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Melerowitz L, Sreenivasa S, Nachbar M, Stsefanenka A, Beck M, Senger C, Predescu N, Ullah Akram S, Budach V, Zips D, Heiland M, Nahles S, Stromberger C. Design and evaluation of a deep learning-based automatic segmentation of maxillary and mandibular substructures using a 3D U-Net. Clin Transl Radiat Oncol 2024; 47:100780. [PMID: 38712013 PMCID: PMC11070663 DOI: 10.1016/j.ctro.2024.100780] [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] [Received: 11/13/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024] Open
Abstract
Background Current segmentation approaches for radiation treatment planning in head and neck cancer patients (HNCP) typically consider the entire mandible as an organ at risk, whereas segmentation of the maxilla remains uncommon. Accurate risk assessment for osteoradionecrosis (ORN) or implant-based dental rehabilitation after radiation therapy may require a nuanced analysis of dose distribution in specific mandibular and maxillary segments. Manual segmentation is time-consuming and inconsistent, and there is no definition of jaw subsections. Materials and methods The mandible and maxilla were divided into 12 substructures. The model was developed from 82 computed tomography (CT) scans of HNCP and adopts an encoder-decoder three-dimensional (3D) U-Net structure. The efficiency and accuracy of the automated method were compared against manual segmentation on an additional set of 20 independent CT scans. The evaluation metrics used were the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and surface DSC (sDSC). Results Automated segmentations were performed in a median of 86 s, compared to manual segmentations, which took a median of 53.5 min. The median DSC per substructure ranged from 0.81 to 0.91, and the median HD95 ranged from 1.61 to 4.22. The number of artifacts did not affect these scores. The maxillary substructures showed lower metrics than the mandibular substructures. Conclusions The jaw substructure segmentation demonstrated high accuracy, time efficiency, and promising results in CT scans with and without metal artifacts. This novel model could provide further investigation into dose relationships with ORN or dental implant failure in normal tissue complication prediction models.
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Affiliation(s)
- L. Melerowitz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S. Sreenivasa
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M. Nachbar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A. Stsefanenka
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M. Beck
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C. Senger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - N. Predescu
- MVision AI, Paciuksenkatu 29 00270 Helsinki, Finland
| | | | - V. Budach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D. Zips
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M. Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S. Nahles
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C. Stromberger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
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Roman RC, Moldovan MA, Pop LS, Megieșan S, Faur CI. Platelet-Rich Fibrin Treatment Evaluation in Patients with Medication-Related Osteonecrosis of the Jaw and Osteoradionecrosis. J Clin Med 2024; 13:3473. [PMID: 38930013 PMCID: PMC11204677 DOI: 10.3390/jcm13123473] [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: 05/28/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization.
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Affiliation(s)
- Rareș Călin Roman
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Mădălina Anca Moldovan
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Loredana Sabrina Pop
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
| | - Sergiu Megieșan
- Department of Mathematics, Imperial College London Alumni, London SW7 2AZ, UK;
| | - Cosmin Ioan Faur
- Department of Oral Radiology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania;
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Clément L, Hélène D, Maud M, Chrystelle D, Constance B, Fréderic M, France R, Pilar GHM, José-Miguel TD, Blandine R. Safety of empirical antibiotic therapy discontinuing for fever of unknown origin during high-risk neutropenia in children. J Infect 2024; 88:106171. [PMID: 38697268 DOI: 10.1016/j.jinf.2024.106171] [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: 02/21/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND ECIL-2021 recommends discontinuing empirical antibiotic therapy (EAT) in febrile-neutropenic children after 72 h of treatment and at least 24-48 h of apyrexia in the case of fever of unknown origin (FUO). These guidelines are rarely applied to high-risk children's neutropenia. MATERIAL AND METHODS We retrospectively included all consecutive FUO episodes occurring during profound neutropenia ≥ 10 days in children in our institution. We evaluated the safety of EAT discontinuation in patients for whom the ECIL guidelines were followed compared to those for whom they didn't. We used a combined criterion of mortality and intensive care unit admission at 30 days. We identified risk factors for recurrent fever after EAT discontinuation. RESULTS Fifty-one FUO episodes occurred in 37 patients. EAT discontinuation followed ECIL guidelines in 19 (37 %) episodes. No deaths and-or transfers in ICU occurred in the ECIL group. The duration of EAT was shorter by nine days in the group following ECIL guidelines (p < 0.001). We observed 14 (27 %) episodes of recurrent fever. Mucositis was significantly associated with recurrent fever (p < 0.01). CONCLUSION EAT discontinuation seems feasible and safe in FUO during prolonged febrile neutropenia in children. However, mucosal lesions should prompt thorough surveillance due to the risk of recurrent fever.
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Affiliation(s)
- Lemaigre Clément
- CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France
| | - Deutch Hélène
- Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | - Meligne Maud
- Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | - Dupraz Chrystelle
- Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | | | - Millot Fréderic
- Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; Service de Pédiatrie, CHU Poitiers, Poitiers, France
| | - Roblot France
- CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; INSERM U1070, Poitiers, France
| | - Gallego-Hernanz Maria Pilar
- Service d'Oncologie Hématologique Et Thérapie Cellulaire, INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Torregrosa-Diaz José-Miguel
- Service d'Oncologie Hématologique Et Thérapie Cellulaire, INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, 86021 Poitiers Cedex, France
| | - Rammaert Blandine
- CHU Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France; Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France; INSERM U1070, Poitiers, France.
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Okamoto H, Sakuramachi M, Yatsuoka W, Ueno T, Katsura K, Murakami N, Nakamura S, Iijima K, Chiba T, Nakayama H, Shuto Y, Takano Y, Kobayashi Y, Kishida H, Urago Y, Nishitani M, Nishina S, Arai K, Igaki H. A novel method for determining dose distribution on panoramic reconstruction computed tomography images from radiotherapy computed tomography. Imaging Sci Dent 2024; 54:129-137. [PMID: 38948189 PMCID: PMC11211031 DOI: 10.5624/isd.20230230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/09/2024] [Accepted: 02/28/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.
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Affiliation(s)
- Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Madoka Sakuramachi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Wakako Yatsuoka
- Dental Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takao Ueno
- Dental Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kouji Katsura
- Department of Oral Radiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Naoya Murakami
- Department of Radiology, Juntendo University, Tokyo, Japan
| | - Satoshi Nakamura
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kotaro Iijima
- Department of Radiology, Juntendo University, Tokyo, Japan
| | - Takahito Chiba
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Nakayama
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasunori Shuto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Takano
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Kobayashi
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hironori Kishida
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuka Urago
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Nishitani
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shuka Nishina
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Koushin Arai
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Carsuzaa F, Dore M, Falek S, Delpon G, Drouet J, Thariat J. [Prevention, diagnosis and management of osteoradionecrosis: Where do we stand?]. Bull Cancer 2024; 111:525-536. [PMID: 38480057 DOI: 10.1016/j.bulcan.2024.01.008] [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: 09/01/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 05/13/2024]
Abstract
Osteoradionecrosis (ORN) is a late secondary iatrogenic complication of external radiotherapy for cancers of the upper aero-digestive tract. Despite the systematization of intensity-modulated radiotherapy and its potential for preserving salivary secretion and limiting the dose delivered to the supporting bone, ORN remains a feared and frequent complication. The objective of this literature review was to provide an overview of the management of ORN and to determine the key points that would make it possible to improve patient care. The diagnosis of ORN requires to eliminate tumor recurrence then is based on clinical arguments and imaging by CT or Cone Beam evolving in a chronic mode (more than 3-6 months). The harmonization of its classifications aims to offer comprehensive and multidisciplinary care as early as possible. Primary prevention is based on pre-therapeutic oral and dental preparation, then associated with fluoroprophylaxis if salivary recovery is insufficient and requires supervision of invasive dental care and prosthetic rehabilitation. Semi-automatic contouring tools make it possible to identify doses delivered to dental sectors and guide dental care with personalized dosimetric mapping. Conservative medical treatment is offered at an early stage where innovative medical treatments, highlighted by early studies, could be of interest in the future. In the event of advanced ORN, a non-conservative treatment is then proposed and frequently consists of interruptive mandibulectomy associated with reconstruction by bony free flap, the conditions of implantation remaining to be defined with the support of prospective clinical trials.
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Affiliation(s)
- Florent Carsuzaa
- Service d'ORL et chirurgie cervico-faciale, centre hospitalo-universitaire de Poitiers, Poitiers, France.
| | - Mélanie Dore
- Service de radiothérapie, institut de cancérologie de l'Ouest, Nantes, France
| | - Sabah Falek
- Service de chirurgie maxillofaciale et stomatologie, centre François-Baclesse, Caen, France
| | - Grégory Delpon
- Service de radiothérapie, institut de cancérologie de l'Ouest, Nantes, France
| | - Julien Drouet
- Service de chirurgie maxillofaciale et stomatologie, centre François-Baclesse, Caen, France
| | - Juliette Thariat
- Service de radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie université, Caen, France; GORTEC, Intergroupe ORL France, France
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Ryu HS, Abueva C, Padalhin A, Park SY, Yoo SH, Seo HH, Chung PS, Woo SH. Oral ulcer treatment using human tonsil-derived mesenchymal stem cells encapsulated in trimethyl chitosan hydrogel: an animal model study. Stem Cell Res Ther 2024; 15:103. [PMID: 38589946 PMCID: PMC11003084 DOI: 10.1186/s13287-024-03694-4] [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: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Oral ulcers are a common side effect of chemotherapy and affect patients' quality of life. While stem cell transplantation is a potential treatment for oral ulcers, its efficacy is limited as the stem cells tend to remain in the affected area for a short time. This study aims to develop a treatment for oral ulcers by using trimethyl chitosan (TMC) hydrogel with human tonsil-derived stem cells (hTMSCs) to increase the therapeutic effect of stem cells and investigate their effectiveness. METHODS Animals were divided into four experimental groups: Control, TMC hydrogel, hTMSCs, and hTMSCs loaded in TMC hydrogel (Hydrogel + hTMSCs) (each n = 8). Oral ulcers were chemically induced by anesthetizing the rats followed by injection of dilute acetic acid in the right buccal mucosa. After confirming the presence of oral ulcers in the animals, a single subcutaneous injection of 100 µL of each treatment was applied to the ulcer area. Histological analyses were performed to measure inflammatory cells, oral mucosal thickness, and fibrosis levels. The expression level of inflammatory cytokines was also measured using RT-PCR to gauge therapeutic the effect. RESULTS The ulcer size was significantly reduced in the TMC hydrogel + hTMSCs group compared to the control group. The stem cells in the tissue were only observed until Day 3 in the hTMSCs treated group, while the injected stem cells in the TMC Hydrogel + hTMSCs group were still present until day 7. Cytokine analysis related to the inflammatory response in the tissue confirmed that the TMC Hydrogel + hTMSCs treated group demonstrated superior wound healing compared to other experimental groups. CONCLUSION This study has shown that the adhesion and viability of current stem cell therapies can be resolved by utilizing a hydrogel prepared with TMC and combining it with hTMSCs. The combined treatment can promote rapid healing of oral cavity wounds by enhancing anti-inflammatory effects and expediting wound healing. Therefore, hTMSC loaded in TMC hydrogel was the most effective wound-healing approach among all four treatment groups prolonging stem cell survival. However, further research is necessary to minimize the initial inflammatory response of biomaterials and assess the safety and long-term effects for potential clinical applications.
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Affiliation(s)
- Hyun Seok Ryu
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea
- Medical Laser Research Center, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Celine Abueva
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea
- Medical Laser Research Center, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Andrew Padalhin
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea
- Medical Laser Research Center, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - So Young Park
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Seung Hyeon Yoo
- School of Medical Laser, Dankook University, Cheonan, Republic of Korea
| | - Hwee Hyon Seo
- School of Medical Laser, Dankook University, Cheonan, Republic of Korea
| | - Phil-Sang Chung
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea
- Medical Laser Research Center, Dankook University College of Medicine, Cheonan, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan, 31116, Republic of Korea
| | - Seung Hoon Woo
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan, Republic of Korea.
- Medical Laser Research Center, Dankook University College of Medicine, Cheonan, Republic of Korea.
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan, 31116, Republic of Korea.
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Kutuk T, Atak E, Villa A, Kalman NS, Kaiser A. Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy. Curr Oncol 2024; 31:2092-2108. [PMID: 38668058 PMCID: PMC11049200 DOI: 10.3390/curroncol31040155] [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: 01/12/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Radiation therapy (RT) plays a crucial role in the treatment of head and neck cancers (HNCs). This paper emphasizes the importance of effective communication and collaboration between radiation oncologists and dental specialists in the HNC care pathway. It also provides an overview of the role of RT in HNC treatment and illustrates the interdisciplinary collaboration between these teams to optimize patient care, expedite treatment, and prevent post-treatment oral complications. The methods utilized include a thorough analysis of existing research articles, case reports, and clinical guidelines, with terms such as 'dental management', 'oral oncology', 'head and neck cancer', and 'radiotherapy' included for this review. The findings underscore the significance of the early involvement of dental specialists in the treatment planning phase to assess and prepare patients for RT, including strategies such as prophylactic tooth extraction to mitigate potential oral complications. Furthermore, post-treatment oral health follow-up and management by dental specialists are crucial in minimizing the incidence and severity of RT-induced oral sequelae. In conclusion, these proactive measures help minimize dental and oral complications before, during, and after treatment.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
| | - Ece Atak
- Department of Radiation Oncology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey;
| | - Alessandro Villa
- Oral Medicine and Oral Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| | - Noah S. Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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8
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Quah B, Yong CW, Lai CWM, Islam I. Efficacy of adjunctive modalities during tooth extraction for the prevention of osteoradionecrosis: A systematic review and meta-analysis. Oral Dis 2024. [PMID: 38396363 DOI: 10.1111/odi.14902] [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: 10/03/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Jaw osteoradionecrosis (ORN) is a complication in patients with previous head and neck radiotherapy. Its incidence increases with dental extractions. Hence, this review aimed to evaluate the efficacy of adjunctive treatment modalities undertaken at the time of extraction in previous head and neck radiotherapy patients in preventing ORN. METHODS A systematic review was conducted, where studies with data on ORN incidence after extraction with or without adjunctive interventions were included. Meta-analyses were conducted to estimate the pooled prevalence of ORN per intervention and the pooled odds ratio for incidence of ORN between interventions. RESULTS In total, 1520 patients in 29 studies were included. Interventions identified were hyperbaric oxygen (HBO), pentoxifylline-tocopherol (PENTO), antibiotics (ABX), platelet-rich fibrin and photobiomodulation. The pooled prevalence of ORN for HBO (4.6%), PENTO (3.4%) and ABX (3.8%) was significantly lower than the Control (17.6%). For studies with direct comparisons between groups, HBO had lower but not significant odds of developing ORN than the Control (OR 0.27) and ABX (OR 0.57). CONCLUSIONS HBO, PENTO and ABX may reduce the incidence of ORN compared to no intervention. Given that all three have similar incidences of ORN, ABX may be the most cost-effective and accessible adjunctive modality.
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Affiliation(s)
- Bernadette Quah
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Department of Oral and Maxillofacial Surgery, Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, Singapore, Singapore
| | - Chee Weng Yong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Department of Oral and Maxillofacial Surgery, Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, Singapore, Singapore
| | - Clement Wei Ming Lai
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Intekhab Islam
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Department of Oral and Maxillofacial Surgery, Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, Singapore, Singapore
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9
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R S, Pandiyan I. Unveiling the Multifaceted Management of Oral Mucositis in Cancer Patients: A Narrative Review. Cureus 2024; 16:e55213. [PMID: 38558646 PMCID: PMC10981506 DOI: 10.7759/cureus.55213] [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: 01/24/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Oral mucositis (OM) is a major and common adverse reaction to cancer treatment, occurring in all patients who undergo radiation therapy or chemotherapy that includes the mucosal areas of the oral and oropharyngeal region. The pathophysiology of OM remains incompletely understood, and there are many unanswered questions about the risk factors for developing OM. Multidisciplinary clinicians and researchers must collaborate to better understand and expand treatment strategies for OM and other inflammatory conditions in oncology. This will lead to the development of more effective treatments and reduce the burden of OM in cancer patients. This article comprehensively reviews the risk factors and patient factors associated with OM, its pathogenesis, clinical presentation, grading, and management.
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Affiliation(s)
- Sangavi R
- Department of Oral Medicine, Radiology, and Special Care Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, IND
| | - Indumathy Pandiyan
- Department of Public Health Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Semprini J, Reynolds J, Zahnd WE, Wehby G. Eliminating Medicaid dental benefits and early-stage oral cancer diagnoses. Cancer Med 2024; 13:e7061. [PMID: 38457253 PMCID: PMC10923030 DOI: 10.1002/cam4.7061] [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: 07/21/2023] [Revised: 11/25/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Despite the importance of regular dental visits for detecting oral cancer, millions of low-income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees. METHODS We analyzed Surveillance, Epidemiology, and End Results-Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference-in-differences model. Our design compares the change in early-stage (Stages 0-II) diagnoses before and after dropping dental benefits in California with the change in early-stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non-OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita. RESULTS Dropping Medicaid dental benefits was associated with a 6.5%-point decline in early-stage diagnoses of non-OPC (95% CI = -14.5, -3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%-point decline in the probability of early-stage non-OPC diagnoses for every additional dentist per 5000 population (p = 0.006). CONCLUSIONS Eliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.
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Affiliation(s)
- Jason Semprini
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Julie Reynolds
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Whitney E. Zahnd
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - George Wehby
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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Belfiore E, Di Prima G, Angellotti G, Panzarella V, De Caro V. Plant-Derived Polyphenols to Prevent and Treat Oral Mucositis Induced by Chemo- and Radiotherapy in Head and Neck Cancers Management. Cancers (Basel) 2024; 16:260. [PMID: 38254751 PMCID: PMC10813700 DOI: 10.3390/cancers16020260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Oral Mucositis (OM) is the most common side effect due to chemotherapy and radiotherapy, which are the conventional treatment options for head and neck cancers. OM is a severe inflammatory condition characterized by multifactorial etiopathogenesis. It further negatively affects patients' quality of life by severe impairment of normal oral functions. Consequently, it is mandatory to identify new effective therapeutic approaches to both prevent and treat OM while also avoiding any recurrence. Polyphenols recently attracted the interest of the scientific community due to their low toxicity and wide range of biological activities making them ideal candidates for several applications in the odontostomatological field, particularly against OM. This review collects the in vivo studies and the clinical trials conducted over the past 13 years evaluating the preventive and curative effects of several polyphenolic compounds towards chemo- and radiotherapy-induced OM, both when administered alone or as a plant-extracted phytocomplex. The literature fully confirms the usefulness of these molecules, thus opening the possibility of their clinical application. However, polyphenol limitations (e.g., unfavourable physicochemical properties and susceptibility to degradation) have emerged. Consequently, the interest of the scientific community should be focused on developing innovative delivery systems able to stabilize polyphenols, thus facilitating topical administration and maximizing their efficacy.
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Affiliation(s)
- Elena Belfiore
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy; (E.B.); (V.P.)
| | - Giulia Di Prima
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Via Archirafi 32, 90123 Palermo, Italy;
| | - Giuseppe Angellotti
- Institute of Nanostructured Materials, National Research Council, Via U. La Malfa 153, 90146 Palermo, Italy;
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy; (E.B.); (V.P.)
| | - Viviana De Caro
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Via Archirafi 32, 90123 Palermo, Italy;
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12
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Semprini JT. Late-Stage Oral Cancer Detection After California and Illinois Restored Medicaid Dental Benefits. OTO Open 2024; 8:e111. [PMID: 38229972 PMCID: PMC10790188 DOI: 10.1002/oto2.111] [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] [Received: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024] Open
Abstract
Objective Previous research found an association between California's Medicaid dental coverage and oral cancer detection. However, this relationship has yet to be explored in other states or by subgroup populations. Study Design In addition to controlling for sociodemographic and tumor characteristics, this study implemented a traditional difference-in-differences design to compare distant-stage diagnosis trends in states restoring Medicaid dental benefits (California [CA] and Illinois [IL]) with trends in states with constant Medicaid dental benefits. Setting This retrospective, observational study analyzed oral cavity and pharynx cancer case data from The Surveillance, Epidemiology, and End Results program (2004-2017). Methods The outcome was a binary variable indicating whether a patient was diagnosed at a distant stage. Subgroup analyses were conducted by state, race/ethnic group, sex, age, and county-level household income. Results The sample included 109,997 adults diagnosed with cancer of the oral cavity and pharynx. Restoring Medicaid dental benefits was associated with a statistically significant 2.7%-point decline in the probability of a distant-stage oral cancer diagnosis. This estimate represented a 14% relative change from baseline rates. Results were consistent for CA and IL and by county-level median income. Estimates were significantly larger for adults under age 65, males, and adults identifying as Hispanic; non-Hispanic Black; American Indian; or Asian American or Pacific Islander. Conclusion Restoring Medicaid dental coverage improved early detection in both CA and IL, with the greatest reductions in distant-stage diagnoses occurring in younger adults, males, and minoritized racial/ethnic groups. Future research should investigate whether earlier detection reduces oral cancer mortality disparities.
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Affiliation(s)
- Jason T. Semprini
- Department of EpidemologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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13
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Chang VKO, See L, Griffin A, Breik O, Batstone MD, Liu TPJ. Impact of dental state and surgical factors on postoperative neck infection in oral cancer patients. Br J Oral Maxillofac Surg 2024; 62:51-57. [PMID: 38044253 DOI: 10.1016/j.bjoms.2023.10.013] [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: 06/04/2023] [Revised: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
Postoperative neck infection (PONI) is a known complication of neck dissection. In this study we explored the impact of dental status on the development of PONI, using orthopantomograms to assess edentulism, periodontal health, and caries status. Retrospective analysis was performed for all new oral cancer patients who had neck dissection between January 2008 and January 2020 in a tertiary head and neck centre. PONI risk factors assessed included patient characteristics, dental status, tumour, and surgical factors. Development of PONI was the primary outcome. Edentulous patients had lower risk of PONI (OR 0.06, p = 0.026) compared to those with 21 or more teeth. Periodontitis and dental caries were not statistically significant. Current smokers (OR 2.09, p = 0.044) and free flap reconstruction (OR 5.41, p < 0.001) were also significant predictors for development of PONI. This study highlights the presence of teeth as a potential source of infection post neck dissection and that orthopantomogram assessment may be inadequate to identify at risk patients. Future studies are required on direct clinical assessment of dentition to evaluate the impact of dental optimisation in prevention of PONI.
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Affiliation(s)
- Victor K O Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
| | - Lydia See
- Metro North Oral Health Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Adjunct Research Fellow School of Dentistry, University of Western Australia, Perth, Australia
| | - Alison Griffin
- Statistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Omar Breik
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Timothy P J Liu
- Metro North Oral Health Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Adjunct Research Fellow School of Dentistry, University of Western Australia, Perth, Australia
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14
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Watson E, El Maghrabi A, Lee JH, Pu J, Xu W, Joudah S, D'Souza V, Quiñonez C, Mojdami ZD, Huang SH, O'Sullivan B, Ringash J, Kim J, Cho J, Bratman S, Waldron J, Goldstein D, Abdalaty AH, Glogauer M, Hope A. Implication of dental insurance status on patterns of pre-radiation dental extraction and risk of osteoradionecrosis of the jaw in head-and-neck cancer patients. Oral Oncol 2023; 145:106527. [PMID: 37499325 DOI: 10.1016/j.oraloncology.2023.106527] [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: 02/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
Oral toxicities such as osteoradionecrosis can be minimized by dental screening and prophylactic dental care prior to head and neck (HN) radiation therapy (RT). However, limited information is available about how dental insurance interacts with prophylactic dental care and osteoradionecrosis. To address this gap in knowledge, we conducted a cohort study of 2743 consecutive adult patients treated with curative radiation for HN malignancy who underwent pre-radiation dental assessment and where required, prophylactic dental treatment. Charts were reviewed to determine patient demographics, dental findings, dental treatment and development of osteoradionecrosis following radiation. Three insurance cohorts were identified: private-insured (50.4 %), public-insured (7.3 %), being patients with coverage through government-funded disability and welfare programs, and self-pay (42.4 %). More than half the public-insured patients underwent prophylactic pre-radiation dental extractions, followed by self-pay patients (44 %) and private-insured patients (26.6 %). After a median follow-up time of 4.23 years, 6.5 % of patients developed osteoradionecrosis. The actuarial rate of osteoradionecrosis in the public-insured patients was 14.7 % at 5-years post-RT, compared to 7.5 % in private-insured patients and 6.7 % in self-pay patients. On multivariable analysis, dental insurance status, DMFS160, age at diagnosis, sex, tumor site, nodal involvement, years smoked and gross income were all significant risk factors for tooth removal prior to HN radiation. However, only public-insured status, tumor site and years smoked were significant risk factors for development of osteoradionecrosis. Our findings demonstrate that lack of comprehensive dental coverage (patients who self-pay or who have limited coverage under public-insured programs) associates strongly with having teeth removed prior to HN RT. Nearly 1 in 6 patients covered under public-insurance developed osteoradionecrosis within 5 years of completing their treatment. Well-funded dental insurance programs for HN cancer patients might reduce the number of pre-RT extractions performed in these patients, improving quality of life post-RT.
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Affiliation(s)
- Erin Watson
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada; Faculty of Dentistry, University of Toronto, Canada.
| | - Amr El Maghrabi
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Jun Hyung Lee
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Jiajie Pu
- Department of Biostatistics, Princess Margaret Cancer Centre, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Canada
| | - Shahad Joudah
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Violet D'Souza
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Canada
| | - Carlos Quiñonez
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Zahra Dorna Mojdami
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, Toronto, Canada
| | - Ali Hosni Abdalaty
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
| | - Michael Glogauer
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada
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15
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Mirfendereski P, Trotter JW, France K. A 65-Year-Old Man with Recent History of Radiation Therapy to the Head and Neck Reporting for Treatment of a Non-restorable Tooth. Dent Clin North Am 2023; 67:671-674. [PMID: 37714621 DOI: 10.1016/j.cden.2023.05.021] [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] [Indexed: 09/17/2023]
Abstract
Patients with a history of head and neck radiation involving or adjacent to tooth-bearing areas are at increased risk of developing osteonecrosis following dental procedures. The dental provider should thus aim to preserve the patient's dentition after radiation therapy. Root canal therapy with coronectomy may be an option for a nonrestorable tooth, whereas atraumatic extraction can be considered if retaining the tooth is impossible. When treating a patient with a history of head and neck radiation, it is recommended that the dental provider reviews the patient's radiation records and consults with the patient's radiation oncologist to better stratify treatment risks.
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Affiliation(s)
- Payam Mirfendereski
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | - Jacob W Trotter
- Department of Radiation Oncology, Penn Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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16
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Goh EZ, Beech N, Johnson NR, Batstone M. The dental management of patients irradiated for head and neck cancer. Br Dent J 2023; 234:800-804. [PMID: 37291302 PMCID: PMC10250190 DOI: 10.1038/s41415-023-5864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 06/10/2023]
Abstract
Patients undergoing radiotherapy for head and neck cancers are prone to a range of dental complications, including mucositis, trismus, xerostomia, radiation caries and osteoradionecrosis. Specific considerations include the preventive, restorative and rehabilitative management of such patients, and the prevention and treatment of complications. This article aims to highlight the current understanding and management of dental needs for patients who have had or will undergo radiotherapy.
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Affiliation(s)
- Elizabeth Z Goh
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Nicholas Beech
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel R Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Martin Batstone
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Royal Brisbane and Women´s Hospital, Brisbane, Queensland, Australia
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17
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Nath J, Singh PK, Sarma G. Dental Care in Head and Neck Cancer Patients Undergoing Radiotherapy. Indian J Otolaryngol Head Neck Surg 2022; 74:6219-6224. [PMID: 36742621 PMCID: PMC9895163 DOI: 10.1007/s12070-021-02941-x] [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: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
External beam radiotherapy is an integral part of the management of head and neck cancer. Radiotherapy for head and neck cancer lead to many treatment-related toxicities, including a wide range of dental morbidities. These complications depend on the various patient and treatment-related factors. Patients with poor oral hygiene, pre-existing periodontal disease, and the conventional mode of radiotherapy delivery are major factors leading to acute and severe late dental problems. Most of the complications are preventable with proper oral and dental care before, during and after radiotherapy. Pre radiotherapy dental evaluation to diagnose patients with potential risk and timely intervention can reduce long-term morbidities like carries, osteoradionecrosis, etc., thereby improving patients' quality of life. This article highlights the various aspects of dental care and management in head neck cancer patients before, during and after radiation therapy.
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Affiliation(s)
- Jyotiman Nath
- Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India
| | | | - Gautam Sarma
- Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India
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18
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Factors Influencing the Survival Rate of Teeth and Implants in Patients after Tumor Therapy to the Head and Neck Region-Part 1: Tooth Survival. J Clin Med 2022; 11:jcm11206222. [PMID: 36294543 PMCID: PMC9605197 DOI: 10.3390/jcm11206222] [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] [Received: 09/30/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
We aimed to evaluate possible factors influencing the long-term survival of teeth after tumor therapy (TT) to the head and neck region with and without radiation. Between January 2019 and January 2020, patients who underwent TT for head and neck cancer and received dental treatment before and after TT at the Department of Prosthetic Dentistry of the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination with assessment of dental status and stimulated salivary flow rate (SFR) was performed and information about disease progression and therapy was retrieved from medical records. Of 118 patients (male: 70.3%; mean age: 63.2 ± 12.4 years), 95 received radiotherapy (RT), and 47 were administered radio-chemotherapy (RCT). The teeth of irradiated patients exhibited a lower 5-year survival probability (74.2%) than those of non-irradiated patients (89.4%). The risk of loss (RL) after RT increased with nicotine use, presence of intraoral defects, reduced SFR, RCT and regarding mandibular teeth, and decreased with crowning following TT. Lower SFR increased the RL even without RT. Consideration of patient’s treatment history, individual risk profile, and clinical findings during the prosthetic planning phase could enable earlier, more targeted dental treatment after TT (e.g., timely crowning).
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Hoffmann L, Marschner SN, Kakoschke TK, Hickel R, Sabbagh H, Wölfle UC. Dental management before radiotherapy of the head and neck region: 4-year single-center experience. Clin Exp Dent Res 2022; 8:1478-1486. [PMID: 36089654 PMCID: PMC9760134 DOI: 10.1002/cre2.662] [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: 06/20/2022] [Revised: 08/18/2022] [Accepted: 08/27/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To review our experience with a standardized dental management approach in patients with planned radiotherapy of the head and neck region based on preradiation and follow-up data. MATERIAL AND METHODS Records of patients who underwent radiotherapy between June 2016 and November 2020 were reviewed. Data on dental findings and therapeutic recommendations were extracted from a prospectively managed database. Hospital records were used to obtain follow-up data. RESULTS Two hundred eighty-one patient records were identified. After the exclusion of 81 patients because of incomplete data, 200 patients were included in the study. Dental findings relevant to radiotherapy were found in 144 cases (72.0%). Teeth extractions were recommended in 112 (56.0%) patients. Follow-up data were available for 172 (86.0%) patients (mean follow-up: 16.8 ± 10.7 months). Radiodermatitis was the most frequently observed sequela of radiotherapy (42.4%), followed by dysphagia (38.4%) and stomatitis (36.6%). Osteoradionecrosis was observed in only 2.3% of the patients. CONCLUSION Dental findings relevant to planned radiotherapy were frequent and in many cases resulted in recommendations for teeth extraction. Based on our standardized dental management protocol, we observed low rates of late oral complications after radiotherapy of the head and neck region.
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Affiliation(s)
- Lea Hoffmann
- Department of Conservative Dentistry and Periodontology, University HospitalLMU MunichMunichGermany,Department of Orthodontics and Dentofacial Orthopedics, University HospitalLMU MunichMunichGermany
| | - Sebastian N. Marschner
- Department of Radiation Oncology, University HospitalLMU MunichMunichGermany,German Cancer Consortium (DKTK)Partner Site MunichMunichGermany
| | - Tamara K. Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University HospitalLMU MunichMunichGermany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University HospitalLMU MunichMunichGermany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University HospitalLMU MunichMunichGermany
| | - Uta C. Wölfle
- Department of Conservative Dentistry and Periodontology, University HospitalLMU MunichMunichGermany
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Başer Can ED, Barut G, Işık V, Algül E, Yaprak G, Can E. Push-out bond strength of fiber posts to irradiated and non-irradiated intraradicular dentin. Clin Oral Investig 2022; 26:7057-7069. [PMID: 35978223 DOI: 10.1007/s00784-022-04666-9] [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: 12/01/2021] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the influence of ionizing radiotherapy on the resin-dentin interface in endodontically treated teeth restored with fiber posts using a dual-cure resin cement performed with the etch-and-rinse (ER) and self-etch (SE) approaches in terms of push-out bond strength (MPa), and to analyze the post/cement/dentin interface using scanning electron microscopy (SEM). MATERIALS AND METHODS Seventy-six single-rooted human teeth were used and randomly assigned into two main groups (n = 38): one non-irradiated group (NoRad) and one group subjected to a cumulative radiation dose of 60 Gy (Rad). All root canals were instrumented and were further subdivided into two subgroups (n = 19) following the adhesive approach: ER (RadER; NoRadER) and SE (RadSE; NoRadSE) used for fiber post luting with the universal adhesive and dual cure resin cement. Each root was sectioned perpendicularly to its long axis and sections from the middle third of the roots were chosen for SEM analysis and push-out bond strength test. Two-way ANOVA with post hoc Tukey tests and a dummy variable linear regression analysis were used for data analysis. RESULTS Regardless of the adhesive approach, push-out bond strength in irradiated teeth resulted in significantly lower values than non-irradiated teeth (p = 0.0001). There were no significant differences between the ER and SE approaches in non-irradiated teeth (p = 0.955), whereas the ER approach showed significantly higher bond strengths than the SE approach in irradiated teeth (p = 0.0001). CONCLUSIONS Ionizing radiotherapy resulted in dentin structure disruption and negatively affected the push-out bond strength of fiber posts to intraradicular dentin. The reduction in bond strength was also more significant with the SE approach than with the ER approach. CLINICAL RELEVANCE The alterations resulting from root dentin irradiation seem to influence adhesive systems bond strength to dentin, as these changes contribute to lower push-out bond strength in irradiated groups before fiber post luting. Thus, clinicians should prepare patients with a reasonable restorative treatment plan prior to radiotherapy and simultaneously initiate a preventive program during radiotherapy.
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Affiliation(s)
- Elif Delve Başer Can
- Department of Endodontics, Yeditepe University Faculty of Dentistry, Bağdat Cad. No: 238 Göztepe, Kadıköy, Istanbul, Turkey.
| | - Güher Barut
- Department of Endodontics, Yeditepe University Faculty of Dentistry, Bağdat Cad. No: 238 Göztepe, Kadıköy, Istanbul, Turkey
| | - Vasfiye Işık
- Department of Endodontics, Istanbul Health and Technology University Faculty of Dentistry, Istanbul, Turkey
| | - Emriye Algül
- Department of Radiation Oncology, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Ministry of Health, Sağlık Bilimleri University, Istanbul, Turkey
| | - Gökhan Yaprak
- Department of Radiation Oncology, Sağlık Bilimleri University, Istanbul, Turkey
| | - Esra Can
- Department of Restorative Dentistry, Yeditepe University Faculty of Dentistry, Istanbul, Turkey
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Pedroso CM, Migliorati CA, Epstein JB, Ribeiro ACP, Brandão TB, Lopes MA, de Goes MF, Santos-Silva AR. Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror. FRONTIERS IN ORAL HEALTH 2022; 3:961594. [PMID: 35911379 PMCID: PMC9330023 DOI: 10.3389/froh.2022.961594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Radiation caries (RC) is an aggressive oral toxicity in head and neck cancer survivors, which develops 6 to 12 months after head and neck radiotherapy. It initially affects the tooth cervical/incisal surfaces, and if not promptly diagnosed/managed, progresses to dental crown amputation and risk of osteoradionecrosis. It results from a multidimensional cluster of treatment-induced oral symptoms, including hyposalivation, dietary changes, and oral hygiene impairment. Although recognized as a frequent complication of radiotherapy and extensively assessed by a myriad of retrospective, in vitro, and in situ studies, RC patients are still orphans of clinically validated methods for risk prediction, prevention, and treatment of early lesions. This review provides a historical overview of science-based concepts regarding RC pathogenesis and treatment, emphasizing the growing demand for interventional clinical studies (randomized trials).
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Affiliation(s)
- Caique Mariano Pedroso
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Joel B. Epstein
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | | | - Thaís Bianca Brandão
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mário Fernando de Goes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: Alan Roger Santos-Silva
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Conti GB, de Lima Oliveira RF, Amorim AA, de Oliveira HF, Pires-de-Souza FDCP, de Queiroz AM. Color stability and microhardness alteration of irradiated dental enamel treated with a high fluoride concentration toothpaste. Clin Oral Investig 2022; 26:5885-5892. [PMID: 35590118 DOI: 10.1007/s00784-022-04546-2] [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: 01/17/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Radiotherapy (RT) is a kind of head and neck cancer (HNC) treatment, which is associated to the habit of smoking and can develop collateral effects in the oral cavity, such as the increase of caries prevalence. This study evaluated the color alteration, the microhardness, and the remineralizing potential of high fluoride concentration toothpastes on irradiated teeth. MATERIALS AND METHODS Forty bovine teeth were used (6 × 6 × 2 mm) and after color (EasyShade, VITA) and microhardness initial readings were separated into two groups: exposed to cigarette smoke and non-exposed. All samples were submitted to RT (30 Gy) and to cariogenic challenge. New color and microhardness readings were done. After RT (60 Gy), the samples were submitted to simulated toothbrushing (73,000 cycles = 5 years of brushing) with two different toothpastes: conventional (1450 ppm) and high fluoride concentration (5000 ppm). Final color and microhardness readings were done after brushing. Data were analyzed with 2-way ANOVA with repeated measures and Tukey's test (p < .05). RESULTS There was no color difference after RT, nor after brushing (p > .05). However, after brushing, microhardness values increased for the samples treated with high fluoride concentration toothpaste (p < .05). CONCLUSION Radiotherapy did not influence the teeth color, and the high fluoride concentration toothpaste presented remineralizing potential; therefore, it could be used on the caries prevention related to HNC radiation. CLINICAL RELEVANCE Considering its remineralizing potential, toothpastes with high fluoride concentration could be a proper alternative for caries prevention in patients undergoing radiotherapy.
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Affiliation(s)
- Giulia Battistini Conti
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Café, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | - Rebeca Franco de Lima Oliveira
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | - Ayodele Alves Amorim
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | | | - Fernanda de Carvalho Panzeri Pires-de-Souza
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil.
- Faculty of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil.
| | - Alexandra Mussolino de Queiroz
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Café, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
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Ozseven A, Ugurlu M. Assessment of the effects of different dental restorative materials on radiotherapy dose distribution: A phantom study. Niger J Clin Pract 2022; 25:516-523. [PMID: 35439913 DOI: 10.4103/njcp.njcp_1826_21] [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: 11/04/2022]
Abstract
Background One of the most specific effects of high-density dental restorative materials on head & neck cancer radiotherapy is generating variations on isodose distributions. These variations might have an impact on the accuracy and effectiveness of the radiation treatment. The aim of this study is investigating the possible dosimetric effect of six different restorative materials on isodose distributions in head & neck radiotherapy planning process. Materials and Methods A special phantom was developed and twenty-one caries-free human third molars (a control group + six different restorative materials) were used for the measurements. After acquiring the computed tomography (CT) images, seven treatment plans were created. Hounsfield Unit (HU) numbers, horizontal line dose profile (HLDP) and vertical line dose profiles (VLDPs) were compared with the control group. Results The amalgam sample deformed the HU numbers in CT images. The median HU value for the S4 material was considerably different than the other samples. The median values were quite close for the remaining samples. For the amalgam sample, the mean of the calculated median isodose values for HLDP and VLDP at 3.5 cm away from the isocenter line were lower than the mean of the control group 4.03% and 6.94%, respectively (for HLDP with tooth numbers of 36 and 38 P = 0.025 and P < 0.001, respectively; for VLDP P < 0.001). In C-S1 comparison results, the statistically significant differences were found for the measurement point at 1 cm away from the isocenter (P = 0.037, P = 0.002, and P = 0.018 for the tooth numbers 36, 37, and 38, respectively). In C-S2 and C-S6 comparisons, there was a statistically significant difference for tooth number 36 (P = 0.035 and P = 0.003, respectively). Conclusions The findings of the present study showed that amalgam should not be used in head & neck cancer patients who are planned to have radiation therapy. A high viscosity glass ionomer cement (GIC) and a ceramic reinforced GIC sample can be used instead of amalgam to minimize the distorting effect on isodose distributions.
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Affiliation(s)
- Alper Ozseven
- Department of Radiation Oncology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Muhittin Ugurlu
- Department of Restorative Dentistry, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
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Propranolol inhibits cell viability and expression of the pro-tumorigenic proteins Akt, NF-ĸB, and VEGF in oral squamous cell carcinoma. Arch Oral Biol 2022; 136:105383. [DOI: 10.1016/j.archoralbio.2022.105383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 12/11/2022]
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Serrano RV, Gomes TP, da Silva FM, Chambrone L, Marques MM, Palma LF. Autologous platelet concentrates in extraction sockets for the prevention of osteoradionecrosis: a systematic review of controlled clinical trials. Oral Maxillofac Surg 2022; 26:555-561. [PMID: 35048208 DOI: 10.1007/s10006-021-01030-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
Abstract
This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.
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Affiliation(s)
- Rafael Verardi Serrano
- Graduate Dentistry Program, Ibirapuera University, Av. Interlagos, 1329 - Chácara Flora, SP, São Paulo, Brazil
| | - Thiago Pallin Gomes
- Graduate Dentistry Program, Ibirapuera University, Av. Interlagos, 1329 - Chácara Flora, SP, São Paulo, Brazil
| | - Felipe Medeiros da Silva
- Graduate Dentistry Program, Ibirapuera University, Av. Interlagos, 1329 - Chácara Flora, SP, São Paulo, Brazil
| | - Leandro Chambrone
- Evidence-Based Hub - CiiEM, Egas Moniz - Cooperativa de Ensino Superior, Caparica, Almada, Portugal
- Unit of Basic Oral Investigation (UIBO), Faculty of Dentistry, Universidad El Bosque, Bogota, Colombia
| | - Marcia Martins Marques
- Graduate Dentistry Program, Ibirapuera University, Av. Interlagos, 1329 - Chácara Flora, SP, São Paulo, Brazil
| | - Luiz Felipe Palma
- Graduate Dentistry Program, Ibirapuera University, Av. Interlagos, 1329 - Chácara Flora, SP, São Paulo, Brazil.
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Munhoz L, Nishimura DA, Iida CH, Watanabe PCA, Arita ES. Head and neck radiotherapy-induced changes in dentomaxillofacial structures detected on panoramic radiographs: A systematic review. Imaging Sci Dent 2021; 51:223-235. [PMID: 34621649 PMCID: PMC8479433 DOI: 10.5624/isd.20210011] [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] [Received: 01/18/2021] [Revised: 02/17/2021] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs. Materials and Methods In this systematic review, the authors searched PubMed Central, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar for original research studies up to February 2020 that included the following Medical Subject Headings keywords: words related to “radiotherapy” and synonyms combined with keywords related to “panoramic radiography” and “oral diagnosis” and synonyms. Only original studies in English that investigated the maxillofacial effects of radiotherapy via panoramic radiographs were included. The quality of the selected manuscripts was evaluated by assessing the risk of bias using Cochrane's ROBINS-I tool for non-randomized studies. Results Thirty-three studies were eligible and included in this review. The main objectives pertained to the assessment of the effects of radiation on maxillofacial structures, including bone architecture alterations, periodontal space widening, teeth development abnormalities, osteoradionecrosis, and implant bone loss. The number of participants evaluated ranged from 8 to 176. Conclusion The interaction between ionizing radiation and maxillofacial structures results in hazard to the tissues involved, particularly the bone tissue, periosteum, connective tissue of the mucosa, and endothelium. Hard tissue changes due to radiation therapy can be detected on panoramic radiographs.
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Affiliation(s)
- Luciana Munhoz
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | | | - Christyan Hiroshi Iida
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Plauto Christopher Aranha Watanabe
- Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, Brazil
| | - Emiko Saito Arita
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Shear bond strength analysis and marginal gap evaluation of restoration–tooth interface of aesthetic restorations after simulated Co-60 gamma irradiation. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Radiotherapy to the head and neck region may cause considerable radiotherapy-induced changes in the surrounding tissues. These changes are oral mucositis, hyposalivation, dental caries, osteoradionecrosis, trismus and overall impact on patients’ quality of life. Tooth-coloured synthetic materials, unlike metallic restoration, did not influence radiation dose distribution. However, their exposure to a gamma radiation therapeutic dose during treatment might cause structural and compositional changes that alter their mechanical and physical properties.
Aim:
This study intends to evaluate the effect of Co 60 gamma rays on shear bond strength and marginal adaptation of already restored tooth surfaces, to help in material selection before the onset of radiotherapy.
Materials and methods:
Hundred freshly extracted human permanent mandibular molar teeth collected and stored in a 0·2% thymol solution for disinfection and were randomly divided into two groups of 50 each, to be tested for the shear bond strength of restoration to dentin and the marginal gap at tooth–restoration interface, respectively.
Results:
ANOVA showed a significant effect of both radiotherapy (F = 40·33, p < 0·001) and restorations (134·00, p < 0·001) on the marginal gap at the interface. In the without radiotherapy group, the mean marginal gap was least in Group Z250, and in with radiation, Bulk Fill has the least mean marginal gap. The mean shear bond strength was comparatively higher for all restorations without radiation than with radiation (p < 0·001).
Findings:
Gamma radiation affects the physical or mechanical properties of tooth structure and the tooth restorative interface. Composites seem to be good restorative material when placed before the onset of radiotherapy in head and neck cancer patients.
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Darwin D, Castelino RL, Babu GS, Asan MF, Sarkar AS, Shaktivel S. Oral Equilibrium in Cachexia. Asia Pac J Oncol Nurs 2021; 8:519-526. [PMID: 34527781 PMCID: PMC8420925 DOI: 10.4103/apjon.apjon-2139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
Oral cancer, a part of head-and-neck cancer (HNC), is associated with a high risk of cancer-associated weight loss causing cachexia which is still an understudied illness. Cachexia is a host-phagocytic syndrome caused by the multiple factors, resulting in the severity of heterogenic fashion. For the current review, a bibliographic search was done in PubMed and other databases for the English articles published from the year 1980 to 2021. Recent studies have revealed that cachexia associated with 35%-60% of all the oral cancer patients is either due to the implication of the tumor or obstruction of food intake for which a strong need for nutritional assistance and hydration is desired. The health of cancer individuals undergoing chemotherapy or bone marrow transplant is negatively affected by poor oral health and reduced dentition status. The impact of a deficient oral condition is not clearly understood to date, possibly due to the limited number of studies and a lack of widely accepted clinical trials to prevent cachexia. The masticatory function of such patients is drastically affected thus contributing to the decreased nutritional status causing wasting of tissues. The aim of this article is to provide substantial evidence that poor oral hygiene with an altered dentition status negatively influences the energy balance of oral cancer patients who experience wasting.
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Affiliation(s)
- Deepthi Darwin
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Renita Lorina Castelino
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Gogineni Subhas Babu
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Mohamed Faizal Asan
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Anand Shankar Sarkar
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Soundarya Shaktivel
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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de Amorim DMG, Veríssimo AH, Ribeiro AKC, de Assunção E Souza RO, de Assunção IV, Caldas MRGR, Borges BCD. Effects of ionizing radiation on surface properties of current restorative dental materials. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:69. [PMID: 34117934 PMCID: PMC8197703 DOI: 10.1007/s10856-021-06543-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
To investigate the impact of radiotherapy on surface properties of restorative dental materials. A conventional resin composite-CRC (Aura Enamel), a bulk-fill resin composite-BFRC (Aura Bulk-fill), a conventional glass ionomer cement-CGIC (Riva self cure), and a resin-modified glass ionomer cement-RMGIC (Riva light cure) were tested. Forty disc-shaped samples from each material (8 mm diameter × 2 mm thickness) (n = 10) were produced according to manufacturer directions and then stored in water distilled for 24 h. Surface wettability (water contact angle), Vickers microhardness, and micromorphology through scanning electron microscopy (SEM) before and after exposition to ionizing radiation (60 Gy) were obtained. The data were statistically evaluated using the two-way ANOVA and Tukey posthoc test (p < 0.05). Baseline and post-radiation values of contact angles were statistically similar for CRC, BFRC, and RMGIC, whilst post-radiation values of contact angles were statistically lower than baseline ones for CGIC. Exposition to ionizing radiation statistically increased the microhardness of CRC, and statistically decreased the microhardness of CGIC. The surface micromorphology of all materials was changed post-radiation. Exposure to ionizing radiation negatively affected the conventional glass ionomer tested, while did not alter or improved surface properties testing of the resin composites and the resin-modified glass ionomer cement tested.
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Affiliation(s)
- Débora Michelle Gonçalves de Amorim
- Department of Dentistry, Universidade Federal do Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP: 59056-000, Brazil
| | - Aretha Heitor Veríssimo
- Department of Dentistry, Universidade Federal do Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP: 59056-000, Brazil
| | - Anne Kaline Claudino Ribeiro
- Department of Dentistry, Universidade Federal do Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP: 59056-000, Brazil
| | - Rodrigo Othávio de Assunção E Souza
- Department of Dentistry, Universidade Federal do Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP: 59056-000, Brazil
| | - Isauremi Vieira de Assunção
- Department of Dentistry, Universidade Federal do Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP: 59056-000, Brazil
| | | | - Boniek Castillo Dutra Borges
- Department of Dentistry, Universidade Federal do Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP: 59056-000, Brazil.
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Oral pH value predicts the incidence of radiotherapy related caries in nasopharyngeal carcinoma patients. Sci Rep 2021; 11:12283. [PMID: 34112869 PMCID: PMC8192759 DOI: 10.1038/s41598-021-91600-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Radiotherapy-related caries is a complication of radiotherapy for nasopharyngeal carcinoma; however, factors influencing the occurrence, accurate prediction of onset, and protective factors of radiotherapy-related caries remain unclear. This study analyzed risk factors, disease predictors, and protective factors for radiotherapy-related caries in nasopharyngeal carcinoma. This prospective study included 138 nasopharyngeal carcinoma patients receiving radical radiotherapy at our hospital during June 2012–December 2016 and were followed up for dental caries. Patients’ clinical data on radiotherapy were collected, dynamic monitoring was performed to assess changes in oral pH values, and a questionnaire survey was administered to collect patients’ lifestyle habits. Time-dependent cox regression trees, event-free Kaplan–Meier curve, Mann–Whitely U test were used to analysis the results. The median follow-up time was 30 (12–60) months. Radiotherapy-related caries occurred in 28 cases (20.3%). Univariate analyses showed that radiotherapy-related caries was associated with patient’s age, oral saliva pH value, green tea consumption, and radiation dose to sublingual glands, but not with the radiation dose to the parotid and submandibular glands. Multivariate analysis showed that oral saliva pH value [hazard ratio (HR) = 0.390, 95% confidence interval = 0.204–0.746] was an independent prognostic factor for radiotherapy-related caries. Patients with oral saliva pH values ≤ 5.3 in the 9th month after radiotherapy represented a significantly higher risks for radiotherapy-related caries (p < 0.001). Green tea consumption was associated with the occurrence of radiotherapy-related caries, and oral saliva pH values could predict the occurrence of radiotherapy-related caries. Limiting radiation doses to sublingual glands can reduce the occurrence of radiotherapy-related caries.
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Abstract
This review summarizes the beginning of radiotherapy, techniques of modern radiation therapy with different types, toxicities induced by radiotherapy and their management. Head and neck radiation therapy is still improving for the better management and control of the cancer and induced radiotherapy toxicities.
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Affiliation(s)
- Afnan F. Alfouzan
- From the Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Afnan Alfouzan, Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: http://orcid.org/0000-0003-2535-4641
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Guimarães JR, Carvalho LG, Damascena LC, Sampaio ME, Ribeiro IL, Sousa SA, Valença AM. The incidence of severe oral mucositis and its occurrence sites in pediatric oncologic patients. Med Oral Patol Oral Cir Bucal 2021; 26:e299-e303. [PMID: 33247566 PMCID: PMC8141319 DOI: 10.4317/medoral.24185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Childhood cancer is one of the main causes of child mortality and its treatment has debilitating effects on the oral cavity. Several oral mucositis (SOM) is one of the most common and may cause undesirable symptoms such as pain and risk of systemic infection. Material and Methods This was a longitudinal, retrospective, and observational study determining the incidence of severe oral mucositis (SOM) and its occurrence sites in pediatric oncologic patients, in João Pessoa, Brazil, between 2013 and 2018. Data from 56 patients aged 1 to 18 years were collected from their medical records and through an oral mucosa examination, from the 1st to 5th week of chemotherapy treatment (CT) using the modified Oral Assessment Guide, by previously calibrated examiners (Kappa index > 0.7). The data were analyzed by the Chi-square test, and Odds Ratios were calculated. Results Most patients were females (54.5%), aged 8.8 years (± 4.8), with hematologic tumors (73.2%), predominantly Acute Lymphoid Leukemia (50.0%). An increase in the occurrence of SOM was observed throughout the CT (P = 0.05), ranging from 12.5% in the 1st to 35.7% in the 5th CT week. In the 1st CT week, there was a predominance of alterations in the lips (5.5%) and saliva (5.5%), while in the 5th, the jugal / palate mucosa (21.4%) remained the most affected site by SOM. Differences in the severity of SOM in the jugal / palate mucosa (P = 0.01) and labial mucosa (P = 0.04) were observed over time. In the 5th CT week, the likelihood of developing SOM was 13.3-fold higher (95% CI: 1.5 - 105.6) in patients with hematologic tumors. Conclusions The incidence of SOM was higher in the 5th CT week, most commonly affecting the jugal / palate mucosa, and patients with hematologic tumors were more prone to develop SOM. Key words:Mucositis, oncology, pediatric dentistry.
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Affiliation(s)
- J-R Guimarães
- Manuel Satyro, 350/2301, Cabo Branco 58045-110, João Pessoa, Paraíba, Brazil
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Evaluation of physical and adhesive properties of enamel after a therapeutic dose of radiation and bonding of orthodontic metal brackets: an in vitro study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396919001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:The study aimed to evaluate the shear bond strength (SBS) of metal brackets and adhesive properties of bonded irradiated and non-irradiated teeth.Methods:Sixty-six extracted premolar samples were randomly divided into three groups—(a) Control group consisting of 22 non-irradiated, non-aged teeth (Group 1), (b) 22 non-irradiated, aged samples (Group 2) and (c) 22 irradiated, aged samples (Group 3). Irradiation was done using gamma irradiation with a fractionated dose of 60 Gy for 5 consecutive days per week over 6 weeks. Metal brackets were bonded on all samples with light cure adhesive and subjected to SBS test using universal testing machine. The samples were assessed under the scanning electron microscope to check for the adhesive remnant index (ARI) and tag depth.Results:There was a statistically significant decrease in the mean SBS of the irradiated samples compared to the non-irradiated teeth. The non-irradiated, aged samples showed a majority of ARI scoring 1 and 2. Whereas, the irradiated samples showed ARI scoring 2 and 3. Approximately, 77·3% of the non-irradiated samples showed no adhesive present on the tooth surface, and 27·2% of the irradiated samples had more than 50% adhesive present on the enamel surface.Conclusion:There is a statistically significant decrease in SBS of irradiated enamel compared to that of non-irradiated teeth. However, the SBS observed in the three groups was well above the ideal SBS for orthodontic bonding, that is, 5·6–6·8 MPa. The adhesive remnant was found on all samples of the irradiated group. Deeper adhesive resin tags were found in the irradiated group in the resin–enamel interface.
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Polce S, Gogineni E, Antone J, Ghaly M, Keith Frank D, Segal JD, Parashar B. Dental radiation dosimetric maps from intensity-modulated radiation therapy planning for head and neck cancers. Head Neck 2021; 43:1428-1439. [PMID: 33452742 DOI: 10.1002/hed.26611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to create dental radiation maps to calculate the mean dose to individual teeth, maxilla and mandible using intensity-modulated radiation therapy (IMRT). METHODS Eighteen common clinical settings were chosen. Radiation plans were extracted, and each tooth was contoured at its junction with the gingiva and labeled based on the Universal/American numbering system. RESULTS All patients were treated with prescribed doses of 50-70 Gy in 1.66-2 Gy/fraction. Patients receiving mean doses >50 Gy to the teeth, mandible, and maxilla included those with advanced tumors of the oral cavity and gross lymphadenopathy of level 1b. CONCLUSION We believe this to be the first study generating dosimetric maps of estimated doses to each tooth and each third of the mandible and the maxilla for common examples of head and neck cancer faced by radiation oncologists. Adoption of these dental maps may help improve clinical workflow efficiency.
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Affiliation(s)
- Simran Polce
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Emile Gogineni
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jeffrey Antone
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Douglas Keith Frank
- Department of Otolaryngology, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA
| | - Joshua D Segal
- Department of Dental Medicine, Division of Oral and Maxillofacial surgery, Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York, USA
| | - Bhupesh Parashar
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Assessment of Force Retention between Milled Metallic and Ceramic Telescopic Crowns with Different Taper Angles Used for Oral Rehabilitation. MATERIALS 2020; 13:ma13214814. [PMID: 33126581 PMCID: PMC7663722 DOI: 10.3390/ma13214814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022]
Abstract
The present study assessed the retention forces corresponding to different telescopic systems used in removable prosthetic dentures. The telescopic systems were represented by Co–Cr alloy or zirconia-based primary crowns and Co–Cr secondary crowns. All crowns were manufactured using computer-aided design/computer-aided manufacturing technology (CAD/CAM). Two types of reference abutment teeth (upper canine and first upper molar) were selected in order to obtain the telescopic crowns and two taper angles—of 0° and 2°—were used for the design of the crowns. A number of 120 samples of telescopic crowns were obtained and subjected to mechanical tests, following a specific protocol, on a mechanical testing equipment. The retention of the telescopic systems was evaluated for different sets of cycles (up to 360), represented by movements that simulate the intraoral insertion and disinsertion of the telescopic systems. The present study highlights that the telescopic systems in which the primary crown is made of zirconia ceramics presents more advantages than those made of Co–Cr. All telescopic systems studied, highlighted that by modifying the taper angle from 0° to 2°, the retention forces have decreased, irrespective of the materials used for the fabrication of the primary crown, suggesting that by using a taper angle of 0°, which is known to be ideal, more efficient, and reliable prosthesis can be developed. Thus, even though the ceramic–metallic telescopic system exhibited the highest retention, all telescopic crowns evaluated registered values between 2–7 N, indicating that they are suitable for clinical use.
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Catalán M, Castro-Castillo V, Gajardo-de la Fuente J, Aguilera J, Ferreira J, Ramires-Fernandez R, Olmedo I, Molina-Berríos A, Palominos C, Valencia M, Domínguez M, Souto JA, Jara JA. Continuous flow synthesis of lipophilic cations derived from benzoic acid as new cytotoxic chemical entities in human head and neck carcinoma cell lines. RSC Med Chem 2020; 11:1210-1225. [PMID: 33479625 DOI: 10.1039/d0md00153h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/30/2020] [Indexed: 01/17/2023] Open
Abstract
Continuous flow chemistry was used for the synthesis of a series of delocalized lipophilic triphenylphosphonium cations (DLCs) linked by means of an ester functional group to several hydroxylated benzoic acid derivatives and evaluated in terms of both reaction time and selectivity. The synthesized compounds showed cytotoxic activity and selectivity in head and neck tumor cell lines. The mechanism of action of the molecules involved a mitochondrial uncoupling effect and a decrease in both intracellular ATP production and apoptosis induction.
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Affiliation(s)
- Mabel Catalán
- Clinical and Molecular Pharmacology Program , Institute of Biomedical Sciences (ICBM) , Faculty of Medicine , Universidad de Chile , Santiago , 8380453 , Chile
| | - Vicente Castro-Castillo
- Department of Organic and Physical Chemistry , Faculty of Chemical and Pharmaceutical Sciences , Universidad de Chile , Santos Dumont 964 , Santiago 8380494 , Chile
| | - Javier Gajardo-de la Fuente
- Department of Organic and Physical Chemistry , Faculty of Chemical and Pharmaceutical Sciences , Universidad de Chile , Santos Dumont 964 , Santiago 8380494 , Chile
| | - Jocelyn Aguilera
- Institute for Research in Dental Sciences (ICOD) , Faculty of Dentistry , Universidad de Chile , Santiago , 8380492 , Chile . ; Tel: +56 2 29781730
| | - Jorge Ferreira
- Clinical and Molecular Pharmacology Program , Institute of Biomedical Sciences (ICBM) , Faculty of Medicine , Universidad de Chile , Santiago , 8380453 , Chile
| | | | - Ivonne Olmedo
- Physiopathology Program , Institute of Biomedical Sciences (ICBM) , Faculty of Medicine , Universidad de Chile , Santiago 8380453 , Chile
| | - Alfredo Molina-Berríos
- Institute for Research in Dental Sciences (ICOD) , Faculty of Dentistry , Universidad de Chile , Santiago , 8380492 , Chile . ; Tel: +56 2 29781730
| | - Charlotte Palominos
- Clinical and Molecular Pharmacology Program , Institute of Biomedical Sciences (ICBM) , Faculty of Medicine , Universidad de Chile , Santiago , 8380453 , Chile
| | - Marcelo Valencia
- Clinical and Molecular Pharmacology Program , Institute of Biomedical Sciences (ICBM) , Faculty of Medicine , Universidad de Chile , Santiago , 8380453 , Chile
| | - Marta Domínguez
- Departamento de Química Orgánica , Facultad de Química , CINBIO and IIS Galicia Sur , Universidade de Vigo , E-36310 , Vigo , Spain .
| | - José A Souto
- Departamento de Química Orgánica , Facultad de Química , CINBIO and IIS Galicia Sur , Universidade de Vigo , E-36310 , Vigo , Spain .
| | - José A Jara
- Institute for Research in Dental Sciences (ICOD) , Faculty of Dentistry , Universidad de Chile , Santiago , 8380492 , Chile . ; Tel: +56 2 29781730
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Priya AHH, Rajmohan, Arun Kumar HP, Akash Raj S, Archana S, Venkatanarasu B. Evaluation of Alteration in Oral Microbial Flora Pre- and Postradiation Therapy in Patients with Head and Neck Cancer. J Pharm Bioallied Sci 2020; 12:S109-S113. [PMID: 33149440 PMCID: PMC7595542 DOI: 10.4103/jpbs.jpbs_38_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/02/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: For decades now, head and neck cancer (HNC) remains to be one of the deadliest; per se the treatment for the same has been evolving for the past years. Radiation therapy (RT) has been one among the various treatment modalities adopted to treat HNC. The fact that RT can affect the quality of life in these patients cannot be denied. In patients with HNC, these can bring about a wide array of lesions in oral cavity and its associated structures as these areas are invariably affected due to exposure to radiation as such. These include alteration in salivary parameters, changes in microbial flora, and occurrence of radiation caries. Aim: In our study we aimed at assessing the alteration in oral microbial flora inclusive of Streptococcus mutans and Lactobacillus colony count before and after RT. Materials and Methods: Saliva and plaque samples were collected from patients with HNC, who were prescribed to undergo intensity-modulated radiation therapy (IMRT) amounting to a mean radiation dosage of 60 Gy units. The aforementioned samples were collected at three different intervals, before, immediately after, and 6 months after RT. The samples were cultured in selective media in three different dilutions (1:10, 1:100, and 1:1000). Following with colony counting is carried out using a standardized colony counter. Conclusion: The results showed a significant alteration in microbial flora pre- and post-RT. Individual parameters do not show a single stand in causing these changes. Moreover, these changes seem to have earned a multifactorial contribution.
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Affiliation(s)
| | - Rajmohan
- Department of Public Health Dentistry, SRM Dental College, Chennai, Tamil Nadu, India
| | - Hari Priya Arun Kumar
- Department of Oral Medicine and Radiology, SRM Dental College, Chennai, Tamil Nadu, India
| | - Shakthi Akash Raj
- Department of Prosthodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Sai Archana
- Department of Oral Medicine and Radiology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
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Watson E, Eason B, Kreher M, Glogauer M. The DMFS160: A new index for measuring post-radiation caries. Oral Oncol 2020; 108:104823. [PMID: 32521312 DOI: 10.1016/j.oraloncology.2020.104823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
Abstract
The current systems used to measure post-radiation caries underestimate the severity of the disease by failing to account for the unique spread of post-radiation caries, including incisal-edge and cusp tip decay, enamel delamination and crown amputation. A novel and clinically applicable index to measure post-radiation caries is proposed. The DMFS160 index counts 5 surfaces per tooth, accounting for incisal-edge caries, and is broken down into missing surfaces and decayed/filled surfaces. A staging and grading system is used to capture enamel delamination and crown amputation. The staging and grading provides a clinically-relevant measure at the whole-mouth level and is paired with evidence-based treatment strategies. In this paper the DMFS160 index is applied to three cases and compared to the DMFS index, demonstrating the improved accuracy of the DMFS160 index in measuring the extent of post-radiation caries.
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Affiliation(s)
- Erin Watson
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada.
| | - Brady Eason
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada.
| | - Matthew Kreher
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada.
| | - Michael Glogauer
- Princess Margaret Cancer Centre, 610 University Avenue, Room 2-933, Toronto, Ontario M5G2M9, Canada; University of Toronto, Faculty of Dentistry, 101 Elm Street, Toronto, Ontario M5G2L3, Canada.
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39
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Spijkervet FKL, Schuurhuis JM, Stokman MA, Witjes MJH, Vissink A. Should oral foci of infection be removed before the onset of radiotherapy or chemotherapy? Oral Dis 2020; 27:7-13. [PMID: 32166855 PMCID: PMC7818265 DOI: 10.1111/odi.13329] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 01/22/2023]
Abstract
Pretreatment dental screening aims to locate and eliminate oral foci of infection in order to eliminate local, loco-regional, or systemic complications during and after oncologic treatment. An oral focus of infection is a pathologic process in the oral cavity that does not cause major infectious problems in healthy individuals, but may lead to severe local or systemic inflammation in patients subjected to oncologic treatment. As head and neck radiotherapy patients bear a lifelong risk on oral sequelae resulting from this therapy, the effects of chemotherapy on healthy oral tissues are essentially temporary and reversible. This has a large impact on what to consider as an oral focus of infection when patients are subjected to, for example, head and neck radiotherapy for cancer or intensive chemotherapy for hematological disorders. While in patients subjected to head and neck radiotherapy oral foci of infection have to be removed before therapy that may cause problems ultimately, in patients that will receive chemotherapy such, so-called chronic, foci of infection are not in need of removal of teeth but can be treated during a remission phase. Acute foci of infection always have to be removed before or early after the onset of any oncologic treatment.
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Affiliation(s)
- Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jennifer M Schuurhuis
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Monique A Stokman
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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40
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Allahyari S. Oral Rehabilitation in Irradiated Patients: Implant- or Tooth-Supported Fixed Prosthesis? A Clinical Report. Front Dent 2020; 16:319-324. [PMID: 32342061 PMCID: PMC7181347 DOI: 10.18502/fid.v16i4.2091] [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] [Received: 09/22/2018] [Accepted: 12/23/2018] [Indexed: 12/03/2022] Open
Abstract
Cranial radiotherapy has several side effects. One of the most important complications is radiation caries that endangers the treatment prognosis. In the literature, the use of crowns and bridges for irradiated patients has been suggested as a contraindication. In addition, due to the risk of osteoradionecrosis (ORN), there are doubts about tooth extraction and implant placement. Here, we present a treatment sequence and recalls for an irradiated young patient. For irradiated patients, it is recommended to replace teeth with implants when there is no possibility for supragingival prosthetic margin.
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Affiliation(s)
- Somayeh Allahyari
- Department of Dental Technology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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41
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Castagnola R, Minciacchi I, Rupe C, Marigo L, Grande NM, Contaldo M, Pesce A, Lajolo C. The Outcome of Primary Root Canal Treatment in Postirradiated Patients: A Case Series. J Endod 2020; 46:551-556. [PMID: 32088010 DOI: 10.1016/j.joen.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/08/2019] [Accepted: 12/21/2019] [Indexed: 12/25/2022]
Abstract
Osteoradionecrosis (ORN) of the jaw is considered the most severe long-term adverse effect that can occur in radiation therapy patients. Teeth extractions and dental diseases are the main risk factors for ORN in irradiated patients. The aim of this case series was to evaluate the outcome of primary root canal treatments performed on patients who underwent head and neck radiotherapy and to evaluate any ORN related to the endodontic treatment. In this case series, primary root canal therapies (absence of radiolucency) were performed on 10 teeth of 8 patients who underwent radiotherapy for head and neck cancers. Radiation doses to the periapical area were calculated using the radiotherapy planning computed tomographic scan. After a 277-day mean follow-up, all patients were asymptomatic, no teeth showed periapical radiolucency, and no ORN was observed. Even if a limitation of buccal opening occurred after radiotherapy and complicated the endodontic procedures, root canal therapy seemed to be safe and a valid alternative to tooth extraction.
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Affiliation(s)
- Raffaella Castagnola
- Department of Operative Dentistry and Endodontics, "Fondazione Policlinico Universitario A. Gemelli IRCCS," School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Irene Minciacchi
- Department of Operative Dentistry and Endodontics, "Fondazione Policlinico Universitario A. Gemelli IRCCS," School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli IRCCS," School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Marigo
- Department of Operative Dentistry and Endodontics, "Fondazione Policlinico Universitario A. Gemelli IRCCS," School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Maria Grande
- Department of Operative Dentistry and Endodontics, "Fondazione Policlinico Universitario A. Gemelli IRCCS," School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania L. Vanvitelli, Naples, Italy
| | - Adele Pesce
- Department of Radiation Oncology, "Fondazione Policlinico Universitario A. Gemelli IRCCS," Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli IRCCS," School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
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42
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Bonzanini LIL, Soldera EB, Ortigara GB, Schulz RE, Knorst JK, Ardenghi TM, Ferrazzo KL. Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients. Braz Oral Res 2020; 34:e009. [PMID: 32049110 DOI: 10.1590/1807-3107bor-2020.vol34.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/10/2019] [Indexed: 11/22/2022] Open
Abstract
The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.
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Affiliation(s)
- Laura Izabel Lampert Bonzanini
- Universidade Federal do Rio Grande do Sul (UFRGS), School of Dentistry, Department of Surgery and Orthopedics, Porto Alegre, RS, Brazil
| | - Eloisa Barbieri Soldera
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Gabriela Barbieri Ortigara
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Riéli Elis Schulz
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Jessica Klöckner Knorst
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Thiago Machado Ardenghi
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Kívia Linhares Ferrazzo
- Universidade Federal de Santa Maria (UFSM), School of Dentistry, Department of Pathology, Santa Maria, RS, Brazil
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43
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Dental caries following radiotherapy for head and neck cancer: A systematic review. Oral Oncol 2020; 100:104484. [DOI: 10.1016/j.oraloncology.2019.104484] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
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44
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Bak SY, Oh WS, Erman A. Treatment of velopharyngeal dysfunction: A clinical report. J Prosthet Dent 2019; 123:888-891. [PMID: 31787271 DOI: 10.1016/j.prosdent.2019.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022]
Abstract
Current tumor therapies can impair velopharyngeal function and lead to the development of hypernasality and nasal regurgitation. This article describes a prosthetic restoration of velopharyngeal dysfunction with a multidisciplinary approach including a speech pathologist and videofluoroscopic and nasal endoscopic procedures.
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Affiliation(s)
- Sun-Yung Bak
- Clinical Assistant Professor, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Mich.
| | - Won-Suk Oh
- Clinical Professor, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Mich
| | - Andrew Erman
- Director, Speech Pathology Clinic, UCLA Health System, Los Angeles, Calif
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45
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The impact of radiation caries in the quality of life of head and neck cancer patients. Support Care Cancer 2019; 28:2977-2984. [DOI: 10.1007/s00520-019-05171-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
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46
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Leroy R, De Gendt C, Stordeur S, Schillemans V, Verleye L, Silversmit G, Van Eycken E, Savoye I, Grégoire V, Nuyts S, Vermorken J. Head and Neck Cancer in Belgium: Quality of Diagnostic Management and Variability Across Belgian Hospitals Between 2009 and 2014. Front Oncol 2019; 9:1006. [PMID: 31649876 PMCID: PMC6794682 DOI: 10.3389/fonc.2019.01006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/18/2019] [Indexed: 01/28/2023] Open
Abstract
Aims: The study assessed the quality of diagnosis and staging offered to patients with a head and neck squamous cell carcinoma (HNSCC) and the variability across Belgian hospitals. Methods: In total, 9,245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry (BCR). The BCR data were coupled with other databases providing information on diagnostic and therapeutic procedures reimbursed by the compulsory health insurance, vital status data, and comorbidities. The use of diagnosis and staging procedures was assessed by four quality indicators (QI) (i.e., use of dedicated head and neck imaging studies, use of PET-CT, TNM reporting and interval between diagnosis and start of treatment), for which a target was defined before the analysis. The association between the binary QIs and observed survival was assessed using Cox proportional hazard models adjusted for potential confounders. Results: Overall, 82.5% of patients received staging by MRI and/or CT of the head and neck region before the start of treatment. In 47.6% of stage III-IV patients eligible for treatment with curative intent, a whole-body FDG-PET(/CT) was performed. The proportion of patients whose cTNM and pTNM stage was reported to the BCR was 80.5 and 78.4%, respectively. The median interval from diagnosis to first treatment with curative intent was 32 days (IQR: 19-46). For none of these QIs the pre-set targets were reached and a substantial variability between centers was observed for all quality indicators. No binary QI was significantly associated with observed survival. Conclusions: The four quality indicators related to diagnosis and staging in HNSCC all showed substantial room for improvement. For none of them the pre-set targets were met at the national level and the variability between centers was substantial. Each Belgian hospital received an individual feedback report in order to stimulate reflection and quality improvement processes.
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Affiliation(s)
- Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Sabine Stordeur
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | | | - Isabelle Savoye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Sandra Nuyts
- Department of Radiotherapy-Oncology, University Hospitals Leuven, University of Leuven, KU Leuven, Leuven, Belgium
| | - Jan Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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47
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Rouers M, Bornert F, Truntzer P, Dubourg S, Bourrier C, Antoni D, Noël G. Ability to Propose Optimal Prosthetic Rehabilitation can be Improved by Discussion between the Dentist and Radiation Oncologist Regarding Upstream Dosimetry. Eur J Dent 2019; 13:88-94. [PMID: 31170766 PMCID: PMC6635961 DOI: 10.1055/s-0039-1688523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective
Improvement of dental rehabilitation for patients who have undergone radiation therapy requires knowledge of the dose in the maxillary and mandible bones.
Materials and Methods
Forty-three patients with head and neck cancers underwent evaluation for dental rehabilitation before radiation treatment dosimetry. The delivered dose to the maxilla and mandible was determined. From the dose data in the literature, three levels of risk of implant failure were defined. According to the delivered doses, the authors calculated the percentage of patients who could be fully rehabilitated with an implant, as proposed by the dentist before radiation planning.
Results
Before dosimetry calculation, all of the completely edentulous arches and 94 partially edentulous (PESs) sextants could be optimally rehabilitated. After dose calculation, among the 14 arches of 7 patients who were completely edentulous, according to the mean and maximal delivered doses, 11 arches (78.6%) and 7 arches (50%) could receive an optimal prosthesis, respectively. For the three patients, who were PESs but with one arch that was completely edentulous, according to the mean and maximal delivered doses, one arch for each dose condition could receive an optimal prosthesis. Among the 94 PESs sextants, according to the mean and maximal delivered doses, 41 (43.6%) and 24 (25.5%) sextants could receive an optimal prosthesis, respectively.
Conclusion
By determining the sites of implantation before dosimetry, the radiation oncologist could shield specified areas, potentially improving the possibilities for dental rehabilitation. The dialogue between the dentist and the radiation oncologist can improve the possibilities for implants and decrease the risk of unsafe implantation.
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Affiliation(s)
- Mélanie Rouers
- Faculty of Dental Medicine, 1 Place de l'Hôpital, Strasbourg, France
| | - Fabien Bornert
- Faculty of Dental Medicine, 1 Place de l'Hôpital, Strasbourg, France
| | - Pierre Truntzer
- University Radiation Department, Centre Paul Strauss, Strasbourg, France
| | - Sarah Dubourg
- Faculty of Dental Medicine, 1 Place de l'Hôpital, Strasbourg, France
| | - Cyrielle Bourrier
- University Radiation Department, Centre Paul Strauss, Strasbourg, France
| | - Delphine Antoni
- University Radiation Department, Centre Paul Strauss, Strasbourg, France.,Strasbourg University, Radiobiology Lab, Centre Paul Strauss, Strasbourg, France
| | - Georges Noël
- University Radiation Department, Centre Paul Strauss, Strasbourg, France.,Strasbourg University, Radiobiology Lab, Centre Paul Strauss, Strasbourg, France
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48
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Parahoo RS, Semple CJ, Killough S, McCaughan E. The experience among patients with multiple dental loss as a consequence of treatment for head and neck cancer: A qualitative study. J Dent 2019; 82:30-37. [DOI: 10.1016/j.jdent.2019.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/25/2022] Open
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49
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Abstract
The treatment of head and neck cancers requires a team approach. Maxillofacial prosthetics and oncologic dentistry are involved in many phases of the treatment. After the cancer ablation surgery, if surgical reconstruction cannot not completely restore the surgical defect site, maxillofacial prostheses plays an important role to rehabilitate the patient's mastication, swallowing, and speech. For patients undergoing chemoradiation therapy, the outcome is enhanced by jaw positioning stent and fluoride carrier mouthpiece. This perioperative care by maxillofacial prosthetics improves the posttreatment outcomes and the patient's quality of life.
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Affiliation(s)
- Kamolphob Phasuk
- Department of Prosthodontics, Indiana University School of Dentistry, 1121 West Michigan Street, Indianapolis, IN 46202, USA.
| | - Steven P Haug
- Department of Prosthodontics, Indiana University School of Dentistry, 1121 West Michigan Street, Indianapolis, IN 46202, USA
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50
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Abstract
Radiotherapy is used in >50% of patients with cancer, both for curative and palliative purposes. Radiotherapy uses ionizing radiation to target and kill tumour tissue, but normal tissue can also be damaged, leading to toxicity. Modern and precise radiotherapy techniques, such as intensity-modulated radiotherapy, may prevent toxicity, but some patients still experience adverse effects. The physiopathology of toxicity is dependent on many parameters, such as the location of irradiation or the functional status of organs at risk. Knowledge of the mechanisms leads to a more rational approach for controlling radiotherapy toxicity, which may result in improved symptom control and quality of life for patients. This improved quality of life is particularly important in paediatric patients, who may live for many years with the long-term effects of radiotherapy. Notably, signs and symptoms occurring after radiotherapy may not be due to the treatment but to an exacerbation of existing conditions or to the development of new diseases. Although differential diagnosis may be difficult, it has important consequences for patients.
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