Oral management of patients following oncology treatment: literature review

doi:10.1054/bjom.2000.0468

British Journal of Oral and Maxillofacial Surgery

Volume 38, Issue 5, October 2000, Pages 519-524

https://doi.org/10.1054/bjom.2000.0468 Get rights and content

Abstract

Many tumours of the head and neck are treated by clinical oncologists using radiotherapy. This treatment modality is particularly effective in destroying rapidly dividing cells, hence its value in cancer treatment. The tissues of the oral mucosa, the salivary glands and blood vessels can be damaged as the result of radiotherapy treatment. As a result, patients experience unwanted oral effects that have both short and long-term implications. The outlook following treatment for head and neck cancer continues to improve and, as people keep their teeth into later life, dentists will increasingly be expected to address the oral problems that patients experience after radiotherapy. The aim of this article is to review the current literature concerning the implications and management of these oral implications of cancer treatment.

References (43)

P.B. Lockhart et al.
Pre-therapy dental status of patients with malignant conditions of the head and neck
Oral Surg Oral Med Oral Pathol
(1994)
F.K.L. Spijkervet et al.
Effect of chlorhexidine rinsing on the oropharyngeal ecology in patients with head and neck cancer who have irradiation mucositis
Oral Surg Oral Med Oral Pathol
(1989)
L. Clayman
Clinical controversies in oral and maxillofacial surgery: Part two. Management of dental extractions in irradiated jaws: a protocol without hyperbaric oxygen
J Oral Maxillofac Surg
(1997)
E. Peters et al.
Assessment of post-endodontic asymptomatic periapical radiolucencies in bone marrow transplant recipients
Oral Surg Oral Med Oral Pathol
(1993)
E.D. Vaughan et al.
Improvements in morbidity of mouth cancer using microvascular free-flap reconstructions
J Maxillofac Surg
(1992)
J.B. Epstein et al.
Benzydamine hydrochloride in prevention and management of pain in oral mucositis associated with radiation therapy
Int J Radiat Oncol Bio Phys
(1986)
G.A. Ferretti et al.
Chlorhexidine prophylaxis for chemotherapy and radiotherapy induced stomatitis: a randomised double blind trial
Oral Surg Oral Med Oral Pathol
(1990)
V. Ramirez-Amador et al.
Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy
Oral Surg Oral Med Oral Pathol Radiol Endod
(1997)
P. Barkvoll et al.
Effect of nystatin and chlorhexidine digluconate on Candida albicans
Oral Surg Oral Med Oral Pathol
(1989)
G.D. Stafford et al.
The effect of overnight drying and water immersion on candidal colonization and properties of complete dentures
J Dent
(1986)

P.M. Finlay et al.

An evaluation of functional outcome after surgery and radiotherapy for intra-oral cancer

Br J Oral Maxillofac Surg

(1992)

G.F. Sinclair et al.

New design for an artificial saliva reservoir for the mandibular complete denture

J Prosthet Dent

(1996)

T.A. Makkonen et al.

Dental extractions in relation to radiation therapy of 224 patients

Int J Oral Maxillofac Surg

(1987)

P. Reher et al.

Therapeutic ultrasound for osteoradionecrosis: an in vitro comparison between 1 MHz and 45 kHz machines

Eur J Cancer

(1998)

P. Townsend

Poverty in the United Kingdom

(1979)

D. Blane

Inequality and social class. Sociology applied to medicine

(1997)

S. Joyston-Bechal

Prevention of dental diseases following radiotherapy and chemotherapy

Int Dent J

(1992)

K. Calman et al.

A Policy Framework for Commissioning Cancer Services: A report by the expert advisory group on Cancer to the Chief Medical Officers of England and Wales

Department of Health

(1995)

S.A. Fayle et al.

Oral problems and the dentists role in the management of paediatric oncology patients

Dental Update

(1992)

S.H. Okuno et al.

A randomized trial of a nonabsorbably antibiotic lozenge given to alleviate radiation-induced mucositis

Cancer

(1997)

M.R. Cohen et al.

Topical anaesthesia and swallowing

JAMA

(1976)

Cited by (26)

Effect of ionizing radiation on properties of restorative materials
2018, Dental Materials
Citation Excerpt :
Ionizing radiation may be one of these factors [10]. Physicians often recommend dental treatment to patients just before head and neck radiotherapy [11–13]. Such treatment usually requires replacement of metal-based restorations by polymer-based restorative materials [10,12,14].
To evaluate the effect of ionizing radiation from high energy X-ray on properties of restorative materials.
Study materials (3M-ESPE) were: Z250—microhybrid resin-based composite (Filtek Z-250); Z350—nanofilled resin-based composite (Filtek Z-350XT); VIT—resin-modified glass ionomer cement (Vitremer); and KME—conventional glass ionomer cement (Ketac Molar Easymix). Sixty bar-shaped and cylinder-shaped specimens were fabricated from each material. Specimens were light activated (980 mW/cm², Radii, SDI) for 60 s (3 × 20 s for Z250 and Z350) and 120 s (3 × 40 s for VIT) and thirty specimens from each shape were irradiated (IR) with 1.8 Gy/day for 39 days (total IR = 70.2 Gy). IR and non-irradiated (NI) specimens were evaluated for flexural strength (σ, n = 30) followed by fractography (SEM), diametral tensile strength (DTS, n = 30), hardness (H, n = 10), surface roughness (R_a, n = 10) and chemical composition (n = 3). The IR effect on each material property was statistically analyzed using Student’s t test (α = 0.05). Data from σ and DTS were also analyzed using Weibull statistics.
IR significantly increased the mean σ values of VIT and KME and the mean DTS value of VIT (p < 0.05). IR increased R_a and H values for VIT and decreased H value for Z-250 (p < 0.05). The remaining materials and properties were not significantly affected by IR (p > 0.05). There was no significant change on materials composition after IR.
The recommended radiotherapy protocol for head and neck cancer altered some material properties, mainly for glass ionomer cements. Such variations on material properties are not related to chemical composition changes.
Early HPV-related tonsil cancer
2017, Oral, Head and Neck Oncology and Reconstructive Surgery
Dental treatment planning and management for the mouth cancer patient
2010, Oral Oncology
Citation Excerpt :
A thorough understanding of the cancer diagnosis and stage, planned cancer therapy and dentition status is required to help the dentist and dental specialist to plan and schedule dental treatment appropriately. The patient’s oncologist should provide information related to previous and planned cancer therapy.10 Head and neck cancer patients are often confused as to why they are being referred to see a dentist and it is important to explain the purpose of the dental pretreatment evaluation – which is also the opportunity to educate the patient regarding short-term and long-term oral complications from cancer therapy and their important role in maintaining dental health.
The need to deliver cancer treatment promptly often requires modification of ideal dental treatment plans. Treatment planning and preventive care is crucial and needs to be done before radiotherapy in order to avoid complications such as osteoradionecrosis. Rapid delivery of this dental care can only be achieved if oral care is given adequate priority in the patient care pathway. Few cancer centres have the resources to provide comprehensive dental care and thus, in most circumstances, this care has to be provided by the patient’s dentist and dental care professional, with advice from the local dental oncology specialist team.
Psychosocial and Economic Impact of Cancer
2008, Dental Clinics of North America
Citation Excerpt :
Among all cancer survivors, the long-term health consequences of therapy, particularly radiotherapy, often include oral complications [105]. Hyposalivation, which has been associated with altered taste and difficulty swallowing, also may affect cancer survivors, leading to nutritional deficiencies and weight loss long after the end of therapy [105–107]. As mentioned previously, another consequence of exposure to radiation and chemotherapy is osteonecrosis of bones in the jaw, a painful and debilitating complication often requiring surgical resection [68,105].
This article explores the psychosocial and economic implications of cancer and their relevance to the clinician. After a general overview of the topic, the authors focus on aspects of particular importance to the dental professional, including the psychosocial and economic implications of the oral complications of cancer and its therapy, head and neck cancers, and special issues among children with cancer and cancer survivors.
Children's acceptance and tolerance of chlorhexidine and benzydamine oral rinses in the treatment of chemotherapy-induced oropharyngeal mucositis
2004, European Journal of Oncology Nursing
Oral care is of great importance in the prevention of chemotherapy-induced oropharyngeal mucositis. Although considerable attention has been given in improving oral care practices, patients’ acceptance and tolerance of oral rinses is a continuing problem in oral care. A randomized crossover design was used to determine the relative acceptability and tolerability of chlorhexidine and benzydamine oral rinse agents in children receiving chemotherapy. At the end of the study, each subject was asked to compare these two agents in relation to stinging and taste, as well as his/her perception in reducing mucositis. Thirty-four children aged 6–17 years completed two courses of chemotherapy during which they alternately practiced oral care using chlorhexidine then benzydamine or benzydamine then chlorhexidine. All of the children tolerated the agents well and continued with rinsing throughout the study. Only a few children had to resort to diluting the agents with normal saline or water. Fifty-nine percent of children reported that the stinging associated with benzydamine was more accepted than chlorhexidine. The taste of both these agents was accepted by 50% of children. Approximately 60% of children reported that chlorhexidine was more helpful than benzydamine in reducing mucositis. About 47% and 50% of them preferred chlorhexidine and benzydamine in their subsequent chemotherapy, respectively. In conclusion, chlorhexidine and benzydamine are acceptable and well-tolerated by children over the age 6 years old.
Bei der Verhinderung der oropharyngealen Mukositis während der Chemotherapie spielt die Mundhygiene eine bedeutende Rolle. Obwohl der Verbesserung der Mundpflegetechnik viel Aufmerksamkeit gewidmet wurde, bleibt bei der Mundpflege die Akzeptanz und Verträglichkeit von Mundspülungen often. In einer randomisierten, gekreuzten Studie wurde die Akzeptanz und Verträglichkeit von Chlorhexidin und Benzydamin bei Kindern unter Chemotherapie geprüft. Bei Studienende sollte jeder Proband die beiden Stoffe in Bezug auf Brennen und Geschmack vergleichen, sowie seinen Eindruck bezüglich Wirkung des Präparats bei der Verminderung von Mukositis schildern. Während jeweils zwei Chemotherapiebehandlungen benutzten 34 Kinder zwischen 6 und 17 Jahren bei der Mundhygiene abwechselnd zunächst Chlorhexidin und dann Benzydamin oder zunächst Benzydamin, dann Chlorhexidin. Alle Kinder vertrugen die Wirkstoffe gut und führten die Spülungen während der ganzen Studiendauer durch. Nur wenige Kinder mussten die Spüllösungen mit Kochsalzlösung oder Wasser verdünnen 59% der Kinder gaben an, dass sie das durch Benzydamin verursachte Brennen besser vertrugen als das Brennen durch Chlorhexidin. Den Geschmack beider Stoffe akzeptierten 50% der Kinder. Etwa 60% der Kinder berichteten, dass sie Chlorhexidin bei der Verminderung von Mukositis als wirksamer empfanden. Etwa 47% der Kinder zogen während der nachfolgenden Chemotherapie Chlorhexidin vor, etwa 50% bevorzugten Benzydamin. Abschließend wird die Akzeptanz und Verträglichkeit von Chlorhexidin und Benzydamin bei Kindern über 6 Jahren als gut bezeichnet.
Prevention of oral mucositis in paediatric patients treated with chemotherapy: A randomised crossover trial comparing two protocols of oral care
2004, European Journal of Cancer
Citation Excerpt :
In fact, the studies on chlorhexidine are difficult to interpret and compare because of differences in the underlying disease, the chosen cancer therapy, the patient's age and the rinse schedules. As chlorhexidine has been shown to reduce oral bacterial and fungal colonisation, some studies support its prophylactic use in patients receiving myelosuppressive therapy [8,19]. Benzydamine is a non-steroidal drug with anti-inflammatory, anaesthetic and antimicrobial properties [20].
This study compared the efficacy of two protocols for oral care using either chlorhexidine or benzydamine as oral rinses to alleviate mucositis in children undergoing chemotherapy. Eligible participants were randomised to receive either protocol for 3 weeks in a two-period crossover design. The occurrence of ulcerative lesions and severity of mucositis were measured at baseline and twice weekly, using the modified Oral Assessment Guide (OAG). Data were continuously analysed by plotting them directly on predefined sequential charts. According to this sequential analysis, the study could be terminated at the 34th within subject comparison, with a statistically significant reduction in ulcerative lesions (P<0.05) and severity of mucositis (P<0.05) in children on the chlorhexidine protocol. These findings suggest that chlorhexidine together with oral care might be helpful in alleviating mucositis when given prophylactically to children on chemotherapy, but the therapeutic benefit needs to be confirmed in a larger trial.

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Regular ArticleOral management of patients following oncology treatment: literature review

Abstract

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

J Maxillofac Surg

Int J Radiat Oncol Bio Phys

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol Radiol Endod

Oral Surg Oral Med Oral Pathol

J Dent

Br J Oral Maxillofac Surg

J Prosthet Dent

Int J Oral Maxillofac Surg

Eur J Cancer

Poverty in the United Kingdom

Inequality and social class. Sociology applied to medicine

Prevention of dental diseases following radiotherapy and chemotherapy

Int Dent J

A Policy Framework for Commissioning Cancer Services: A report by the expert advisory group on Cancer to the Chief Medical Officers of England and Wales

Department of Health

Oral problems and the dentists role in the management of paediatric oncology patients

Dental Update

A randomized trial of a nonabsorbably antibiotic lozenge given to alleviate radiation-induced mucositis

Cancer

Topical anaesthesia and swallowing

JAMA

Regular Article
Oral management of patients following oncology treatment: literature review