Oral Complications in Patients with Advanced Cancer

Identification of taste abnormalities can help understand difficulties in nutrition. We evaluated 15 hospice inpatients with advanced cancer for subjective taste changes. The majority had both subjective and objective taste changes. Most thought all food was tasteless followed by loss of sweet sensation and meat aversion. About half of the participants exhibited anorexia and weight loss with decreased energy intake. Both detection and recognition thresholds for these basic tastes were abnormal for the majority of participants. Reduced sensitivity for sweet and salt taste and altered perception for sour predominated in formal taste testing.

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“…Potential causes of taste changes, eg thrush, dentures, dry mouth, and medication were also sought on day 1 using a standard checklist. 6,16–18…”

Section: Methodsmentioning

confidence: 99%

A Pilot Study of Taste Changes Among Hospice Inpatients With Advanced Cancer

Mahmoud

Aktaş

Walsh

et al. 2011

Am J Hosp Palliat Care

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“…Taste disorders, including taste loss and taste distortion, can substantially decrease quality of life and contribute to depression, anorexia and malnutrition [ 1 - 5 ]. While etiological studies have suggested the association of a range of conditions and diseases with taste impairment, the underlying cellular and molecular mechanisms of taste disorders remain largely unknown [ 2 , 5 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Lipopolysaccharide-induced inflammation attenuates taste progenitor cell proliferation and shortens the life span of taste bud cells

et al. 2010

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BackgroundThe mammalian taste bud, a complex collection of taste sensory cells, supporting cells, and immature basal cells, is the structural unit for detecting taste stimuli in the oral cavity. Even though the cells of the taste bud undergo constant turnover, the structural homeostasis of the bud is maintained by balancing cell proliferation and cell death. Compared with nongustatory lingual epithelial cells, taste cells express higher levels of several inflammatory receptors and signalling proteins. Whether inflammation, an underlying condition in some diseases associated with taste disorders, interferes with taste cell renewal and turnover is unknown. Here we report the effects of lipopolysaccharide (LPS)-induced inflammation on taste progenitor cell proliferation and taste bud cell turnover in mouse taste tissues.ResultsIntraperitoneal injection of LPS rapidly induced expression of several inflammatory cytokines, including tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and interleukin (IL)-6, in mouse circumvallate and foliate papillae. TNF-α and IFN-γ immunoreactivities were preferentially localized to subsets of cells in taste buds. LPS-induced inflammation significantly reduced the number of 5-bromo-2'-deoxyuridine (BrdU)-labeled newborn taste bud cells 1-3 days after LPS injection, suggesting an inhibition of taste bud cell renewal. BrdU pulse-chase experiments showed that BrdU-labeled taste cells had a shorter average life span in LPS-treated mice than in controls. To investigate whether LPS inhibits taste cell renewal by suppressing taste progenitor cell proliferation, we studied the expression of Ki67, a cell proliferation marker. Quantitative real-time RT-PCR revealed that LPS markedly reduced Ki67 mRNA levels in circumvallate and foliate epithelia. Immunofluorescent staining using anti-Ki67 antibodies showed that LPS decreased the number of Ki67-positive cells in the basal regions surrounding circumvallate taste buds, the niche for taste progenitor cells. PCR array experiments showed that the expression of cyclin B2 and E2F1, two key cell cycle regulators, was markedly downregulated by LPS in the circumvallate and foliate epithelia.ConclusionsOur results show that LPS-induced inflammation inhibits taste progenitor cell proliferation and interferes with taste cell renewal. LPS accelerates cell turnover and modestly shortens the average life span of taste cells. These effects of inflammation may contribute to the development of taste disorders associated with infections.

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“…Drug-related xerostomia is also highly prevalent in people at the end of life. 2,3 Cancer treatment can cause salivary dysfunction 3 and painful oral mucositis and stomatitis, 2,4 hindering proper oral hygiene. Poor oral hygiene and low salivary flow increase the risk of dental caries.…”

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confidence: 99%

Dental Caries in Older Adults in the Last Year of Life

Chen

Clark

Preisser

et al. 2013

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Older adults experience dramatic declines in health and function at the end of life. These complex physiological, psychological and functional changes may substantially increase risk of dental caries. This study’s objective was to examine dental caries severity (measured by number of carious teeth) in older adults in the last year of life. DESIGN Cross-sectional study based on dental records SETTING A community-based geriatric dental clinic PARTICIPANTS 1216 older adults aged 65 or above, including 168 individuals in the last year of life (e.g., individuals died within one year after their new patient exams). MEASUREMENTS Participants’ socioeconomics, medical history, medications, functional status and oral health measures, including number of carious teeth, were abstracted from dental records. End-of-life status was determined using the National Death Index. Propensities of death were first calculated using a logistic regression, then adjusted together with mobility and oral care function in the multivariable regression model to examine the impact of end-of-life status on dental caries. RESULTS Caries severity differed in end-of-life participants with different oral care function. Among those needing help with oral care, end-of-life participants had only slightly elevated and non-statistically significant risk (7.5 vs. 6.1, adjusted IDR= 1.12, 95% CI=0.85–1.48) to have more carious teeth than those not in the last year of life. However, caries severity decreased among end-of-life participants without impaired oral care function (IDR=0.53, 95% CI: 0.30–0.92). CONCLUSION Oral care function modifies the association between caries severity and end-of-life status. Individuals who could maintain oral hygiene independently had a relatively low level of caries at the end of life; however, dental caries had increased before functionally-dependent patients entered their last year of life.

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Oral Complications in Patients with Advanced Cancer

Cited by 15 publications

References 94 publications

A Pilot Study of Taste Changes Among Hospice Inpatients With Advanced Cancer

A Pilot Study of Taste Changes Among Hospice Inpatients With Advanced Cancer

Lipopolysaccharide-induced inflammation attenuates taste progenitor cell proliferation and shortens the life span of taste bud cells

Dental Caries in Older Adults in the Last Year of Life

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