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

Abstract

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.

Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study

“…Likewise, Bonan et al [11] showed that most Brazilian patients with low socioeconomic level who are diagnosed with head and neck squamous cell carcinoma need complex dental treatment before radiotherapy due to severe periodontal disease and caries. On the other hand, the lack of spread preradiotherapy dental treatment protocols maintain advanced periodontal disease and radiation-related caries common problems within recent dental practice for irradiated patients in developing countries [11].…”

Oral microbiota and mucositis in patients with head and neck cancer undergoing radiotherapy: literature review

“…The occurrence and populations of autochthonous microorganisms of the oral microbiota may be higher among patients with head and neck squamous cell carcinoma 23 , but this phenomenon is not universal 12,19,20,48 . Alcohol and tobacco consumption and poor hygiene might facilitate oral colonization of the patients by exotic microbial species 12,20,48 .…”

“…Alcohol and tobacco consumption and poor hygiene might facilitate oral colonization of the patients by exotic microbial species 12,20,48 . Patients with severe xerostomia are generally colonized by some Gram-negative microaerophilic and anaerobic bacteria.…”

“…Moreover, since most of patients undergoing RT in Brazil for cancer treatment present low socioeconomic conditions and inadequate oral hygiene standards 20,48,55 , the relevance of protocols capable to restore the equilibrium between patients' immune response and microbial biofilm should be considered priority in the prevention of side effects of RT. Moreover, ameliorate xerostomia by using sialogogues and artificial saliva is considered relevant to reduce the impact of RT on oral ecology and, as consequence on severity of mucositis.…”

Maxillary osteoradionecrosis – review of published literature: incidence, classification, risk factors, physiopathology and prevention

“…The authors found that pre-RT extractions do not seem to reduce the risk of ORN, and teeth with good condition do not require prophylactic extraction for the sole purpose of preventing ORN in the future 29 . Bonan et al 30 (2006) in a study with a much smaller cohort of 40 patients with head and neck cancer and poor oral hygiene received dental treatment before radiotherapy. The most common treatment performed was dental extractions with an average of 8.6 extracted teeth per patient; five of them developed ORN later.…”