Background: Treatment of head and neck cancers may cause sequelae affecting patients’ quality of life during and after treatment. As a result, periodontal management of a patient with parotid gland adenoid cystic carcinoma, particularly in advanced stage 4, can be challenging for dental practitioners, especially if the patient is on active oral molecular therapy and undergoing long-term radiotherapy and chemotherapy. Purpose: This report was intended to describe the conservative non-surgical management of tooth 27 with poor prognosis owing to grade II mobility in a patient on active Lenvatinib therapy – where the extraction was not advisable to lessen the risk of osteonecrosis. Case: A 52-year-old female patient was referred by an oncologist to our dental clinic for noncarious toothache. Five years ago, the patient was diagnosed with adenoid cystic carcinoma (ACC) and had a treatment history of radiotherapy, chemotherapy and surgical removal of the left parotid gland to manage the malignancy. Oral examination revealed characteristic findings of periodontitis. Case Management: Ultrasonic scaling, antimicrobial mouth rinses and reinforcement in oral hygiene instructions manage the tooth 27 conservatively. Conclusion: A cautious approach by the dental surgeon, together with the multidisciplinary team caring for cancer patients, is fundamental and helps with the palliative periodontal management of this patient to enhance oral health-related quality of life. With a lack of reports on conservative periodontal therapy in ACC patients, this report highlights the combination of smoking cessation, reinforcement of oral hygiene instructions and conservative periodontal treatment.
Temporomandibular joint disorder (TMD) refers to persistent medical conditions that affect the temporomandibular joint (TMJ) and related structures. Studies showed that stress was closely linked to the development of TMD. Furthermore, healthcare students are particularly susceptible to stress compared to the general population. This can have a negative impact on their quality of life and mental health during their training. The increased prevalence of TMD has also been reported among the same cohort of the population. However, there is a lack of literature published highlighting the prevalence of TMD and their association with increased levels of stress in dental students. This study aims to explore whether increased stress levels are associated with the prevalence of TMD in undergraduate dental students. A total of 218 dental students participated. Two online self-reported questionnaires consisted of structured case history on past medical and dental history with a Fonseca Amnestic Index (FAI) questionnaire used to identify the prevalence of TMD and DESS questionnaire for stress prediction were used. Data were analyzed using SPSS version 22 with a p-value less than 0.05. It was reported that about 48% of students had various TMD with no significant association found between the year of study and gender. However, a significant association was reported between stress gender. A positive correlation was also found between stress and TMD among participants. This study revealed a significant association between stress and the prevalence of TMD in undergraduate dental students. Educational institutions must adopt coping strategies to help trainees manage their psychological stress, which could reduce the incidence of TMD.
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