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Mizutani-Yoshimura M, Mizutani S, Uchida N, Taniguchi S, Fueki K. Do oral conditions influence the incidence of bloodstream infection after hematopoietic stem cell transplantation? A retrospective study in Japan. Support Care Cancer 2024; 32:398. [PMID: 38819687 DOI: 10.1007/s00520-024-08609-w] [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: 01/31/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE This study aimed to evaluate the incidence of bloodstream infection (BSI) among patients undergoing hematopoietic stem cell transplantation (HSCT) for teeth indicated for extraction. METHODS Patients who underwent HSCT at Toranomon Hospital (Tokyo, Japan) between January 2017 and December 2019 were retrospectively evaluated. The incidence of BSI among patients with teeth indicated for extraction who did not undergo extraction (oral high-risk group) and patients who did not have this risk (oral low-risk group) was compared. RESULTS Among the 191 consecutive patients included in this study, 119 patients were classified as undergoing high-risk transplantation. BSI after HSCT was observed in 32 out of 60 (53.3%) patients and 56 out of 131 (42.7%) patients in the oral low-risk and oral high-risk groups, respectively (p = 0.173). Multivariable analyses revealed that the presence of > 3 teeth as intraoral sources of infection and age over 50 years were determinants of BSI originating from the oral cavity after engraftment (odds ratio [OR], 9.11; 95% confidential interval [CI] 2.27-36.61]; p = 0.002; OR, 3.22; CI [1.47-7.08], p = 0.004, respectively). CONCLUSION In patients undergoing HSCT, the presence of less than three intraoral sources of infection did not affect the incidence of BSI after HSCT.
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Affiliation(s)
| | - Saneyuki Mizutani
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koutoubashi Sumida-Ku, Tokyo, 130-8575, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon Minato-Ku, Tokyo, 105-8470, Japan
| | - Shuichi Taniguchi
- Department of Hematology, Hamanomachi Hospital, 3-3-3 Nagahama Chuou-Ku, Fukuoka, 810-0072, Japan
| | - Kenji Fueki
- Department of Masticatory Function and Health Science, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-Ku, Tokyo, 113-8510, Japan
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2
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Bertl K, Kogelnik SL, Kukla E, Herrmann H, Schneider S, Altorjai G, Stavropoulos A. A survey on oral health-related standard of care for head and neck cancer patients in the EU. Oral Dis 2024; 30:1935-1944. [PMID: 37466114 DOI: 10.1111/odi.14685] [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: 02/11/2023] [Revised: 05/18/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To map oral health-related standard of care in the context of head and neck cancer (HNC) treatment across the European Union (EU). MATERIALS AND METHODS Six hundred and ninety centers across the European Union were contacted. The questionnaire contained questions focusing on the team/department structure, HNC treatment planning routines, and assessment and handling of dental treatment needs prior to cancer treatment. RESULTS Eighty-seven centers across the EU responded. Department structure and number of HNC patients treated per year varied widely and dental professionals are included as part of the team in about 25% of the centers. Standard of care, in terms of dental assessment and preventive dentistry routines, such as recording an orthopantomogram, offering dental treatment, and providing a radiation protection splint and splint for fluoride application, differed significantly among the European regions. Independent of the region, these aspects are positively affected if dental professionals are part of the interdisciplinary treatment team and if dental treatment is offered within the center. CONCLUSION Dental professionals are still only to a very limited extent included in interdisciplinary treatment planning teams of HNC patients. However, their inclusion and/or offering dental treatment within the same hospital/center appears to improve oral health-related standard of care. CLINICAL RELEVANCE Inclusion of dental professionals in treatment planning teams of HNC patients appears to improve oral health-related standard of care within HNC treatment.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Sophie Livia Kogelnik
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Edmund Kukla
- Comprehensive Center Unit, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Harald Herrmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Steffen Schneider
- Department of Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriela Altorjai
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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3
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Vesala T, Ventä I, Snäll J, Marinescu Gava M, Ekholm M. Assessing current clinical eruption stage of mandibular third molars by dental panoramic radiography. Acta Odontol Scand 2024; 83:174-179. [PMID: 38651519 DOI: 10.2340/aos.v83.40477] [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: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE We examined whether dental panoramic radiography (PAN) can be used to identify the clinical stage of eruption of mandibular third molars at the time of radiological examination. MATERIALS AND METHODS Cross-sectional data included records from clinical oral examination and PANs of university students. In the retrospective analysis of 345 mandibular third molars in 189 participants (20% men, 80% women; mean age 20.7 years; standard deviation [SD] ± 0.6), clinical stages of eruption were compared with their radiographic depth in bone, inclination, and root development. Statistics included χ2, Mann-Whitney U tests, and logistic regression. RESULTS Significant (p < 0.001) predictor variables for assessing the clinical stage of eruption were radiographic depth in bone and inclination. All teeth radiologically at a depth of the cementoenamel (CE) junction of the neighbouring second molar or deeper were clinically unerupted. Above the CE junction, 80% of vertical and 97% of distoangular teeth were connected to the oral cavity, and 82% of mesioangular and 69% of horizontal teeth were clinically unerupted. CONCLUSION All teeth below or at the CE junction are clinically unerupted. Above the CE junction, stage of eruption should be assessed together with the inclination, but horizontally inclined teeth are recommended to be verified clinically.
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Affiliation(s)
- Tommi Vesala
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Irja Ventä
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Marja Ekholm
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Turku University Hospital and University of Turku, Turku, Finland
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4
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Buurman DJM, Speksnijder CM, Granzier ME, Timmer VCML, Hoebers FJP, Kessler P. Response to: Comment on: The extent of unnecessary tooth loss due to extractions prior to radiotherapy based on radiation field and dose in patients with head and neck cancer. Radiother Oncol 2024; 190:110026. [PMID: 38008415 DOI: 10.1016/j.radonc.2023.110026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Doke J M Buurman
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
| | - Caroline M Speksnijder
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; University Medical Center Utrecht Cancer Center, Department of Head and Neck Surgical Oncology, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands; University Medical Center Utrecht, Department of Oral and Maxillofacial Surgery and Special Dental Care, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - Marlies E Granzier
- MAASTRO, Department of Radiation Oncology, Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands
| | - Veronique C M L Timmer
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Frank J P Hoebers
- Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616, 6200 MD Maastricht, the Netherlands; MAASTRO, Department of Radiation Oncology, Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands
| | - Peter Kessler
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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5
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Alberga JM, Vissink A, Korfage A, de Visscher SAHJ, Witjes MJH, Langendijk JA, Raghoebar GM. Site-specific radiation dosage and implant survival in oral cancer patients: A cohort study. Oral Dis 2023. [PMID: 37983849 DOI: 10.1111/odi.14813] [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: 07/24/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES We assessed the radiation dosages (Dmean ) on implant regions to identify the threshold for implant loss in patients with an intraoral malignancy treated with dental implants to support a mandibular denture during ablative surgery before volumetric-modulated arc therapy (VMAT). MATERIALS AND METHODS Data was collected prospectively from 28 patients treated surgically for an intraoral malignancy, followed by postoperative radiotherapy (VMAT) and analyzed retrospectively. Patients received 2 implants in the native mandible during ablative surgery. Implant-specific Dmean values were retrieved from the patients' files. Radiographic bone loss was measured 1 year after implant placement and during the last follow-up appointment. Implant survival was analyzed with the Kaplan-Meier method. Univariate logistic regression and Cox-regression analyses were performed to investigate the effect of increasing implant-specific radiation dosages on implant loss. RESULTS Five out of 56 placed implants were lost during follow-up (median 36.0 months, IQR 39.0). Radiographically, peri-implant bone loss occurred in implants with a Dmean > 40 Gy. Implant loss occurred only in implants with a Dmean > 50 Gy. CONCLUSION An implant-specific Dmean higher than 50 Gy is related to more peri-implant bone loss and, eventually, implant loss.
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Affiliation(s)
- Jamie M Alberga
- 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
| | - Anke Korfage
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sebastiaan A H J de Visscher
- Department of Oral and Maxillofacial Surgery, 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
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Buurman DJM, Speksnijder CM, Granzier ME, Timmer VCML, Hoebers FJP, Kessler P. The extent of unnecessary tooth loss due to extractions prior to radiotherapy based on radiation field and dose in patients with head and neck cancer. Radiother Oncol 2023; 187:109847. [PMID: 37543058 DOI: 10.1016/j.radonc.2023.109847] [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: 04/11/2023] [Revised: 07/01/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND PURPOSE Prior to radiotherapy (RT), teeth with poor prognosis that pose a risk for post-RT osteoradionecrosis (ORN) are removed. To allow enough time for adequate wound healing prior to RT, decisions are made based on the estimated radiation dose. This study aimed to gain insight into (1) the overall number of teeth extracted and (2) the patient and tumor characteristics associated with the number of redundantly extracted teeth. MATERIALS AND METHODS Patients with head and neck cancer (HNC), treated with RT between 2015 and 2019, were included in this cross-sectional study. For each extracted tooth the radiation dose was calculated retrospectively. The cut-off point for valid extraction was set at ≥ 40 Gy in accordance with the national protocol. Potential factors for doses ≥ 40 Gy were identified, including age, sex, tumor location, tumor (T) and nodal stage (N), overall tumor stage and number of teeth extracted. RESULTS A total of 1759 teeth were removed from 358 patients. Of these 1759 teeth, 1274 (74%) appeared to have been removed redundantly, based on the mean dose (Dmean) of < 40 Gy. Using the maximum dose (Dmax) of < 40 Gy, 1080 teeth (61%) appeared to have been removed redundantly. Tumor location and N-classification emerged as the most important associative variables in the multivariable regression analysis. CONCLUSION To our knowledge this is the first study to provide insight into the amount of teeth redundantly extracted prior to RT and represents a step forward in de-escalating the damage to the masticatory system prior to RT.
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Affiliation(s)
- Doke J M Buurman
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800 6202 AZ, Maastricht, the Netherlands; Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616 6200 MD, Maastricht, the Netherlands.
| | - Caroline M Speksnijder
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800 6202 AZ, Maastricht, the Netherlands; University Medical Center Utrecht Cancer Center, Department of Head and Neck Surgical Oncology, Utrecht University, P.O. Box 85500 3508 GA, Utrecht, the Netherlands; University Medical Center Utrecht, Department of Oral and Maxillofacial Surgery and Special Dental Care, Utrecht University, P.O. Box 85500 3508 GA, Utrecht, the Netherlands
| | - Marlies E Granzier
- MAASTRO, Department of Radiation Oncology, Doctor Tanslaan 12 6229 ET, Maastricht, the Netherlands
| | - Veronique C M L Timmer
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800 6202 AZ, Maastricht, the Netherlands; Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616 6200 MD, Maastricht, the Netherlands
| | - Frank J P Hoebers
- Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616 6200 MD, Maastricht, the Netherlands; MAASTRO, Department of Radiation Oncology, Doctor Tanslaan 12 6229 ET, Maastricht, the Netherlands
| | - Peter Kessler
- Maastricht University Medical Center, Department of Cranio-Maxillofacial Surgery, P.O. Box 5800 6202 AZ, Maastricht, the Netherlands; Maastricht University Medical Center, GROW School for Oncology and Reproduction, P.O. Box 616 6200 MD, Maastricht, the Netherlands
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Zecha JAEM, Laheij AMGA, Raber-Durlacher JE, Westermann AM, de Lange J, Smeele LE. Pre-Chemotherapy Dental Screening: Is There Additional Diagnostic Value for a Panoramic Radiograph? Dent J (Basel) 2023; 11:dj11050122. [PMID: 37232773 DOI: 10.3390/dj11050122] [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: 04/10/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The oral cavity is a potential source of infectious complications in patients treated with myelosuppressive chemotherapy (CT). Pre-chemotherapy oral examination to identify foci of infection is recommended, but it is unclear whether this should include panoramic radiography. The present study aimed to evaluate the additional diagnostic merit of panoramic radiography as part of pre-CT oral screening. METHODS Patients with solid tumors scheduled to receive a myelosuppressive CT were eligible. The foci definition followed the guidelines of the Dutch Association of Maxillofacial Surgery. Oral foci assessed by clinical evaluation and panoramic radiography were compared. RESULTS In 33 out of 93 patients (35.5%), one or more foci were identified by clinical examination, whereas in 49.5% of patients, panoramic radiography showed pathology. In 19 patients, an oral focus was missed by clinical examination only, whereas in 11 patients, panoramic radiography indicated periodontal bone loss, but advanced periodontitis was not substantiated by clinical examination. CONCLUSIONS Panoramic radiographs complement clinical examinations and have additional diagnostic value. Nevertheless, the additional merit seems small, and the clinical relevance may vary depending on the anticipated risk of developing oral complications and the need for detailed diagnosis and rigorous elimination of oral foci prior to the start of cancer therapy.
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Affiliation(s)
- Judith A E M Zecha
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Alexa M G A Laheij
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands
| | - Anneke M Westermann
- Department of Oncology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands
| | - Ludwig E Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands
- Department of Head & Neck Oncology & Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
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8
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Alberga JM, Meijer J, Raghoebar GM, Langendijk JA, Korfage A, Steenbakkers RJHM, Meijer TWH, Reintsema H, Vissink A, Witjes MJH. Planned dose of intensity modulated proton beam therapy versus volumetric modulated arch therapy to tooth-bearing regions. Oral Oncol 2023; 140:106392. [PMID: 37084567 DOI: 10.1016/j.oraloncology.2023.106392] [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: 01/23/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Intensity modulated proton beam therapy (IMPT) for head and neck cancer offers dosimetric benefits for the organs at risk when compared to photon-based volumetric modulated arch therapy (VMAT). However, limited data exists about the potential benefits of IMPT for tooth-bearing regions. The aim of this study was to compare the IMPT and VMAT radiation dosimetrics of the tooth-bearing regions in head and neck cancer patients. Also, we aimed to identify prognostic factors for a cumulative radiation dose of ≥40 Gy on the tooth-bearing areas, which is considered the threshold dose for prophylactic dental extractions. METHODS A total of 121 head and neck cancer patients were included in this retrospective analysis of prospectively collected data. We compared the average Dmean values of IMPT versus VMAT of multiple tooth-bearing regions in the same patients. Multivariate logistic regression analysis was performed for receiving a cumulative radiation dose of ≥40 Gy to the tooth-bearing regions (primary endpoint) in both VMAT and IMPT. RESULTS A lower Dmean was seen after applying IMPT to the tooth-bearing tumour regions (p < 0.001). Regarding VMAT, oral cavity tumours, T3-T4 tumours, molar regions in the mandible, and regions ipsilateral to the tumour were risk factors for receiving a cumulative radiation dose of ≥40 Gy. CONCLUSIONS IMPT significantly reduces the radiation dose to the tooth-bearing regions.
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Affiliation(s)
- J M Alberga
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - J Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J A Langendijk
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Korfage
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R J H M Steenbakkers
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - T W H Meijer
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H Reintsema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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9
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Bhandari S, Wadhwa Soni B, Gupta A, Ghoshal S. Time required for prophylactic oral care in head and neck cancer patients scheduled for radiotherapy: A single center, prospective cohort study. Head Neck 2023; 45:913-920. [PMID: 36794635 DOI: 10.1002/hed.27317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/21/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Prophylactic oral care (POC) before radiotherapy (RT) is an adjunct but an integral process toward preparing patients for RT, however, time to be invested in POC remains unexplored. METHODS Prospective treatment records were maintained in head and neck cancer patients, who received POC following a standardized protocol with definite timelines. Data collected for oral treatment time (OTT), interruption in RT due to oro-dental issues, future extraction(s), and incidence of osteoradionecrosis (ORN) up to 18 months after treatment were analyzed. RESULTS Three hundred thirty-three patients, 275 males and 58 females, mean age 52.45 ± 11.2 years were included. Mean OTT was 21.0 ± 6.2 days and was influenced significantly with the number of extractions (p < 0.00). There was no interruption in RT schedule due to oro-dental issues. Five patients were diagnosed with ORN. CONCLUSION Performing POC as demonstrated aid in timely removal of nidus of infection(s), perform RT as scheduled, and maintain satisfactory oral health through the survivorship of patients.
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Affiliation(s)
- Sudhir Bhandari
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavita Wadhwa Soni
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Centre, HBNI, Navi Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Skallsjö K, von Bültzingslöwen I, Hasséus B, Johansson JE, Öhman J, Raber-Durlacher JE, Huysmans MCDNJM, Laheij AMGA, van Leeuwen SJM, Hovan AJ, Garming Legert K, Nguyen HM, Turk PJ, Rozema FR, Blijlevens NMA, Brennan MT. Oral health in patients scheduled for hematopoietic stem cell transplantation in the Orastem study. PLoS One 2023; 18:e0285615. [PMID: 37200298 DOI: 10.1371/journal.pone.0285615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
Despite advances in transplant medicine, prevalence of complications after hematopoietic stem cell transplantation (HSCT) remains high. The impact of pre-HSCT oral health factors on the incidence and severity of complications post-HSCT is poorly understood. The aim of this prospective, observational study was to analyze oral health in patients planned for HSCT. Patients ≥18 years requiring HSCT were included from five sites between 2011-2018. General health, oral findings and patient-reported symptoms were registered in 272 patients. Oral symptoms around disease onset were reported by 43 patients (15.9%) and 153 patients (58.8%) reported oral complications during previous chemotherapy. One third of patients experienced oral symptoms at the oral examination before conditioning regimen and HSCT. In total, 124 (46.1%) patients had dental caries, 63 (29.0%) had ≥one tooth with deep periodontal pockets, 147 (75.0%) had ≥one tooth with bleeding on probing. Apical periodontitis was observed in almost 1/4 and partially impacted teeth in 17 (6.3%) patients. Oral mucosal lesions were observed in 84 patients (30.9%). A total of 45 (17.4%) of 259 patients had at least one acute issue to be managed prior to HSCT. In conclusion, oral symptoms and manifestations of oral disease were prevalent in patients planned for HSCT. The extent of oral and acute dental diseases calls for general oral screening of patients pre-HSCT.
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Affiliation(s)
- Kristina Skallsjö
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger von Bültzingslöwen
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Erik Johansson
- Department of Hematology and Coagulation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Öhman
- Department of Oral medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Stephanie J M van Leeuwen
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Allan J Hovan
- Oral Oncology and Dentistry, British Columbia Cancer, Vancouver, British Columbia, Canada
| | | | - Hieu M Nguyen
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, United States of America
| | - Philip J Turk
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michael T Brennan
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, United States of America
- Department of Otolaryngology/Head and Neck Surgery, Wake Forest University School of Medicine, Wake Forest, North Carolina, United States of America
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11
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Yan R, Liu J, Dong Z, Peng Q. Nanomaterials-mediated photodynamic therapy and its applications in treating oral diseases. BIOMATERIALS ADVANCES 2022; 144:213218. [PMID: 36436431 DOI: 10.1016/j.bioadv.2022.213218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Oral diseases, such as dental caries, periodontitis and oral cancer, have a very high morbidity over the world. Basically, many oral diseases are commonly related to bacterial infections or cell malignant proliferation, and usually located on the superficial positions. These features allow the convenient and efficient application of photodynamic therapy (PDT) for oral diseases, since PDT is ideally suitable for the diseases on superficial sites and has been widely used for antimicrobial and anticancer therapy. Photosensitizers (PSs) are an essential element in PDT, which induce the generation of a large number of reactive oxygen species (ROS) upon absorption of specific lights. Almost all the PSs are small molecules and commonly suffered from various problems in the PDT environment, such as low solubility and poor stability. Recently, reports on the nanomedicine-based PDT have been well documented. Various functionalized nanomaterials can serve either as the PSs carriers or the direct PSs, thus enhancing the PDT efficacy. Herein, we aim to provide a comprehensive understanding of the features of different oral diseases and discuss the potential applications of nanomedicine-based PDT in the treatment of some common oral diseases. Also, the concerns and possible solutions for nanomaterials-mediated PDT are discussed.
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Affiliation(s)
- Ruijiao Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jianhong Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zaiquan Dong
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Qiang Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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12
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Mazzetti T, Sergio da Silva Santos P, Spindola Antunes H, Fernandes Montagner A, Hélène van de Sande F, Timm Maske T. Required time for pre-oncological dental management - A rapid review of the literature. Oral Oncol 2022; 134:106116. [PMID: 36115328 DOI: 10.1016/j.oraloncology.2022.106116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
This study identified the scientific literature comparing the influence of different times in which dental procedures were performed before the oncological treatments (radiotherapy and/or chemotherapy) on the risk of oral complications development. MEDLINE/PubMed and Embase databases were searched, and articles were selected by title, abstract and full-text assessment. The search identified 2,356 articles and three retrospective observational studies were included. Data were collected and analyzed according to the dental procedure, the time before oncological treatment, and oral complications. Risk of bias (ROBINS) and certainty of evidence (GRADE) were evaluated. Pairwise meta-analyses were performed from dental extractions (Exo) data according to the time which were performed and ORN development using a random-effect model (RR and 95 % CI, p < 0.05). meta-analyses showed a higher risk of ORN development in patients with Exo performed < 2 weeks before oncological treatment than in those who Exo was performed > 2 weeks ≤ 1 month before oncological therapy (RR 1.29; 95 % CI 1.12-1.48; p < 0.01). There was a higher prevalence of oral mucositis (OM) in patients who received periodontal treatment ≤ 3 weeks before oncological therapy than those who received dental procedures > 3 weeks ≤ 6 months before. Although the risk of bias ranged from serious to critical, with very low certainty of evidence, the findings suggest that dental extractions should be performed within > 2 weeks before oncological treatment to avoid ORN complications. More studies are needed to conclude the appropriate time to perform dental procedures to decrease other associated oral complications. (CRD42021272652).
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Affiliation(s)
- Thais Mazzetti
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | - Paulo Sergio da Silva Santos
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
| | | | | | | | - Tamires Timm Maske
- Department of Preventive and Community Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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13
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Zecha JAEM, Raber-Durlacher JE, Laheij AMGA, Westermann AM, de Lange J, Smeele LE. The Potential Contribution of Dental Foci and Oral Mucositis to Febrile Neutropenia in Patients Treated With Myelosuppressive Chemotherapy for Solid Tumors and Lymphoma. FRONTIERS IN ORAL HEALTH 2022; 3:940044. [PMID: 35846111 PMCID: PMC9280026 DOI: 10.3389/froh.2022.940044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Febrile neutropenia (FN) is a potential life-threatening complication of myelosuppressive chemotherapy, particularly when induced by infection. There is evidence that FN can originate from the oral cavity, but its contribution to FN is largely understudied in patients treated for solid tumors. The aim of this study was to assess the prevalence of FN in these patients and to evaluate its relation with dental foci and oral mucositis. Material and Methods A prospective longitudinal observational study was conducted. Patients diagnosed with solid tumors and lymphoma scheduled to be treated with myelosuppressive chemotherapy with an intermediate risk of developing FN were included. A pre-chemotherapy dental examination was performed and patients were followed during and after chemotherapy regimen. During subsequent hospital visits for chemotherapy administration, the oral cavity was inspected and oral mucositis (OM) was scored using the CTC-AE version 3.0. When patients presented with fever, a comprehensive full body examination including laboratory/microbiological/imaging investigation was performed. Results Eighty-eight patients were included. Pre-chemotherapy, 39 patients (44.3%) were diagnosed with a dental focus. During chemotherapy, 46 patients developed OM (53.4%), of which 15 patients had a maximum score of grade II (ulcerative mucositis). Ten patients developed FN during the follow-up period. Patients with FN more often suffered from ulcerative OM compared to patients without FN; both FN and mucositis risk was associated with the myelotoxicity of chemotherapy. However, no relation could be established between the presence of dental foci prior to chemotherapy and the development of FN (p > 0.05). Conclusion A significant relation was identified between ulcerative OM and FN, but no robust conclusions could be drawn with respect to a relationship between the presence of dental foci and FN.
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Affiliation(s)
- Judith A. E. M. Zecha
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Judith A. E. M. Zecha
| | - Judith E. Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Alexa M. G. A. Laheij
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Anneke M. Westermann
- Department of Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Academic Center for Dentistry (ACTA), Amsterdam, Netherlands
| | - Ludi E. Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Academic Center for Dentistry (ACTA), Amsterdam, Netherlands
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute- Antoni van Leeuwenhoek, Amsterdam, Netherlands
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14
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Schmalz G, Reuschel F, Bartl M, Schmidt L, Runge J, Haak R, Goralski S, Roth A, Ziebolz D. One Third of Patients before Endoprosthesis Implantation Show an Oral Focus as Potential Source of Infectious Complication—The Value of Pre-Operative Dental Risk Stratification in a German Cohort. J Clin Med 2022; 11:jcm11133686. [PMID: 35806971 PMCID: PMC9267610 DOI: 10.3390/jcm11133686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 ± 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
- Correspondence: ; Tel.: +49-341-9721211
| | - Florentine Reuschel
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
| | - Markus Bartl
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
| | - Laura Schmidt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
| | - Janine Runge
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
| | - Szymon Goralski
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (S.G.); (A.R.)
| | - Andreas Roth
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (S.G.); (A.R.)
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103 Leipzig, Germany; (F.R.); (M.B.); (L.S.); (J.R.); (R.H.); (D.Z.)
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15
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Valdec S, Bosshard FA, Hüllner M, Schwaninger DR, Stocker L, Giacomelli-Hiestand B, Stadlinger B. Value of FDG-PET/MR in Oral Focus Assessment in Head and Neck Cancer Patients-A Feasibility Study. Front Med (Lausanne) 2022; 9:809323. [PMID: 35386916 PMCID: PMC8977518 DOI: 10.3389/fmed.2022.809323] [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: 11/04/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
FDG-PET/MR is a hybrid imaging modality used for the staging and restaging of advanced head & neck cancer (HNC) patients. Their treatment typically involves radiation therapy, which requires previous dental focus assessment. The aim of this study was to analyze if staging FDG-PET/MR is a valuable tool for oral focus assessment. For this purpose, FDG-PET/MR findings, such as metabolic activity of periapical radiolucencies and marginal periodontitis, were retrospectively compared with conventional standardized dental focus assessment, including dental radiographs and clinical assessment of 124 teeth in seven patients. Increased FDG uptake of periapical lesions was found in one out of 23 lesions. Increased FDG uptake of the marginal periodontium was recorded in one out of 34 lesions. In summary, standardized dental focus assessment by panoramic radiography and periapical radiographs may be enriched by information from FDG-PET/MR, showing active inflammation in dental foci. However, many dental foci have no correlate in FDG-PET/MR. The treatment decision for oral foci may benefit from the visualized presence or absence of metabolic activity on FDG-PET/MR.
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Affiliation(s)
- Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Division of Periodontology, Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
| | - Fabienne A Bosshard
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Dominic R Schwaninger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Larissa Stocker
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Barbara Giacomelli-Hiestand
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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16
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Schwaninger DR, Hüllner M, Bichsel D, Giacomelli-Hiestand B, Stutzmann NS, Balermpas P, Valdec S, Stadlinger B. FDG-PET/CT for oral focus assessment in head and neck cancer patients. Clin Oral Investig 2022; 26:4407-4418. [PMID: 35254526 PMCID: PMC9203386 DOI: 10.1007/s00784-022-04403-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/06/2022] [Indexed: 01/15/2023]
Abstract
Objectives To compare oral and maxillo-mandibular inflammatory foci on standard oral radiographs (OPT, periapical radiograph) with available fluorine-18-labelled fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) data and to discuss whether additional metabolic information derived from FDG-PET/CT can support oral care specialists when performing oral focus examinations. Materials and methods Data from 23 patients with head and neck cancer who underwent FDG-PET/CT and panoramic and periapical radiography in close succession before first-line radiotherapy and/or chemotherapy were included in this exploratory retrospective study. Periapical lesions and marginal periodontal inflammation on FDG-PET/CT scans and standard oral radiographs were analysed and compared with regard to metabolic activity on FDG-PET/CT in comparison to recorded clinical symptoms and radiological scores. Additionally, inflammatory maxillo-mandibular pathologies were analysed using FDG-PET/CT. Results The maximum standardised uptake value (SUVmax) in FDG-avid marginal periodontal sites could not be conclusively associated with the radiologically recorded severity of marginal bone loss, but a potential positive correlation was identified. No association was found either between the metabolic activity of periapical lesions and their extent, as recorded on standard oral radiographs, or regarding clinical symptoms (percussion test). Most maxillo-mandibular pathologies did not show increased FDG uptake. Conclusions FDG-PET/CT provided additional metabolic information that can help clinicians identify lesions with increased inflammatory activity. The incorporation of available oral FDG-PET/CT findings into the primary oral focus assessment may allow for more accurate oral focus treatment. Clinical relevance FDG-PET/CT provides valuable metabolic information for oral care specialists. The detection of inflammatory oral processes using FDG-PET/CT facilitates treatment.
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Affiliation(s)
- Dominic Raphael Schwaninger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Zurich, Switzerland
| | - Dominique Bichsel
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Barbara Giacomelli-Hiestand
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
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17
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Tooth extractions prior to chemoradiation or bioradiation are associated with weight loss during treatment for locally advanced oropharyngeal cancer. Support Care Cancer 2022; 30:5329-5338. [PMID: 35278135 PMCID: PMC9046292 DOI: 10.1007/s00520-022-06942-6] [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: 12/08/2021] [Accepted: 02/26/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Prior to radiotherapy combined with chemotherapy (CRT) or biotherapy (BRT) for oropharyngeal squamous cell carcinoma (OPSCC), teeth with poor prognosis that pose a risk for post-RT osteoradionecrosis (ORN) are removed. The effect of tooth loss on body weight loss and tube feeding (TF) dependency during CRT/BRT is unknown. This study aimed to evaluate the effect of incomplete dentition, tooth extractions prior to CRT/BRT, and the subsequent loss of functional units on (1) weight loss during CRT/BRT and (2) the need for TF during CRT/BRT for OPSCC. METHODS OPSCC patients treated with CRT/BRT between 2013 and 2016 were included in this retrospective cohort study. Dental status was determined during the dental assessment at first visit and after tooth extractions prior to the start of CRT/BRT. Weight loss during CRT/BRT was scored dichotomously, comparing weight loss > 5% to stable or increased weight. Potential factors associated with weight loss were identified, including patient, tumor, and treatment characteristics. RESULTS Seventy-seven OPSCC patients were included. Forty patients (52%) experienced weight loss > 5% during CRT/BRT. Extractions were performed in 66% of the OPSCC patients. The mean number of extracted teeth was 4.1 ± 5.6 per patient. Tooth extractions prior to CRT/BRT were associated with weight loss > 5% during CRT/BRT (HR 1.130 (95% CI 1.011-1.262), p = 0.031). None of the dental status-related parameters showed any significant associative value for TF during CRT/BRT. CONCLUSIONS Pre-CRT/BRT tooth extractions intended to reduce the risk of ORN, are a risk factor for weight loss during CRT/BRT for OPSCC. TRIAL REGISTRATION NUMBER This study was approved by the medical ethics committee of the MUMC + (METC 2020-1589) on July 28, 2020.
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18
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Bertl K, Savvidis P, Kukla EB, Schneider S, Zauza K, Bruckmann C, Stavropoulos A. Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status. Clin Oral Investig 2021; 26:2937-2948. [PMID: 34792667 PMCID: PMC8600104 DOI: 10.1007/s00784-021-04276-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
Objective To assess in a cross-sectional study the impact of including dental professionals in the multidisciplinary treatment team of head and neck squamous cell carcinoma (HNSCC) patients on the long-term oral health status. Materials and methods Oral health status, dental care behaviours, and oral health–related quality of life were assessed based on a clinical and radiographic examination, interview, and medical records in patients treated for HNSCC ≥ 6 months ago. This patient group (‘cohort 2’) was treated in a multidisciplinary treatment team including dental professionals and compared to a group of HNSCC patients previously treated at the same university, but without dental professionals included in the multidisciplinary treatment team (‘cohort 1’). Results Cohort 2 consisted of 34 patients, who had received a dental check-up and if necessary, treatment by dental professionals prior to the initiation of cancer treatment. This cohort showed significantly improved oral hygiene habits and a better periodontal health status compared to cohort 1. However, cohort 2 still presented high demand for treatment due to active carious lesions; only a few, statistically insignificant improvements were detected compared to cohort 1. Conclusion Including dental professionals in the multidisciplinary treatment team of HNSCC patients has a positive impact on patient oral health status—primarily in terms of periodontal disease—6 months and longer after finishing cancer therapy. Clinical relevance A team-based approach including dental professionals specialised in head and neck cancer improves oral health status. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04276-x.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Philippe Savvidis
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Edmund Benjamin Kukla
- Comprehensive Center Unit, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Steffen Schneider
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Konstantin Zauza
- Comprehensive Center Unit, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Corinna Bruckmann
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden. .,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria. .,Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.
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19
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Mercadante V, Jensen SB, Smith DK, Bohlke K, Bauman J, Brennan MT, Coppes RP, Jessen N, Malhotra NK, Murphy B, Rosenthal DI, Vissink A, Wu J, Saunders DP, Peterson DE. Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline. J Clin Oncol 2021; 39:2825-2843. [PMID: 34283635 DOI: 10.1200/jco.21.01208] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy.Additional information can be found at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Valeria Mercadante
- University College London and University College London Hospitals Trust, London, United Kingdom
| | | | | | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Robert P Coppes
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels Jessen
- Danish Cancer Society Network for Patients with Head and Neck Cancer, Copenhagen, Denmark
| | | | | | | | - Arjan Vissink
- University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Jonn Wu
- Vancouver Cancer Centre, British Columbia Cancer Agency, and University of British Columbia, Vancouver, BC, Canada
| | - Deborah P Saunders
- North East Cancer Centre, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Douglas E Peterson
- School of Dental Medicine & Neag Comprehensive Cancer Center, UConn Health, Farmington, CT
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20
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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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21
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Vosselman N, Alberga J, Witjes MHJ, Raghoebar GM, Reintsema H, Vissink A, Korfage A. Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments. Oral Dis 2020; 27:64-72. [PMID: 32343862 PMCID: PMC7818410 DOI: 10.1111/odi.13374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 01/23/2023]
Abstract
Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three‐dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish.
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Affiliation(s)
- Nathalie Vosselman
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Jamie Alberga
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Max H J Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Harry Reintsema
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Anke Korfage
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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22
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Alberga JM, Vosselman N, Korfage A, Delli K, Witjes MJH, Raghoebar GM, Vissink A. What is the optimal timing for implant placement in oral cancer patients? A scoping literature review. Oral Dis 2020; 27:94-110. [PMID: 32097511 PMCID: PMC7818452 DOI: 10.1111/odi.13312] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing. OBJECTIVE To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline. METHODS A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival. RESULTS Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery. CONCLUSION Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care.
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Affiliation(s)
- Jamie M Alberga
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nathalie Vosselman
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anke Korfage
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, 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
| | - Gerry M Raghoebar
- 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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