Oral complications from radiation to the head and neck or chemotherapy for any malignancy can compromise patients health and quality of life, and affect their ability to complete cancer treatment.
Oral complications from cancer treatment because of acute and late toxicities there are und2242eported and unrecognized.
Complications of treatment can be so debilitating that they may tolerate only lower doses of therapy, postpone scheduled treatments, or discontinue treatment entirely.
Oral complications can also lead to serious systemic infections.
Oral care before, during, and after cancer treatment can prevent or reduce the incidence and severity of oral complications, enhancing both patient survival and quality of life.
Oral complications common to both chemotherapy and radiation include: Oral mucositis: inflammation and ulceration of the mucous membranes, xerostomia/salivary gland dysfunction, due to thickened, reduced, or absent salivary secretions, infection, functional disabilities of the mouth, taste alterations, impaired nutrition, abnormal dentition, and abnormal dental development.
Mucositis increases the risk for pain, local and systemic infection, and nutritional compromise.
Infections by viral, bacterial, and fungal elements can result from myelosuppression, xerostomia, and/or damage to the mucosa from chemotherapy or radiotherapy.
Xerostomia/salivary gland dysfunction increases the risk of infection and compromises speaking, chewing, and swallowing.
A persistent dry mouth increases the risk for dental caries.
Neurotoxicity with deep aching and burning pain mimicking a toothache may be seen with certain drugs, including, vinca alkaloids.
Radiation induces avlifelong risk of rampant dental decay.
Dental decay may begin within 3 months after completing radiation treatment, if changes in either the quality or quantity of saliva persist.
Radiation is associated with tissue fibrosis and loss of elasticity of masticatory muscles, restricting normal ability to open the mouth.
Radiation compromises blood vessel flow and can lead to osteonecrosis, and decreased healing ability when tissues are traumatized.
Oral complications occur in virtually all patients receiving radiation for head and neck malignancies.
Pretreatment oral care reduces the risk and severity of oral complications, allows for prompt identification and treatment of infections, improves the likelihood that the patient will successfully complete planned cancer treatment, prevents, eliminates, or reduces pain, prevents nutritional compromise, prevents or reduces incidence of bone necrosis, improves oral health, improves quality of life, and decreases cost of care.
Oral evaluation should take place 1 month before cancer treatment starts to allow adequate time recovery from any required invasive dental procedures.
It is standard of care for patients to undergo dental evaluation prior to radiation therapy of the head and neck region to have infected teeth, teeth at high risk for infection, or teeth with a poor prognosis extracted at that time.
Pretreatment evaluation includes a thorough examination of hard and soft tissues, and radiographs to detect possible sources of infection, carious and compromised teeth, and tissue pathology.
Teeth that are nonrestorable or may pose a future problem are removed to prevent later extraction-induced osteonecrosis.
After radiation the remaining dentition must be well-maintained in order to avoid future extractions and risk of developing osteonecrosis of the jaw.
Oral surgery should be performed 2 weeks before radiation therapy and 7-10 days prior to myelosuppressive chemotherapy, to allow healing.
Patients undergoing head and neck radiation therapy should use of supplemental fluoride via gel-applicator trays.
Avoiding tobacco and alcohol can prevent or minimize oral complications.
The tongue, gums and teeth are brushed with fluoride toothpaste with each meal, and at bedtime, and daily flossing required during radiation therapy.
Rinsing the mouth with a baking soda and salt solution should be done several times a day.
Jaw muscles should be exercised three times a day to prevent stiffness from radiation.
Elective oral surgery should not be performed during the radiation treatment.
Following the completion of head and neck radiation therapy and acute oral complications have abated, evaluate the patient regularly for the first 6 months.
High-dose radiation treatment carries a lifelong risk of xerostomia, dental caries, and osteonecrosis.
Other complications of radiation includes possible damage to the gums and soft tissues, xerostomia, trismus, velopharyngeal inadequacy, mucositis, dysphasia, and dysguesia.
The risk of osteonecrosis, affects the mandible primarily.
Surgical procedures should be avoided, including extractions that involve irradiated bone.
If surgical procedures are required the use of antibiotics and hyperbaric oxygen therapy before and after surgery should be considered.
Children who have received radiation to craniofacial and dental structures should be monitored for abnormal growth and development.