Many patients with upper airway sleep disorders can be successfully treated with oral appliance therapy. It is necessary for dentists to recognize these patients and refer them to a physician for further evaluation. Dentists must not become the primary care providers for these patients or attempt to treat a medical problem with an oral appliance without a proper diagnosis, which usually requires a sleep study and can only be diagnosed by a physician. Dentists must also be able to treat the patients referred by physicians and to follow accepted procedures when fabricating, inserting, titrating, and providing follow-up care for oral appliance therapy. In addition, the dental community needs to continue to heighten the awareness in their local medical community and in their patient population as to the possible contribution of oral appliance therapy to the management of snoring and some of the sleep-related breathing disorders.     

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.     

Prevention of oral disease for long-term care and homebound elderly

Despite the fact that many oral diseases afflicting the long-term care or homebound elderly are preventable or treatable, many older people do not seek available treatment, or their oral health care needs are not being met. The dental profession must, therefore, increase the preventative dental awareness of elders and make preventative and treatment services more accessible to this population. Interdisciplinary training and collaborative efforts among the dental profession, medical profession and caregivers are necessary in preventing oral disease for this geriatric population, which would improve not just oral health, but overall systemic health as well, thereby improving their quality of life.