Dental disease before radiotherapy in patients with head and neck cancer

Abstract

Background No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in head and neck cancer (HNC) patients. An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad) (1U01DE022939-01), is addressing this knowledge gap. The present manuscript evaluates the level of pre-RT dental disease in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made pre-RT. Methods As part of OraRad, caries, periodontal disease, dental recommendations, and dental interventions performed pre-RT were assessed. Results Baseline measures are reported for 356 participants (77% male) with mean (SD) age 59.9 (11.0) years. Measures included mean number of teeth (22.9), participants with at least one tooth with caries (37.2%), and participants with at least 1 tooth with probing depth ≥5 mm (47.4%). Factors associated with less extensive pre-RT dental disease included having at least a high school diploma, having dental insurance, history of routine dental care, and a smaller tumor size (T1 or T2). Based on the pre-RT dental examination, 163 (49.5%) participants had dental treatment recommended before RT, with extractions recommended most frequently. Conclusion Many HNC patients require dental treatment pre-RT; over one-third require extractions. Practical Implications Most HNC patients have some level of dental disease at the start of RT, indicating the importance of pre-RT dental evaluation. By observing dental outcomes post-RT, OraRad has the potential to determine best dental treatment recommendations for HNC patients.

Hospital and oncological dental care: a series of cases

“…Radiation therapy has a site-specific effect, whereas chemotherapy has a systemic effect. These two latter modalities cause disturbances in the integrity and function of the oral cavity because they are not able to destroy tumor cells without causing damage or death to normal cells [1,3,4,11].…”

“…In view of the complications resulting from cancer treatments, discomfort and pain may be responsible for causing a nutritional deficit, altered immune response and a longer hospital stay, and may even trigger a sepsis and expose the patient to a greater risk of life. However, oral alterations can be minimized with the support of the multidisciplinary team and commitment of the dental surgeon in the clinical management of the patient in cancer treatment [1][2][3]17].…”

“…The most frequently used forms of antineoplastic therapy are radiation therapy, chemotherapy and surgery. Each of them acts in a different way, but, within their specificities, they all have some potential to cause side effects in the oral cavity [1,[3][4][5][6].…”

A New Phantom for Individual Verification of the Dose Distribution in Precision Radiotherapy for Head-and-Neck Cancer

“…This would ensure that measurements can be carried out, with or without metallic fillings, without major modifications of the phantom. The phantom should be usable for various issues related to the dose distribution of external beam radiotherapy, brachytherapy and stereotactic radiotherapy (13)(14)(15)(16)(17)(18). Moreover, it should be usable for magnetic resonance (MR)-imaging.…”

Strategies for the dentist management of cancer patients: narrative literature review

“…The dental surgeon must diagnose and treat the RT acute oral toxicities 24 (OM [25][26][27] , dysgeusia, 12,22,28,29 infections, pain, and xerostomia) (Table 3), that implicate an inability to eat, speak, clean, increased costs with hospitalization, and reduced quality of life. [30][31][32][33] Nutritional care, constant water intake, and use of salivary substitutes are recommended 12,93 In a recent study, the use of zinc-L-carnosine demonstrated encouraging results in the treatment of dysgeusia in these patients 94…”