1
|
Peřina V, Šmucler R, Němec P, Barták V. Update on Focal Infection Management: A Czech Interdisciplinary Consensus. Int Dent J 2024; 74:510-518. [PMID: 38044216 PMCID: PMC11123548 DOI: 10.1016/j.identj.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The focal infection theory has been used to explain several chronic systemic diseases in the past. Systemic diseases were thought to be caused by focal infections, such as caries and periodontal diseases, and dentists were held responsible for these diseases due to the spread of oral infections. As knowledge of the interrelationship between oral microorganisms and the host immune response has evolved over the last few decades, the focal infection theory has been modified in various ways. The relationship between oral and systemic health appears to be more complex than that suggested by the classical theory of focal infections. Indeed, the contribution of the oral microbiota to some systemic diseases is gaining acceptance, as there are strong associations between periodontal disease and atherosclerotic vascular disease, diabetes, and hospital-associated pneumonia, amongst others. As many jurisdictions have various protocols for managing this oral-systemic axis of disease, we sought to provide a consensus on this notion with the help of a multidisciplinary team from the Czech Republic. METHODS A multidisciplinary team comprising physicians/surgeons in the specialities of dentistry, ear-nose and throat (ENT), cardiology, orthopaedics, oncology, and diabetology were quetioned with regard to their conceptual understanding of the focal infection theory particularly in relation to the oral-systemic axis. The team also established a protocol to determine the strength of these associations and to plan the therapeutic steps needed to treat focal odontogenic infections whenever possible. RESULTS Scoring algorithms were devised for odontogenic inflammatory diseases and systemic risks, and standardised procedures were developed for general use. CONCLUSIONS The designed algorithm of the oral-systemic axis will be helpful for all health care workers in guiding their patient management protocol.
Collapse
Affiliation(s)
- Vojtěch Peřina
- Department of Oral and Maxillofacial Surgery, Masaryk University, Faculty of Medicine and University Hospital Brno, Brno, Czech Republic; Czech Dental Chamber, Prague, Czech Republic.
| | - Roman Šmucler
- Czech Dental Chamber, Prague, Czech Republic; Department of Stomatology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Stomatology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - Petr Němec
- Department of Cardiovascular Surgery and Transplantations, Masaryk University, Faculty of Medicine and St. Anne´s University Hospital, Brno, Czech Republic
| | - Vladislav Barták
- 1. Orthopedic Clinic of the 1st Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| |
Collapse
|
2
|
Olofsson R, Korytowska M, Almhöjd U, Almståhl A, Cevik-Aras H. Oral health, dental treatment, and medication related osteonecrosis of the jaw in multiple myeloma - a longitudinal cohort study. BMC Oral Health 2024; 24:184. [PMID: 38317122 PMCID: PMC10840162 DOI: 10.1186/s12903-024-03943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The objective of the present study was to investigate oral health status, oral health related quality of life, and identify risk factors associated with invasive dental treatment and medication related osteonecrosis of the jaw in patients with multiple myeloma. MATERIAL AND METHODS Patients newly diagnosed with multiple myeloma (n = 144) referred between January 2015 and September 2022 were retrospectively included. The patients underwent a thorough clinical and radiological oral examination and odontogenic infections were treated before the start of bisphosphonate treatment. The patients were followed annually, including clinical and radiological examinations. The oral health related quality of life was investigated by the OHIP-14 questionnaire. RESULTS Dental treatment (RR = 7.75), receiving combination antineoplastic therapy≥3 (RR =4.13), periodontitis (RR = 4.21), and reduced number of teeth (RR = 2.87) were associated with an increased risk of medication related osteonecrosis of the jaw. The response rate of the OHIP-14 questionnaire was 70.2%. Oral pain or discomfort in the mouth related to the medical treatment was reported by 30.5%. CONCLUSION Dental screening and treatment planning in patients with Multiple Myeloma may result in fewer oral infections and fewer interruptions of the medical treatment of myeloma.
Collapse
Affiliation(s)
- Richard Olofsson
- Specialist Clinic for Orofacial Medicine Uddevalla - Trollhättan, Public Dental Service, Region Västra Götaland, Uddevalla, Sweden.
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | - Magdalena Korytowska
- Specialist Clinic for Orofacial Medicine, Karlstad, Public Dental Service, Region Värmland, Sweden
- Department of Oral Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
| | - Ulrica Almhöjd
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annica Almståhl
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Section 4 - Oral health, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Hülya Cevik-Aras
- Specialist Clinic for Orofacial Medicine Uddevalla - Trollhättan, Public Dental Service, Region Västra Götaland, Uddevalla, Sweden
- Department of Oral Pathology and Medicine, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
3
|
Talekar AL, Musale PK, Kothare SS. Dental Caries and Dental Anomalies in Children Undergoing Chemotherapy for Malignant Diseases. Int J Clin Pediatr Dent 2022; 15:428-432. [PMID: 36875976 PMCID: PMC9983583 DOI: 10.5005/jp-journals-10005-2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose The study aims to evaluate the prevalence of dental caries and anomalies in pediatric patients undergoing chemotherapy or those who have completed chemotherapy. Methods A total of 250 pediatric patients within the age group of 6 months to 17 years, either admitted to hospitals for chemotherapy or on follow-up, were included as a part of the study. Complete oral examination inclusive of the diet history, oral hygiene methods, past dental history, the decayed, missing, and filled teeth (DMFT), def score, and any dental anomaly was diagnosed clinically and radiographically using an orthopantomogram. The samples were further categorized under type of malignancies and duration of chemotherapeutic drug usage groups (from 6 months to 10 years and more than 10 years) to establish a correlation of these variables with the prevalence of dental caries and dental anomalies. Results Among all patients, 108 (43.2%) had completed the treatment (chemotherapy), while 142 (56.8%) were undergoing the treatment. Forty-three (17.2%) patients showed positive findings for dental anomalies. Conclusion The present study confirms the strong positive correlation between long-term exposure to chemotherapeutic agents and the prevalence of dental anomalies and dental caries in children. How to cite this article Talekar AL, Musale PK, Kothare SS. Dental Caries and Dental Anomalies in Children Undergoing Chemotherapy for Malignant Diseases. Int J Clin Pediatr Dent 2022;15(4):428-432.
Collapse
Affiliation(s)
- Abhinav Liladhar Talekar
- Department of Pediatric and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences & Research Centre, Pune, Maharashtra, India
| | - Prasad K Musale
- Department of Pediatric and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences & Research Centre, Pune, Maharashtra, India
| | - Sneha Sunil Kothare
- Department of Pediatric and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences & Research Centre, Pune, Maharashtra, India
| |
Collapse
|
4
|
Olsson J, Mattsson U, Bültzingslöwen IV, Pettersson B, Warfvinge G, Ljunggren A. Pre-medical dental evaluation and treatment of oral infection - a survey study among hospital-affiliated dentists in Sweden. Acta Odontol Scand 2022; 80:29-37. [PMID: 34107238 DOI: 10.1080/00016357.2021.1934535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention. MATERIALS AND METHODS A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis. RESULTS Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%. CONCLUSION Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof.
Collapse
Affiliation(s)
- Jenny Olsson
- Section of Oral Biology and Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ulf Mattsson
- Section of Oral Biology and Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Inger von Bültzingslöwen
- Department of Oral Microbiology and Immunology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
| | - Bo Pettersson
- Department of Orofacial Medicine, Vrinnevi Hospital in Norrköping, Östergötland, Sweden
| | - Gunnar Warfvinge
- Section of Oral Biology and Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anna Ljunggren
- Section of Oral Biology and Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| |
Collapse
|
5
|
Lajolo C, Rupe C, Gioco G, Troiano G, Patini R, Petruzzi M, Micciche’ F, Giuliani M. Osteoradionecrosis of the Jaws Due to Teeth Extractions during and after Radiotherapy: A Systematic Review. Cancers (Basel) 2021; 13:cancers13225798. [PMID: 34830954 PMCID: PMC8616343 DOI: 10.3390/cancers13225798] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 01/10/2023] Open
Abstract
Teeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor. METHODS This systematic review was conducted according to PRISMA protocol, and the PROSPERO registration number was CRD42018079986. An electronic search was performed on the following search engines: PubMed, Scopus, and Web of Science. A cumulative meta-analysis was performed. RESULTS Two thousand two hundred and eighty-one records were screened, and nine were finally included. This systematic review revealed an ORN incidence of 5.8% (41 patients out of 462, 95% CI = 2.3-9.4); 3 ORN developed in the maxilla. No other clinical risk factors were detected. CONCLUSION Post-RT teeth extractions represent a major risk factor for ORN development, especially in the mandible, with a diminishing trend in the last years. Further research on other possible risk factors might improve this evidence.
Collapse
Affiliation(s)
- Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.L.); (C.R.)
- School of Dentistry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.L.); (C.R.)
- School of Dentistry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gioele Gioco
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.L.); (C.R.)
- School of Dentistry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: (G.G.); (R.P.)
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (G.T.); (M.G.)
| | - Romeo Patini
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.L.); (C.R.)
- School of Dentistry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: (G.G.); (R.P.)
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy;
| | - Francesco Micciche’
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michele Giuliani
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (G.T.); (M.G.)
| |
Collapse
|
6
|
Skallsjö K, Johansson JE, Jonasson P, Hasséus B. Apical periodontitis as potential source of infection in patients with lymphoma treated with chemotherapy. Clin Oral Investig 2019; 24:133-140. [DOI: 10.1007/s00784-019-02909-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/09/2019] [Indexed: 12/22/2022]
|
7
|
Antibiotic Prophylaxis for Dental Treatment in Patients with Immunodeficiency. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:819-823. [PMID: 30677537 DOI: 10.1016/j.jaip.2019.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 01/19/2023]
Abstract
Routine antibacterial prophylaxis is recommended before dental procedures in select patient populations. Currently, no guidelines are in place for routine prophylaxis before dental procedures in patients with primary immunodeficiency diseases. We review risk factors and provide recommendations on routine dental care and antibacterial prophylaxis in patients with primary immunodeficiency diseases.
Collapse
|
8
|
Cardoso RC, Qazali A, Zaveri J, Chambers MS, Gunn GB, Fuller CD, Lai SY, Mott FE, Hutcheson KA. Self-reported oral morbidities in long-term oropharyngeal cancer survivors: A cross-sectional survey of 906 survivors. Oral Oncol 2018; 84:88-94. [DOI: 10.1016/j.oraloncology.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 01/30/2023]
|
9
|
Usmani S, Choquette L, Bona R, Feinn R, Shahid Z, Lalla RV. Transient bacteremia induced by dental cleaning is not associated with infection of central venous catheters in patients with cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:286-294. [PMID: 29428697 PMCID: PMC5944361 DOI: 10.1016/j.oooo.2017.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 12/20/2017] [Accepted: 12/31/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of bacteremia resulting from dental cleaning and of subsequent established bloodstream infection (BSI) caused by oral microorganisms in patients with cancer with central venous catheters (CVCs). STUDY DESIGN Twenty-six patients with cancer with CVCs and absolute neutrophil count over 1000 cells/µL received dental cleaning without antibiotic prophylaxis. Periodontal status was assessed at baseline by using the Periodontal Screening and Recording (PSR) score. Blood cultures were drawn via the CVCs at baseline, 20 minutes into cleaning, and 30 minutes and 24 hours after cleaning. Medical records were monitored for 6 months. RESULTS Baseline blood culture results were negative in 25 patients. Nine of 25 patients (36%) had positive blood culture 20 minutes into cleaning, all associated with at least 1 microorganism typically found in the mouth. These 9 patients had significantly higher mean PSR score (3.22) compared with the other 16 (2.56; P = .035). These expected bacteremias did not persist, with blood culture results (0/25) at 30 minutes and 24 hours after cleaning showing no positivity (P = .001). There were no cases of CVC-related infection or BSI attributable to dental cleaning. CONCLUSIONS Bacteremia resulting from dental cleaning is transient and unlikely to cause CVC-related infection or BSI in patients with absolute neutrophil count greater than 1000 cells/µL.
Collapse
Affiliation(s)
- Saad Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Carolinas Healthcare System, Charlotte, NC, USA
| | | | - Robert Bona
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Zainab Shahid
- Division of Infectious Diseases, Carolinas Healthcare System, Charlotte, NC, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA.
| |
Collapse
|
10
|
Sultan AS, Zimering Y, Petruzziello G, Alyea EP, Antin JH, Soiffer RJ, Ho VT, Sonis ST, Woo SB, Marty FM, Treister NS. Oral health status and risk of bacteremia following allogeneic hematopoietic cell transplantation. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:253-260. [PMID: 28823316 DOI: 10.1016/j.oooo.2017.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/27/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of oral health status on bacteremia risk in a cohort of patients with acute myeloid leukemia (AML) who underwent chemotherapy followed by myeloablative allogeneic hematopoietic cell transplantation (allo-HCT). STUDY DESIGN A retrospective study was conducted in patients with AML from 2007 to 2011. Oral health status was determined from a pre-allo-HCT dental evaluation. Positive blood cultures were recorded from AML induction to post-allo-HCT day +60. Organisms that caused bacteremia were classified as "of possible oral source" by a blinded microbiologist. Two-sided Fisher's exact test was used to compare the oral health status of the entire cohort with that of patients with blood cultures of potential oral source. RESULTS Pre-allo-HCT dental evaluations were completed in 91 (99%) of 92 patients. Of these 91 patients, 13 (14%) with dental pathology (13 of 13 [100%]) completed all required dental treatment before allo-HCT. Bacteremias occurred in 63 of 92 patients (68%), and 12 (19%) of 63 patients had positive blood cultures of potential oral source. Of these, 1 of 12 patients developed bacteremia during AML induction, and 11 of 12 developed bacteremia during allo-HCT. CONCLUSIONS Oral health status was not associated with risk of bacteremia of potential oral source either at AML induction or consolidation or at allo-HCT.
Collapse
Affiliation(s)
- Ahmed S Sultan
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Yvette Zimering
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Edwin P Alyea
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Vincent T Ho
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephen T Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Francisco M Marty
- Microbiology Laboratory, Brigham and Women's Hospital, Boston, MA, USA; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| |
Collapse
|
11
|
Markman RL, Conceição-Vasconcelos KG, Brandão TB, Prado-Ribeiro AC, Santos-Silva AR, Lopes MA. Calcified carotid artery atheromas on panoramic radiographs of head and neck cancer patients before and after radiotherapy. Med Oral Patol Oral Cir Bucal 2017; 22:e153-e158. [PMID: 28160583 PMCID: PMC5359713 DOI: 10.4317/medoral.21436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022] Open
Abstract
Background The aims of this study were to verify if head and neck radiotherapy (RT) is able to induce calcified carotid artery atheroma (CCAA) in a large head and neck cancer (HNC) population and also to compare the socio-demographic and clinical findings of patients with and without CCAA detected on panoramic radiographs. Material and Methods Panoramic radiographs taken before and after head and neck radiotherapy (RT) of 180 HNC patients were selected and analyzed in order to identify the presence of CCAA. In addition, CCAA presence or absence on panoramic radiographs were compared and correlated with clinicopathological findings. Results A high overall prevalence of CCAA was found on panoramic radiographs (63 out of 180 = 35%) of HNC patients. No significant difference of CCAA before and after RT was observed. There were also no differences between groups (with and without CCAA) regarding age, gender, tobacco and alcohol use, arterial hypertension, diabetes mellitus, acute myocardial infarction, hypercholesterolemia, tumor location, clinical stage of disease and RT dose. However, there was a greater prevalence of strokes in patients with CCAA (p<0.05). Conclusions Although CCAA were frequently found in panoramic radiographs of patients with HNC, RT seems not to alter the prevalence of these calcifications. Key words:Head and neck cancer, radiotherapy, carotid artery diseases, panoramic radiography.
Collapse
Affiliation(s)
- R-L Markman
- Av Limeira, 901, Bairro Areão, Piracicaba, CEP 13414-903, Department of Oral Diagnosis, Semiology Area, Piracicaba Dental School University of Campinas, São Paulo, Brazil,
| | | | | | | | | | | |
Collapse
|
12
|
Lalla RV, Long-Simpson L, Hodges JS, Treister N, Sollecito T, Schmidt B, Patton LL, Brennan MT. Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations. BMC Oral Health 2017; 17:59. [PMID: 28241807 PMCID: PMC5327511 DOI: 10.1186/s12903-017-0344-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background Most head and neck (H&N) cancer patients receive high-dose external beam radiation therapy (RT), often in combination with surgery and/or chemotherapy. Unfortunately, high-dose RT has significant adverse effects on the oral and maxillofacial tissues, some of which persist for the life of the patient. However, dental management of these patients is based largely on individual and expert opinion, as few studies have followed patients prospectively to determine factors that predict adverse oral sequelae. In addition, many previous studies were conducted before wide-spread adoption of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The objective of this multi-center study is to systematically evaluate the oral health of subjects for 2 years after commencement of RT, with the goal of identifying risk factors that predict adverse oral outcomes post-RT. Methods This is a prospective multi-center longitudinal cohort study of H&N cancer patients who receive high-dose RT with curative intent. Planned enrollment is 756 subjects at 6 primary clinical sites (and their affiliated sites) in the USA. A baseline visit is conducted prior to the beginning of RT. Follow-up visits are conducted at 6, 12, 18 and 24 months from the start of RT. The primary outcome measure is the 2-year rate of tooth loss in patients who have received at least one session of external beam RT for H&N cancer. Secondary outcome measures include the incidence of exposed intraoral bone; incidence of post-extraction complications; change in Decayed Missing and Filled Surfaces (DMFS); change in periodontal measures; change in stimulated whole salivary flow rates; change in mouth opening; topical fluoride utilization; chronic oral mucositis incidence; changes in RT-specific quality of life measures; and change in oral pain scores. Discussion This study will contribute to a better understanding of the dental complications experienced by these patients. It will also enable identification of risk factors associated with adverse outcomes such as tooth loss and osteoradionecrosis. These findings will support the development of evidence-based guidelines and inform the planning of future interventional studies, with the goal of advancing improvements in patient care and outcomes. Trial registration ClinicalTrials.gov Identifier NCT02057510, registered 5 February 2014.
Collapse
Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, 263, Farmington Avenue, Farmington, CT, 06030-1605, USA.
| | - Leslie Long-Simpson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Brian Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA
| | - Lauren L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | | |
Collapse
|
13
|
Dental treatment in patients with leukemia. JOURNAL OF ONCOLOGY 2015; 2015:571739. [PMID: 25784937 PMCID: PMC4345074 DOI: 10.1155/2015/571739] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/23/2014] [Accepted: 01/11/2015] [Indexed: 12/18/2022]
Abstract
Dental treatment of patients with leukemia should be planned on the basis of antineoplastic therapy which can be chemotherapy with or without radiotherapy and bone marrow transplantation. Many are the oral manifestations presented by these patients, arising from leukemia and/or treatment. In addition, performing dental procedures at different stages of treatment (before, during, or after) must follow certain protocols in relation to the haematological indices of patients, aimed at maintaining health and contributing to the effectiveness of the results of antineoplastic therapy. Through a literature review, the purpose of this study was to report the hematological abnormalities present in patients with leukemia, trying to correlate them with the feasibility of dental treatment at different stages of the disease. It is concluded in this paper that dental treatment in relation to haematological indices presented by patients with leukemia must follow certain protocols, mainly related to neutrophil and platelet counts, and the presence of the dentist in a multidisciplinary team is required for the health care of this patient.
Collapse
|
14
|
Halperson E, Moss D, Tickotsky N, Weintraub M, Moskovitz M. Dental pulp therapy for primary teeth in children undergoing cancer therapy. Pediatr Blood Cancer 2014; 61:2297-301. [PMID: 25214367 DOI: 10.1002/pbc.25227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/29/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Childhood cancer treatment negatively affects the immune system, increasing the risk for bacteremia and septicemia. As the oral cavity is a major entry portal for pathogens into the bloodstream dental care in such children tends to be radical, favouring tooth extraction over less drastic treatments such as pulpotomy, the amputation of infected dental pulp. The present study aimed to compare pulpotomy treatment success rate in children with cancer receiving immunosuppressive therapy with that of healthy children, and investigate if unsuccessful pulpotomy treatment in oncologic patients may lead to systemic complications. PROCEDURE Twenty-six medical records of children from a paediatric oncology referral centre who had dental pulpotomy treatment (in 41 teeth) while receiving active cancer care during the years 2006-2012 were compared with records of 41 randomly selected healthy children who had undergone pulpotomy treatment (41 teeth) in the same institute during these years. Clinical and radiographic data were collected during treatments and at the end of the follow-up period (six months post dental treatment). RESULTS No statisticaly significant difference was found between pulpotomy success rate amongst the two groups. Treatments success rates in the study and control groups were 82.9% (± 5.9) and 90.2% (± 4.7), respectively. No patient in the study group suffered from sepsis from a dental origin during follow-up period. CONCLUSIONS Pulpotomy in paediatric cancer patients did not increase the risk for bacteremia or systemic complications from oral origin. We therefore recommend the re-evaluation of the current protocol for treating paediatric oncology patients.
Collapse
Affiliation(s)
- Elinor Halperson
- Department of Pediatric Dentistry, the Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
15
|
Dangra ZR, Gandhewar MA. Complete occlusal rehabilitation of patient with radiation caries - a case report. J Clin Diagn Res 2014; 8:ZD34-6. [PMID: 25386544 DOI: 10.7860/jcdr/2014/10162.4873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 08/16/2014] [Indexed: 11/24/2022]
Abstract
One of the most distressing and dramatic causes of xerostomia is radiotherapy for the cure of maxillofacial and neck carcinomas. Patient with radiotherapy induced xerostomia presents with challenges in prosthodontic management and in unique radiation caries control. This clinical report illustrates step by step execution of complex treatment planning that lead to successful outcome in 34-year-old man, who had been treated with Radical Neck Dissection (RND) and therapeutic radiotherapy for squamous cell carcinoma of tongue and due to radiation caries, was presented with chief complaint of difficulty in mastication. Rehabilitation was carried out with metal-ceramic fixed restorations and cast removable prostheses after extensive endodontic intervention. This article also discusses the maintenance strategies for radiation caries patient requiring complete occlusal reconstruction, who certainly presents with special needs in post-treatment management.
Collapse
|
16
|
Zadik Y, Yarom N, Elad S. Medicolegal considerations in bisphosphonate-related osteonecrosis of the jaw. Oral Dis 2013; 19:628. [PMID: 23530851 DOI: 10.1111/odi.12100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
de Monès E, Vergez S, Barry B, Righini C, Rolland F, Raoul G, Langeard M, Chassagne JF, Badoual C, Morinière S, de Raucourt D. Initial staging for squamous cell carcinoma of the mouth, larynx and pharynx (except nasopharynx). Part 3: general assessment. 2012 SFORL recommendations. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:165-72. [PMID: 23332168 DOI: 10.1016/j.anorl.2012.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. MATERIALS AND METHODS A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. RESULTS The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. CONCLUSION Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.
Collapse
Affiliation(s)
- E de Monès
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, CHU, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Frydrych AM, Slack-Smith LM, Park JH, Smith AC. Expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian dentists. Open Dent J 2012; 6:197-207. [PMID: 23284592 PMCID: PMC3529396 DOI: 10.2174/1874210601206010197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/09/2012] [Accepted: 10/12/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Dental care forms an important part of the multidisciplinary management of oral cancer patients. The aim of this study was to examine actual and self-perceived knowledge and clinical expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian general dentists. MATERIALS AND METHODS An invitation to participate in a web-based questionnaire was emailed to 1095 dentists registered with the Australian Dental Association (ADA), WA branch. To assess dentists' knowledge and expertise, actual and perceived knowledge was investigated. Information regarding type of practice, practice location, year of graduation and number of oral cancer patients treated in the preceding 12 months was also obtained. RESULTS One hundred and ninety one dentists responded to the survey. General dentists who took part in the study appeared to possess some knowledge regarding dental management of oral cancer patients treated with radiation therapy. The majority of responders however identified deficiencies in their knowledge and willingness to participate in continuing education programs. CONCLUSION In view of the rising incidence of oral cancer in Western Australia, efforts should be made to provide more clinically relevant training to dentists in this area.
Collapse
Affiliation(s)
- AM Frydrych
- School of Dentistry, The University of Western Australia, Perth, Western Australia
| | | | | | | |
Collapse
|
19
|
Bueno AC, Ferreira RC, Barbosa FI, Jham BC, Magalhães CS, Moreira AN. Periodontal care in patients undergoing radiotherapy for head and neck cancer. Support Care Cancer 2012; 21:969-75. [PMID: 23052920 DOI: 10.1007/s00520-012-1614-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 09/19/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to evaluate periodontal changes after periodontal treatment and control in patients with malignant tumors of the upper aerodigestive tract who were submitted to radiotherapy with or without chemotherapy. METHODS We included all patients attending the Oncology Clinic of the Federal University of Minas Gerais, School of Dentistry. Clinical periodontal parameters obtained by a single calibrated examiner were evaluated at baseline, 10 days after radiotherapy, and 180 days after radiotherapy. Patients were grouped into healthy or periodontally diseased individuals. All patients received oral hygiene instructions, and the diseased patients received periodontal therapy at baseline. Comparisons between the groups were performed via the McNemar and Wilcoxon tests using SPSS v. 17.0. RESULTS A total of 28 patients were examined at baseline, of which 27 were examined 10 days after radiotherapy and 25 were examined 180 days after radiotherapy. The prevalence of periodontal disease at baseline was 67.9 % and did not decrease over time (p = 1.0). There was a significant reduction in probing depth (PD), plaque index (PI), and bleeding on probing between baseline and follow-up, which was not observed in the attachment level (AL). CONCLUSIONS Periodontal therapy was effective in reducing PI and improving periodontal status, as evidenced by the decreases in PD and the maintenance of AL.
Collapse
Affiliation(s)
- Audrey Cristina Bueno
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
| | | | | | | | | | | |
Collapse
|
20
|
Zadik Y, Abu-Tair J, Yarom N, Zaharia B, Elad S. The importance of a thorough medical and pharmacological history before dental implant placement. Aust Dent J 2012; 57:388-92. [PMID: 22924366 DOI: 10.1111/j.1834-7819.2012.01717.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The risk of osteonecrosis in patients treated with bisphosphonates is well known and guidelines intended to prevent this complication have been established and accepted. Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a unique condition in which even past administration of medication may be of current and future relevance. We present a case of BRONJ in the maxilla after dental implant placement. The patient suffered from osteoporosis and had been treated with oral alendronate sodium in the past. However, the medication was stopped two years before implant placement, and the treating dentist was unaware of the patient's past bisphosphonate use. Prevention of BRONJ is based on identifying at-risk patients, and then avoiding or modifying dentoalveolar surgical procedures in these individuals. Nevertheless, there seems to be some difficulties identifying patients at risk. We present some of the challenges that impede thorough assessment of a patient's medical background (review of systems) in the dental office, and suggest possible solutions.
Collapse
Affiliation(s)
- Y Zadik
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer and Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine and Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | | | | | | | | |
Collapse
|
21
|
Alikhasi M, Kazemi M, Nokar S, Khojasteh A, Sheikhzadeh S. Step-by-step full mouth rehabilitation of a nasopharyngeal carcinoma patient with tooth and implant-supported prostheses: A clinical report. Contemp Clin Dent 2011; 2:256-60. [PMID: 22090777 PMCID: PMC3214541 DOI: 10.4103/0976-237x.86489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This clinical report presents a 46-year-old man diagnosed with nasopharyngeal carcinoma with the chief complaint of masticatory and speech deficiency because of radiation therapy. After a period of controlling post radiation caries, the patient was rehabilitated with tooth and implant supported metal ceramic restorations following surgical and endodontic intervention.
Collapse
Affiliation(s)
- Marzieh Alikhasi
- Department of Dental Research and Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
22
|
Lino MDMDC, Carvalho FBD, Oliveira LRD, Magalhães EB, Pinheiro ALB, Ramalho LMP. Laser phototherapy as a treatment for radiotherapy-induced oral mucositis. Braz Dent J 2011; 22:162-5. [PMID: 21537592 DOI: 10.1590/s0103-64402011000200013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 11/22/2022] Open
Abstract
Oral mucositis is a harmful side effect of radiotherapy (RT) on the head and neck region. There are encouraging reports on the beneficial aspects of the use of laser light on the treatment of oral mucositis. This paper reports the efficacy of laser phototherapy (LPT) on the treatment of oral mucositis in a patient undergoing RT after surgical removal of a squamous cell carcinoma with osseous invasion of the maxilla. Palatal and commissural lesions were treated with λ660 nm, 40 mW, ∅=4 mm(2), in contact mode, 5 x 2.4 J/cm(2) per point, 14.4 J/cm(2) per session. For treating the lesion on the patient's nasal mucosa, LPT (∅=4 mm(2), λ780 nm, 70 mW, 3 x 2.1 J/cm(2) per point, 6.3 J/cm(2) per session, contact mode) was used on the external area of the nose. A single dose (2.4 J/cm(2)) with the λ660 nm laser, as described before, was applied on the entrance of each nostril. LPT was used 3 times/week during 4 weeks. Treatment results indicate that the use of LPT on oral mucositis was effective and allowed the patient to carry on the RT without interruption. However, long-term and controlled clinical trials are necessary to establish both preventive and curative protocols using LPT.
Collapse
|
23
|
Meier JKH, Wolff D, Pavletic S, Greinix H, Gosau M, Bertz H, Lee SJ, Lawitschka A, Elad S. Oral chronic graft-versus-host disease: report from the International Consensus Conference on clinical practice in cGVHD. Clin Oral Investig 2010; 15:127-39. [PMID: 20859645 DOI: 10.1007/s00784-010-0450-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 07/26/2010] [Indexed: 01/12/2023]
Abstract
Chronic graft-versus-host disease (cGVHD) is a multi-organ disease that occurs post-hematopoietic stem cell transplantation, with the mouth being one of the most frequently affected organs. In 2009, the German-Austrian-Swiss working party on bone marrow and blood stem cell transplantation held a consensus conference to define clinical management of cGVHD. The consensus conference aimed to summarize the literature on diagnosis and topical treatment options for oral cGVHD and to provide recommendations for clinical practice, including routine dental and oral care as well as monitoring for secondary malignancies and bisphophonate-induced osteonecrosis of the jaw.
Collapse
Affiliation(s)
- Johannes K-H Meier
- Department of Cranio-Maxillo-Facial Surgery, University of Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Joshi VK. Dental treatment planning and management for the mouth cancer patient. Oral Oncol 2010; 46:475-9. [PMID: 20400359 DOI: 10.1016/j.oraloncology.2010.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 12/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Vinod K Joshi
- Restorative Dentistry Oncology Clinic, St. Luke's Hospital, Bradford, UK.
| |
Collapse
|
25
|
Two-year clinical performance of glass ionomer and resin composite restorations in xerostomic head- and neck-irradiated cancer patients. Clin Oral Investig 2009; 15:31-8. [DOI: 10.1007/s00784-009-0355-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
|
26
|
Mawardi H, Cutler C, Treister N. Medical management update: Non-Hodgkin lymphoma. ACTA ACUST UNITED AC 2009; 107:e19-33. [PMID: 19101479 DOI: 10.1016/j.tripleo.2008.08.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 08/11/2008] [Accepted: 08/27/2008] [Indexed: 11/19/2022]
Abstract
Lymphoma is a heterogeneous malignancy of the lymphatic system characterized by proliferation of lymphoid cells or their precursors. Non-Hodgkin lymphoma (NHL) is associated with significant morbidity and is the seventh leading cause of death in the United States. Manifestations of NHL as well as complications of the disease and its management are frequently encountered in the head and neck region and often require specific treatment and modifications in the provision of oral health care. The purpose of this article is to review current concepts of the pathophysiology, as well as medical and oral health care management of NHL.
Collapse
Affiliation(s)
- Hani Mawardi
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | | | | |
Collapse
|