The oral management of oncology patients requiring radiotherapy, chemotherapy and/or bone marrow transplantation

Abstract

Patients undergoing cancer therapy may experience unwanted side-effects involving the oral cavity and more evidence is emerging regarding the management of these complications. These oral effects have both short and long-term implications. Dentists need to be aware of these implications and liaise closely with the oncology teams to establish pathways of oral care. This enables patients to have appropriate dental support in place before, during and after cancer therapy. This article is an executive summary of a review undertaken for a national clinical guideline, The Oral Management of Oncology Patients following Radiotherapy, Chemotherapy and/or Bone Marrow Transplanation. The full text is available on the FDS website: www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/

Physical and adhesive properties of dental enamel after radiotherapy and bonding of metal and ceramic brackets

“…[25][26][27] Thus, we tested adhesion after aging dental enamel through thermal cycling, using a total of 10,000 cycles at temperatures ranging from 5 C to 55 C to simulate approximately 1 to 2 years in the oral cavity. 30 The decision was made to age the teeth through thermal cycling because this was an in-vitro study, in which the type of storage solution and the frequency of the replacement of this solution could cause alterations in dental enamel that could affect the radiotherapy process.…”

“…Orthodontic intervention in patients after radiotherapy should be implemented when the patient has good general health and the risk of the recurrence of cancer has decreased. [25][26][27] However, the literature on the optimal period for postradiotherapy orthodontic intervention is sparse. The limited data vary between 1 year 25,26 and 2 years 27 after the end of radiotherapy.…”

“…28 In patients undergoing radiation therapy, the duration of orthodontic treatment should be short and involve light forces. 26,27 However, the bonding of orthodontic brackets may be compromised on dental surfaces altered by radiotherapy, leading to a frequent need for rebonding, which extends the length of orthodontic treatment. 28 The scarcity of information regarding the effects of radiation on the structure of tooth enamel and the absence of studies addressing the adhesion of orthodontic brackets to tooth surfaces justified the need to conduct this study, the aim of which was to evaluate the properties of tooth enamel and the bonding of metal and ceramic brackets on tooth enamel after radiotherapy.…”

The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women’s Cancer Center Multidisciplinary Guideline

“…The median time reported from initiation of RT to ORN onset is 13 months (range: 2–122 months) . For this reason, it is standard of care for patients to undergo dental evaluations prior to RT and to have infected teeth, teeth at high risk for infection, or teeth with a poor prognosis extracted at this time . It is also recommended that the remaining dentition be well‐maintained subsequent to completing RT in order to avoid future extractions and thus reduce the risk of developing ORN .…”

Oral Manifestations of Cancer Therapies: Advice for the Medical Team

“…At least 2 weeks before initiating cancer therapy, it is imperative that the patient undergoes a thorough periodontal and dental assessment to identify any preexisting oral concerns such as gingival infection, dental disease, or any fractured teeth that could potentially contribute to oral complications once the oncology treatment has begun. 1 Additionally, cryotherapy can be implemented with ice chips or ice water that is held in the patient's mouth during the chemotherapy session to reduce the incidence of developing oral mucositis. 2 This causes vasoconstriction and decreases the oral mucous membranes' exposure to the toxic medications.…”