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

BackgroundNutrient and caloric intake is critical during therapy for head and neck cancer.MethodsThe authors review the oral complications experienced by, and dietary and nutritional needs of, patients during therapy. They also present recommendations for oral care and calorie and nutrient intake.ConclusionsOral health care professionals can assist patients during treatment for cancer in maintaining oral, systemic and nutritional health, as well as in controlling oral symptoms. Recovery from the acute toxicities of therapy often requires diet modification, tube feeding or both to meet patients' energy and nutrient demands.Clinical ImplicationsEffective management of oral complications of therapy for cancer is necessary to facilitate oral intake throughout treatment. Oral health care professionals should be part of the multidisciplinary team helping meet the needs of patients during treatment.     

Dietary guidance for people wearing removable prostheses

BackgroundThe authors identified and described dietary strategies appropriate for dental patients who receive dental care that includes the placement and maintenance of dental prostheses.ConclusionsIdentification of a patient's perception of food choices associated with placement of a dental prosthesis can lead to delivery of patient-focused dietary guidance for the promotion of targeted food choices to improve oral health and systemic health. An interview guide for assessment of patient satisfaction and a guide for suggested dietary choices and modifications are provided.Clinical ImplicationsDental professionals can tailor food modification strategies and promote healthful food choices, enhance patient satisfaction and improve health outcomes.     

Under the Influence: Informing Oral Health Care Providers About Substance Abuse

Treating the drug addicted dental patient is different than treating the non-addicted patient due to differences related to the emotional/behavioral/personality issues of the addict, the addict's often poor general health and poor nutrition, ongoing problems of oral hygiene and the effects of drugs on the oral mucosa, gingiva and dentitionBackgroundOral health care providers need to be aware of the emerging trends in substance abuse, able to recognize patient's addicted to drugs and to be knowledgeable about the effects of substance abuse to provide the most efficacious treatment to avoid the consequences of contraindicated dental procedures and therapy. This article defines the scope of the problem of drug abuse and provides an overview of commonly abused substances and their effects on health and oral health.MethodsA review of the literature combined with the authors' extensive experience in the substance abuse field explains parameters of oral health care treatment of the drug addicted individual for patient and provider safety.ConclusionsThe drug culture has evolved and the drug user is different. Oral health care providers need to realize that any patient may be an addict in order to identify them, provide appropriate oral care and direct them, if they desire, toward appropriate treatment.     

Diet and prevention of oral cancer: strategies for clinical practice

BackgroundOral health care professionals can play an important role in preventing oral cancer by performing oral mucosal examinations to detect pre-cancerous changes and by educating patients about oral cancer prevention strategies, including dietary approaches.ConclusionsCurrent evidence supports a diet high in fruits, vegetables and plant-based foods for prevention of oral cancer. Dietary supplements—including vitamins and minerals—have not been shown to be effective as substitutes for a diet high in fruits and vegetables.Clinical ImplicationsIn addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillo-mavirus, clinicians should provide dietary advice for the prevention of oral cancer as part of routine patient education practices.     

Nutritional and dental issues in patients with intellectual and developmental disabilities

Background

People with intellectual and developmental disabilities are among the most disadvantaged and underserved groups of dental patients. Considerable health care disparities for this population have been identified, particularly oral and dental health as well as access to dental care services. People with Down syndrome and cerebral palsy have a variety of nutritional and dental considerations.

Diet,cardiovascular disease and oral health: Promoting health and reducing risk

BackgroundPrimary prevention of cardiovascular disease includes screening as well as education and risk-reduction efforts.MethodsThe author reviewed diet and nutritional risk factors for cardiovascular disease (CVD), as well as dietary approaches to reduce the risk of developing CVD. The author also presented applications for use in dental practice.ConclusionsThe multifaceted relationship between diet/nutrition, CVD and oral health supports the role of CVD risk-reduction strategies in dental practice.Clinical ImplicationsReinforcement of healthful lifestyle principles may help reduce patients' risk of developing CVD and improve their systemic and oral health.     

National Oral Health Policy and Financing and Dental Health Status in 19 Countries

ObjectiveDental caries in permanent teeth is one of the most common health issues—despite being preventable in early stages—due to inadequate regulation of preventive dental services in many countries. This study evaluates the association between regulation of preventive dental services and oral health outcomes.MethodsThis mixed-method study analysed data from 19 member countries of the Organisation for Economic Co-operation and Development (OECD). Oral health outcomes were measured using decayed missing and filled teeth (DMFT) indexes for children aged 12 to 18 years. Oral health expenditures were measured as a percentage of each country's gross domestic product (GDP). We conducted web-based research and systematically extracted and coded data on dental policy regarding children's preventive dental services. Preventive care was assessed based on legal policy mandating children receive preventive services, availability of free services for children, and regulation of the services provided. We assessed the relationship amongst oral health policy, outcomes, and expenditure using bivariate regression analysis.ResultsThe most common preventive policy category is the availability of free dental services for children (78.95%), and the least common is policy mandating dental services for children (26.32%). The oral health expenditure is correlated with DMFT index (−4.42, P < 0.05). The legal policy mandating dental services for children is correlated with DMFT index (−1.32, P < 0.05) and correlated with average oral health expenditure (0.16, P < 0.05).ConclusionsA percentage increase in oral health expenditure is associated with a 4.42 reduction in DMFT. The existence of legal policy mandating dental care for children is associated with a 1.32 reduction in mean DMFT score and a 0.16% increase in oral health expenditure. These findings highlight the importance of preventive care and may aid policymaking and health system reforms.     

Empowerment Through Mentorship and Leadership

Leadership is vital to future growth and change in the dental hygiene profession.Background and PurposeAs health care reform emerges, state practice acts expand and new models of dental hygiene practice are created and implemented, dental hygienists will assume leadership positions that may be quite different from the more traditional leadership roles they assume today. These dental hygienist leaders will envision, creatively design and implement oral health care programs to improve the oral health of the public. Mentoring, a vital component of leadership development, is critical for dental hygienists to acquire knowledge, guidance, and growth.MethodsThis paper provides a literature-supported overview of leadership and mentoring principles applicable to dental hygienists in their personal and professional lives. Opportunities for dental hygienists to assume leadership roles are also described.ConclusionsDental hygienists are poised to become leaders and vital members of the professional team promoting and integrating oral health care as a part of general health. Consequently, the dental hygienist's leadership roles are likely to expand and can be strengthened through mentoring relationships and mentoring teams. Ultimately, this can increase professional growth and career satisfaction for the dental hygienist as well as improve oral health care for the public.     

Dental lesions: Diagnosis and treatment

Oral health care has been an integral part of the care of patients with HIV infection and AIDS since the disease was first identified in the early eighties. The spectrum of HIV-associated opportunistic diseases occurring in the oral cavity propelled dental health care providers to the forefront of patient care. Infection control issues soon became important in oral health care for patients infected with HIV, and for the first decade these two issues overshadowed the concerns about appropriate management of the dental needs of HIV-infected patients. Several concerns need to be considered in the management of dental care for patients infected with HIV. These include decreased salivary flow and increased sugar intake, prevention and management of routine inflammatory gingival and periodontal disease as well as the atypical forms of gingival and periodontal disease associated with HIV infection (linear gingival erythema [LGE], necrotizing ulcerative gingivitis [NUG] and necrotizing ulcerative periodontitis [NUP]). Finally, although reports of complications secondary to dental treatment of HIV-infected individuals are rare, it is important to consider those factors related to the medical status of HIV-infected patients which may interfere with oral health care These include potential bleeding problems related to thrombocytopenia and disease or medication related liver abnormalities, increased risk of local infection particularly in patients with severe neutropenia and adverse effects of multiple medications taken by HIV patients. Prevention and management of dental and periodontal disease in HIV-infected individuals is important to self esteem, quality of life and maintenance of adequate nutritional intake. Oral health care continues to be an important component of overall health care for HIV-infected patients.     

Oral chronic graft-versus-host disease: What the general dental practitioner needs to know

BackgroundLong-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers.MethodsThe authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD).ResultsChronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management.ConclusionsGeneral dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration.Practical ImplicationsFrequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.     

Could oral health care professionals help increase human papillomavirus vaccination rates by engaging patients in discussions?

BackgroundOral health care professionals are well positioned to contribute to the prevention of human papillomavirus (HPV)–related oropharyngeal and other HPV-related cancers through engaging patients in conversations about HPV vaccination. This scoping review evaluates evidence regarding oral health care provider knowledge of, and discussion related to, HPV prevention, transmission, and associated risks, including oropharyngeal cancer. This review outlines relevant barriers to, and facilitators of, this knowledge and discussion. In addition, to determine the potential population that could be reached by an oral health care provider for a conversation about HPV vaccination, this review evaluates the prevalence of HPV vaccination as well as dental visits in a US population.Types of Studies ReviewedFour databases were systematically searched (MEDLINE [PubMed], EMBASE, APA PsycInfo, Cumulative Index to Nursing and Allied Health Literature). Studies written in English and conducted in the United States were eligible. Eligibility criteria were not restricted to publication year or oral health care provider type. Behavioral Risk Factor Surveillance System 2018 data were analyzed to evaluate the prevalence of HPV vaccination and dental visits among patients aged 18 through 49 years.ResultsAfter duplicate record removal and second-stage screening, 32 full-text articles were retrieved, and data were independently extracted by 2 reviewers. Twenty-four studies were included in this review. Knowledge regarding HPV prevalence, transmission, disease processes, and risks varied. In general, discussions related to HPV in dental settings were infrequent. Facilitators to improve knowledge and discussion included guidance from professional dental organizations, education, and communication skills. Behavioral Risk Factor Surveillance System data showed that most people who are not vaccinated have visited their oral health care providers in the past year, highlighting the potential role of oral health care providers regarding discussion of HPV and promoting awareness and acceptance of vaccination.Conclusions and Practical ImplicationsThis review indicates that discussions related to HPV were infrequent in the oral health care setting, which may be related to lack of knowledge and communication skills among oral health care professionals; however, evidence exists supporting the interest of oral health care professionals in improving vaccine uptake to prevent oropharyngeal cancer.     

Why Patients Visit Dentists – A Study in all World Health Organization Regions

ObjectiveThe dimensions of oral health–related quality of life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the major areas where patients are impacted by oral diseases and dental interventions. The aim of this study was to evaluate whether dental patients' reasons to visit the dentist fit the 4 OHRQoL dimensions.MethodsDentists (N = 1580) from 32 countries participated in a web-based survey. For their patients with current oral health problems, dentists were asked whether these problems were related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact or whether they do not fit the aforementioned 4 categories. Dentists were also asked about their patients who intended to prevent future oral health problems. For both patient groups, the proportions of oral health problems falling into the 4 OHRQoL dimensions were calculated.ResultsFor every 100 dental patients with current oral health problems, 96 had problems related to teeth, mouth, and jaws' function, pain, appearance, or psychosocial impact. For every 100 dental patients who wanted to prevent future oral health problems, 92 wanted to prevent problems related to these 4 OHRQoL dimensions. Both numbers increased to at least 98 of 100 patients when experts analyzed dentists' explanations of why some oral health problems would not fit the four dimension. For the remaining 2 of 100 patients, none of the dentist-provided explanations suggested evidence against the OHRQoL dimensions as the concepts that capture dental patients' suffering.ConclusionOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact capture dental patients' oral health problems worldwide. These 4 OHRQoL dimensions offer a psychometrically sound and practical framework for patient care and research, identifying what is important to dental patients.     

Oral health–related quality of life and unmet dental needs among women living with HIV

BackgroundOral health–related quality of life (OHRQoL) is a multidimensional, perception-based measure of how oral health affects social and physical functioning and self-image. OHRQoL is important for assessing women living with HIV (WLWH) who may have unmet dental needs and experience disparities that impact dental care accessibility.MethodsIn 2016, the authors conducted an assessment of OHRQoL among a national sample of 1,526 WLWH in the Women’s Interagency HIV Study using the Oral Health Impact Profile instrument, which assesses the frequency of 14 oral health impact items. OHRQoL was measured using multivariable linear regression with a negative binomial distribution to assess the association between report of a recent unmet dental need and OHRQoL.Results“Fair or poor” oral health condition was reported by 37.8% (n = 576) of WLWH. Multivariable linear regression showed that unmet dental needs had the strongest positive association with poor OHRQoL (difference in Oral Health Impact Profile mean, 2.675; P < .001) compared with not having unmet needs. The frequency of dental care utilization was not associated with higher OHRQoL. Older age, fair or poor dental condition, smoking, symptoms of anxiety and loneliness, and poor OHRQoL were also associated with worse OHRQoL.ConclusionSelf-perceived impact of oral health on social and physical function and self-image, as measured by OHRQoL, may be an easily assessable but underrecognized aspect of OHRQoL, particularly among women aging with HIV.Practical ImplicationsDentists should implement OHRQoL assessments in their management of the care of patients with HIV to identify those who do have significant oral health impacts.     

Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid

BackgroundReducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children’s dental care use, including the association with children’s oral health.MethodsA cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means.ResultsThe 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33).ConclusionsIt was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship.Practical ImplicationsOral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children’s oral health.     

A cross-sectional analysis of oral health care spending over the life span in commercial- and Medicaid-insured populations

BackgroundLife course theory creates a better framework to understand how oral health care needs and challenges align with specific phases of the life span, care models, social programs, and changes in policy.MethodsThe authors obtained data from the 2018 IBM Watson Multi-State Medicaid MarketScan Database (31 million claims) and the 2018 IBM Watson Dental Commercial and Medicare Supplemental Claims Database (45 million claims). The authors conducted analysis comparing per enrollee spending on fee-for-service dental claims and medical spending on oral health care for patients from ages 0 through 89 years.ResultsOral health care use rate and spending are lower during the first 4 years of life and in young adulthood than in other periods of life. Stark differences in the timing, impact, and severity of caries, periodontal disease, and oral cancer are seen between those enrolled in Medicaid and commercial dental plans. Early childhood caries and oral cancer occur more frequently and at younger ages in Medicaid populations.ConclusionsThis life span analysis of the US multipayer oral health care system shows the complexities of the current dental service environment and a lack of equitable access to oral health care.Practical ImplicationsHealth policies should be focused on optimizing care delivery to provide effective preventive care at specific stages of the life span.     

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.     

Supragingival and subgingival microbiota from patients with poor oral hygiene submitted to radiotherapy for head and neck cancer treatment

ObjectiveThis case-control study aimed to evaluate the effects of conventional radiotherapy (RT) on the prevalence and populations of oral microorganisms in head and neck cancer patients who did not receive adequate preventive dental care. It was hypothesized that side effects of radiotherapy could be associated with radiation dose, microbiological aspects, and socioeconomic conditions of the patients.DesignTwenty-eight dentate patients with head and neck cancer submitted to RT were included in the study. Radiation dose received varied from 4320 to 7020 cGy. Patients with the same demographic and health conditions, but no history of cancer or antineoplastic treatment were used as controls. Clinical examinations were carried out before RT, 15–22 days after starting RT, immediately after and 6 months after RT. Supra and subgingival biofilms were collected and cultivated onto selective and non-selective media. Isolates were identified by biochemical and physiological characteristics. Stimulated and unstimulated salivary flow rate and saliva buffer capacity were also determined.ResultsMucositis, dermatitis, xerostomia, dysgeusia, dysphagia and candidiasis were common after starting RT and during the treatment period. Xerostomia was followed by a decrease in salivary pH and buffer capacity, which showed association with the increase of cariogenic cocci and yeast populations, which were also associated with deterioration of hygiene. Candida and family Enterobacteriaceae showed increased prevalence with RT, and were associated with the occurrence of mucositis and xerostomia.ConclusionsModifications in oral biofilms of irradiated patients showed association with xerostomia and hygiene conditions, which reinforces the necessity of improving patient compliance to oral health care programs.     

Evaluating dietary intake in dental practices: doing it right

BackgroundIn three separate scenarios, the authors illustrate dietary assessment evaluations completed in dental settings by oral health care professionals (OHCPs) using time-efficient guidelines and targeted realistic patient education messages.ConclusionsPatients' responses to key questions can provide OHCPs with a road map for conducting dietary assessments and evaluations, selecting specific assessment approaches, and developing targeted patient nutrition and oral health education messages.Clinical ImplicationsTo individualize and enhance comprehensive patient care, OHCPs can conduct dietary assessments, evaluate results, refer patients when indicated, and provide patient nutrition and oral health education.     

Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations

BackgroundIn light of the uncertainty surrounding the incidence of bisphosphonate-associated osteonecrosis of the jaw (BON) and concomitant risk factors, dentists have questioned how to manage the care of patients receiving oral bisphosphonate therapy. Expert panelists were selected by the American Dental Association Council on Scientific Affairs on the basis of their expertise in the relevant subject matter and on their respective dental or medical specialties, and the panel was tasked with developing guidance for dentists treating these patients.MethodsThere are no data from clinical trials evaluating dental management of the care of patients receiving oral bisphosphonate therapy and, therefore, these recommendations are based on a thorough review of the available literature relating to bisphosphonate use and osteonecrosis of the jaw. After reviewing the literature, the panel developed these recommendations based on their expert opinion.ResultsThese panel recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of effective antibiotic therapy.ConclusionsThe recommendations are a resource for dentists to use in their practice, in addition to the dentist's own professional judgment, the information available in the dental and medical literature, and information from the patient's treating physician. The recommendations must be balanced with the practitioner's professional judgment and the individual patient's preferences and needs.