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Chin D, Mast H, Verduijn GM, Möring M, Petit SF, Rozema FR, Wolvius EB, Jonker BP, Heemsbergen WD. Personalizing dental screening and prevention protocols in dentulous patients with oropharyngeal cancer undergoing radiotherapy: A retrospective cohort study. Clin Transl Radiat Oncol 2024; 46:100759. [PMID: 38495648 PMCID: PMC10940125 DOI: 10.1016/j.ctro.2024.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives Patients with head and neck cancer are routinely screened for dental foci prior to radiotherapy (RT) to prevent post- RT tooth extractions associated with an increased risk of osteoradionecrosis. We evaluated the risk factors for post-RT tooth extraction to personalise dental screening and prevention protocols prior to RT. Materials and methods This retrospective cohort study included dentulous patients diagnosed with oropharyngeal cancer who had undergone radiation therapy at doses 60-70 Gy and achieved a disease-free survival of ≥ 1 year (N = 174). Risk factors were assessed using Cox regression models. Results The cumulative incidence of post-RT tooth extraction was 30.7 % at 5 years. Main indications for extraction (n = 62) were radiation caries (n = 20) and periodontal disease (n = 27). Risk factors associated (p < 0.05) with radiation caries-related extractions included active smoking, alcohol abuse, poor oral hygiene, parotid gland irradiation, and mandibular irradiation. A high-dose volume in the mandible was associated with periodontal disease events. Conclusion Post-RT extractions due to radiation caries were influenced by lifestyle factors and RT dose in the mandible and parotid glands. Periodontal disease-related extractions were primarily associated with the mandibular dose. During dental screening these post-RT risk factors should be taken into account to prevent osteoradionecrosis.
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Affiliation(s)
- Denzel Chin
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Gerda M. Verduijn
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Michelle Möring
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Steven F. Petit
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Frederik R. Rozema
- Academic Centre for Dentistry Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Eppo B. Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Brend P. Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Wilma D. Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Alvarez PB, Perez-Sayáns M, Alves MGO, Torreira MG, Iruegas MEP, Carrión AB, García-García A. Dental management prior to radiation therapy in patients with head and neck cancer. Indian J Cancer 2019; 55:251-256. [PMID: 30693889 DOI: 10.4103/ijc.ijc_20_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Patients diagnosed with head and neck tumors, are treated by surgery, radiation therapy (RT), chemotherapy (CT) or a combination thereof. The goal is to describe the management protocol for patients subjected to radiation therapy (RT) and to study their long-term oral health status. MATERIALS AND METHODS A retrospective study was performed in a sample of 50 patients. We analyzed the oral health status and all the variables included applying the adapted protocol of pre-RT. RESULTS Prior to RT, 84% of patients required scaling and 32% conservative treatment. Around 74% of patients required at least one exodontia. The mean of exodontias for patients presenting Grade 3 of oral hygiene was 6.50 per person (p<0.0001). The pre-RT study of possible candida infection showed that 78% of patients were negative for this infection. The mean resting saliva production was 39.10 (SD: 23.30; range: 13-145), with a stimulated value of 64.78 (SD: 33.92; range: 16-200). CONCLUSIONS All patients should be protocoled to ensure that they present optimal oral conditions prior to initiating RT treatment.
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Affiliation(s)
- Paula Bonar Alvarez
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Santiago de Compostela, Spain
| | - Mario Perez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Mercedes Gallas Torreira
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Santiago de Compostela, Spain
| | - María Elena Padín Iruegas
- Human Anatomy and Embryology Area, Faculty of Physiotherapy, Department of Functional Biology and Health Sciences, Pontevedra, Spain
| | - Andrés Blanco Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, Santiago de Compostela, Spain
| | - Abel García-García
- Maxillofacial Surgery, Oral Medicine, Oral Surgery and Implantology Unit, Department of Maxillofacial Surgery, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
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Osteoradionecrosis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kumar S, Chandran C, Chacko R, Jesija JS, Paul A. Osteoradionecrosis of Jaw: An Institutional Experience. Contemp Clin Dent 2018; 9:242-248. [PMID: 29875568 PMCID: PMC5968690 DOI: 10.4103/ccd.ccd_843_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims and Objectives: Osteoradionecrosis (ORN) of the jaw is a significant yet rare complication of radiotherapy (RT) associated with the management of head-and-neck malignancies. Recent decrease in the incidence of ORN following RT to the head and neck is being mainly attributed to refinement in RT techniques and improvement in our understanding of this morbid disease. The aim of this study is to assess the patients with ORN following head-and-neck RT to determine the various contributing risk factors involved in the development of ORN. Subjects and Methods: A retrospective data review from 2003 onward was conducted on the cases of ORN which presented to the Department of Dental and Oral Surgery, Christian Medical College, Vellore. Details of the patients with regard to the site of primary malignancy, type of treatment provided - RT alone or in combination of surgery and chemotherapy, dose of RT, presenting complaint, duration between the RT and presentation of ORN, and method of management considered were evaluated. Results: A total of 25 patients were evaluated. The average age of the 25 patients in our study was 58 years. Oropharynx (about 50%) was the leading site of primary malignancy. More than half of the patients in the study (52%) had undergone radical RT for the primary malignancy and all the patients were given >60 Gy dose of RT. About 48% of the patients in the study reported with pus discharge as their chief complaint. The average intervening time period from completion of RT to the presentation of ORN was 48 months. The mandibular alveolus was the most common site for ORN. Twelve of the 25 cases in the study were managed conservatively with only 3 patients requiring major resection. Conclusion: Due to its rare presentation, ORN still remains a challenge for the clinician in its management. Our study revealed that radical RT and concurrent chemo-RT for the oropharyngeal and base of the tongue malignancies have a higher risk of developing ORN. Patients subjected to the dose of RT above 60 Gy for head-and-neck malignancies have an increased risk of future ORN; henceforth, newer modality treatment like intensity-modulated RT regimen is recommended for such sites. Most of the patients in the study were satisfactorily managed of the symptoms with conservative modality treatment; hence, it is recommended to consider for surgical methods only in severe end-stage form of ORN.
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Affiliation(s)
- Saurabh Kumar
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Catherine Chandran
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rabin Chacko
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - J S Jesija
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Arun Paul
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Sharma N, Om H. Usage of Probabilistic and General Regression Neural Network for Early Detection and Prevention of Oral Cancer. ScientificWorldJournal 2015; 2015:234191. [PMID: 26171415 PMCID: PMC4485993 DOI: 10.1155/2015/234191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 12/20/2022] Open
Abstract
In India, the oral cancers are usually presented in advanced stage of malignancy. It is critical to ascertain the diagnosis in order to initiate most advantageous treatment of the suspicious lesions. The main hurdle in appropriate treatment and control of oral cancer is identification and risk assessment of early disease in the community in a cost-effective fashion. The objective of this research is to design a data mining model using probabilistic neural network and general regression neural network (PNN/GRNN) for early detection and prevention of oral malignancy. The model is built using the oral cancer database which has 35 attributes and 1025 records. All the attributes pertaining to clinical symptoms and history are considered to classify malignant and non-malignant cases. Subsequently, the model attempts to predict particular type of cancer, its stage and extent with the help of attributes pertaining to symptoms, gross examination and investigations. Also, the model envisages anticipating the survivability of a patient on the basis of treatment and follow-up details. Finally, the performance of the PNN/GRNN model is compared with that of other classification models. The classification accuracy of PNN/GRNN model is 80% and hence is better for early detection and prevention of the oral cancer.
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Affiliation(s)
- Neha Sharma
- Dr. D.Y. Patil Institute of Master of Computer Applications, Akurdi, Savitribai Phule Pune University, Maharashtra 411007, India
| | - Hari Om
- Computer Science and Engineering Department, Indian School of Mines, Dhanbad, Jharkhand 826004, India
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Abstract
Patients with a history of head and neck cancer resection require extensive prosthodontic rehabilitation following cancer treatment. The oral anatomy drastically changes from ablative therapy, and the oral tissue response becomes altered as a consequence of radiation and chemotherapy. Successful restoration of oral function in this specific patient population was increasingly difficult before the widespread use of dental implants. Implant-borne prosthetics are now often used. However, surgical guidelines remain unclear with regard to oncology-related parameters. In this article, guidelines are introduced for implant therapy in the cancer patients according to radiation dosage and timing. Indications for hyperbaric oxygen treatment are highlighted along with risk assessment associated with implant placement. These guidelines are intended to augment knowledge obtained through oncology consultation; moreover, provide a rationale for implant therapy within the course of cancer treatment.
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Funk CS, Warmling CM, Baldisserotto J. A randomized clinical trial to evaluate the impact of a dental care program in the quality of life of head and neck cancer patients. Clin Oral Investig 2013; 18:1213-1219. [PMID: 23989505 DOI: 10.1007/s00784-013-1068-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 07/22/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVES A randomized clinical trial (RCT) to evaluate the impact of dental care program on the quality of life (QOL) of head and neck cancer patients under oncological treatment. MATERIALS AND METHODS The study design was a parallel RCT where 46 subjects with a diagnosis of head and neck primary neoplasy were randomly allocated to the control (CG) or test group (TG). Both groups received basic dental care but the TG received a complimentary care before and during, oncological therapy. Data related to general (WHOQOL-BREF) and specific (EORTC QLQ H&N 35) QOL were assessed before and 15 days after the conclusion of the oncological therapy. RESULTS The TG showed an improvement in the general and specific QOL, while the CG showed a worsening in these indexes but without significant difference. The variation between the initial and final measures in the TG shows a tendency of significant improvement along the time. A reduction in candidiasis (p < 0.05) and muccositis was observed in the TG. CONCLUSION In a short follow-up period, dental care was able to reduce damage from the oncological therapy especially related to muccositis and candidiasis, although the QOL was not significantly improved. However, a longer follow-up to measure the late side effects over the QOL of these patients is necessary. CLINICAL RELEVANCE Provision of continuous dental care for head and neck cancer patients can reduce deleterious side effects of the oncological treatment.
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Affiliation(s)
- Camila Samara Funk
- Community Health Service, Health School of Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Cristine Maria Warmling
- Department of Social and Preventive Dentistry, School of Dentistry of Federal University of Rio Grande do Sul, Rua Dona Leonor 194/1407, 90420-180, Porto Alegre, Brazil
| | - Julio Baldisserotto
- Community Health Service, Health School of Grupo Hospitalar Conceição, Porto Alegre, Brazil.
- Department of Social and Preventive Dentistry, School of Dentistry of Federal University of Rio Grande do Sul, Rua Dona Leonor 194/1407, 90420-180, Porto Alegre, Brazil.
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Lawrence M, Aleid W, McKechnie A. Access to dental services for head and neck cancer patients. Br J Oral Maxillofac Surg 2012; 51:404-7. [PMID: 23127589 DOI: 10.1016/j.bjoms.2012.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/12/2012] [Indexed: 11/27/2022]
Abstract
Dental assessment is important for patients with cancer of the head and neck who are to have radiotherapy, as many of these patients have poor dental health before they start treatment. This, compounded by the fact that radiotherapy to the head and neck has a detrimental effect on oral health, has led the National Institute for Clinical Excellence (NICE) to issue guidance that the dental health of these patients should be assessed before treatment. Unfortunately some multidisciplinary teams, such as the one at United Lincolnshire Hospitals, do not have access to a restorative dentist or a dental hygienist. In a retrospective survey we investigated access to general dental services by patients with head and neck cancer who were to have radiotherapy at our hospital and found that 37/71 (52%) had not been reviewed by a dentist within the past 12 months. A secondary national survey that investigated the availability of restorative dental and dental hygienic services showed that of the 56 multidisciplinary teams that deal with head and neck cancer in England, 19 (34%) do not have access to a restorative dentist and 23 (41%) do not have access to a dental hygienist, suggesting that this problem may be countrywide.
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Affiliation(s)
- Mark Lawrence
- OMFS Department, Clinic 9, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, United Kingdom.
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Siddall KZ, Rogers SN, Butterworth CJ. The prosthodontic pathway of the oral cancer patient. ACTA ACUST UNITED AC 2012; 39:98-100, 103-6. [PMID: 22482267 DOI: 10.12968/denu.2012.39.2.98] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Oral cancer patients undergo life-altering curative treatment that consists of surgery or a combination of surgery and radiotherapy. This can severely alter the functional anatomy of the oral cavity and create a challenging environment for successful oral rehabilitation. A multidisciplinary team approach is required to rehabilitate these patients successfully. It is essential to have assessment by an oral rehabilitation specialist before treatment, especially where primary rehabilitation interventions are being considered. Following cancer treatment, patients may suffer from a range of difficulties, from dento-facial appearance, to chewing, speech and swallowing. This dysfunction often leads to psychosocial problems, such as reduced self esteem, social contact and quality of life. Conventional prosthodontics has a role to play in the management of these patients but osseointegrated implants (OII), can be required to overcome the anatomical and physiological barriers. OII can be used in an environment where there is poor soft tissue function or little bone support, and where there is a dry mouth. CLINICAL RELEVANCE This paper introduces readers to the prosthodontic pathway taken by some oral cancer patients. It provides an overview of current oral rehabilitation techniques that supplement the supportive dental care provided by general dental practitioners and their team after cancer treatment.
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Affiliation(s)
- Krista Z Siddall
- Liverpool University, Liverpool University Dental Hospital, Pembroke Place, Liverpool, UK
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Shaw RJ, Butterworth C. Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part II: prevention. Br J Oral Maxillofac Surg 2011; 49:9-13. [DOI: 10.1016/j.bjoms.2009.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 11/04/2009] [Indexed: 10/19/2022]
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Scully C, Ettinger RL. The influence of systemic diseases on oral health care in older adults. J Am Dent Assoc 2007; 138 Suppl:7S-14S. [PMID: 17761840 DOI: 10.14219/jada.archive.2007.0359] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OVERVIEW Systemic diseases are more common in older adults than in younger people, even among those who are functionally independent. Dentists should understand how these diseases can affect the dental care of their aging patients. The authors review some of the management issues associated with selected systemic diseases common in older adults who are functionally independent. CONCLUSIONS To provide good oral health care, dental professionals must understand the special needs of older people and their ability to undergo and respond to care; they should work closely with the rest of the health care team; and they should be prepared to manage emergencies. CLINICAL IMPLICATIONS Many older people have a variety of systemic diseases that have an impact on their oral health care. The dentist may need to consult with the patient's physician to develop an appropriate treatment plan.
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Affiliation(s)
- Crispian Scully
- University College London Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD, England.
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Elad S, Thierer T, Bitan M, Shapira MY, Meyerowitz C. A decision analysis: the dental management of patients prior to hematology cytotoxic therapy or hematopoietic stem cell transplantation. Oral Oncol 2007; 44:37-42. [PMID: 17307024 DOI: 10.1016/j.oraloncology.2006.12.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 12/05/2006] [Accepted: 12/05/2006] [Indexed: 11/18/2022]
Abstract
There is a controversy regarding whether dental treatment before chemotherapy protocols, including hematopoietic stem cell transplantation (HSCT), is helpful to prevent infections during the consequent immunosuppression. The aim of this study was to develop a decision analysis framework that would test the effect of dental treatment prior to chemotherapy on the survival of the patient. A decision tree was created to compare the clinical outcomes of two treatment alternatives for a base-case patient receiving cytotoxics or undergoing HSCT. The variables used to build the model were "systemic infection", "unmet dental needs", "dental needs". The outcomes evaluate to compare the two strategies was "survival". We performed MEDLINE and PubMed searches of English-language literature according to a list of related terms. The decision analysis model selected dental treatment prior to chemotherapy as the preferred strategy for the base case analysis. The results of this study suggest that dental treatment prior to chemotherapy is the preferred treatment strategy. Using our base case data, 1.8 of every 1000 hemato-oncologic patients or HSCT patients will die compared to the non-treatment prior to chemotherapy strategy.
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Affiliation(s)
- Sharon Elad
- Department of Oral Medicine, The Hebrew University - Hadassah School of Dental Medicine, POB 12272, Jerusalem 91120, Israel.
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Jackson NG, Waterhouse PJ, Maguire A. Management of dental trauma in primary care: a postal survey of general dental practitioners. Br Dent J 2005; 198:293-7; discussion 281. [PMID: 15870756 DOI: 10.1038/sj.bdj.4812127] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Accepted: 03/05/2004] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. DESIGN AND SETTING A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. MAIN OUTCOME MEASURES Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. RESULTS The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Eighty-eight per cent of GDPs felt that aids to management would be useful. CONCLUSIONS Although GDPs believed that financial remuneration was inadequate, this did not prevent them treating trauma cases. They strongly agreed that they had responsibility for the management of dental trauma in primary care and that they believed trauma could be treated more effectively in practice if payment was greater. Time constraints were perceived as a barrier to long-term management of complex trauma cases in primary care. GDPs would welcome the use of management aids.
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Affiliation(s)
- N G Jackson
- School of Dental Sciences, University of Newcastle, Newcastle upon Tyne, UK
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Affiliation(s)
- Eneida A. Mendonça
- Department of Biomedical Informatics; College of Physicians and Surgeons; Columbia University
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Abstract
A comprehensive dental oncologic screening should be part of the pretreatment workup of patients who have head and neck cancer. This screening should be performed by a dentist who is familiar with the pathologic process of disease and type of treatment being rendered; in addition, he or she should comprehend the various morbidities associated with eradicating head and neck malignancy. The dental oncologist must provide the timeline for the surgeon and radiation oncologist in which all necessary dental treatment will be completed. It is important at this juncture to educate the patient as to the possible short- and long-term complications,no matter what treatment course they choose.Osseointegrated implants used in the rehabilitation of patients who have undergone head and neck surgery have provided a more reliable means of retaining intraoral and extraoral prostheses. With close communication between the head and neck surgeon and dental oncologist, and careful patient selection, better functional outcomes may be provided.
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Affiliation(s)
- Sullivan Maureen
- Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Cramer CK, Epstein JB, Sheps SB, Schechter MT, Busser JR. Modified Delphi survey for decision analysis for prophylaxis of post-radiation osteonecrosis. Oral Oncol 2002; 38:574-83. [PMID: 12167435 DOI: 10.1016/s1368-8375(01)00115-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES to augment epidemiological data from the literature, assist Bayesian perspectives and a decision analytic framework for the minimization of post-radiation osteonecrosis (PRON; osteoradionecrosis) and its impacts in irradiated head and neck cancer patients. MATERIALS AND METHODS a modified Delphi process survey of 15 international clinical experts was used to identify and assess outcome data and factors related to PRON risk, extraction, and factor suitability for formal decision analysis. Clinimetric pain and function outcome scales were created and assessed for relevance to quality of life. RESULTS AND CONCLUSIONS expert opinion qualitative assessments were generally adequate and consistent between open- and close-ended items, but many quantitative (e.g. PRON risk rate) estimates were not. A research agenda advocated to validate the epidemiological database for minimization of PRON and decision analysis includes: adoption of a uniform definition of PRON, and ICD code for non-experimental databases; more detailed, consistent data reporting in articles; and quality of life studies.
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Affiliation(s)
- Carl K Cramer
- Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, BC, Vancouver, Canada.
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Bruins HH, Jolly DE, Koole R. Preradiation dental extraction decisions in patients with head and neck cancer. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:406-12. [PMID: 10519746 DOI: 10.1016/s1079-2104(99)70053-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The first objectives of this international survey were to study how dental-related and radiotherapy-related risk factors influence clinicians' preradiation dental decision making in patients with head and neck cancer and to evaluate clinicians' degree of certainty in making such decisions. A further objective was to examine the correlation of clinicians' policies with a policy based on a model for dental decision support that was presented in an earlier article. STUDY DESIGN A consensus questionnaire was mailed to 54 oral-maxillofacial surgeons and hospital-based dentists at a number of international locations. The responses were aggregated and anonymously analyzed through use of a multiple regression procedure. RESULTS Forty-four clinicians returned the questionnaire (response rate, 81%). Nine clinicians (20%) were using printed clinical guidelines for preradiation dental screening. Eighty-eight percent of clinicians' preradiation decisions and 49% of their certainty could be explained by the studied risk factors. Not all risk factors were significant at P <.001. Clinicians' policies showed high correlation (.85) with the policy based on the model for dental decision support. CONCLUSIONS The findings support our previous assumption that policies in this field seem to be based primarily on clinical experience and opinions rather than on evidence-based clinical guidelines. We conclude that the clinical usefulness and validity of the model for dental decision support should now be tested and that it could also serve as a training tool.
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Affiliation(s)
- H H Bruins
- Department of Oral & Maxillofacial Surgery, University Medical Center Utrecht, University of Utrecht, The Netherlands
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Silverman S. Oral cancer: complications of therapy. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:122-6. [PMID: 10468451 DOI: 10.1016/s1079-2104(99)70103-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S Silverman
- Department of Oral Medicine, University of California, San Francisco 94143, USA
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