Dental therapy before and after radiotherapy–an ev

Authors: Sabine SennhennKirchner Friederike Freund Sven Grundmann Alexios Martin Margarete Borgvon Zepelin Hans Christiansen Hendrik Andreas Wolff HansGeorg Jacobs

Publish Date: 2008/10/17

Volume: 13, Issue: 2, Pages: 157-164

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Abstract

The present investigation evaluates the dental care situation of patients with head and neck cancer before and after radiotherapy The situations of these patients in 1993 and 2005 were compared to detect similarities differences and developments In the years 1993 and 2005 37 and 36 patients respectively with head and neck cancer treated by the local departments of otorhinolaryngology and of radiotherapy were examined consecutively according to their aftercare appointments Time points of radiotherapy treatment of the patients evaluated in 1993 varied from 1984 to 1993 The patients evaluated in 2005 had received radiotherapy between 1998 and 2005 Therefore the applied radiotherapeutic regimen differed not only between the two groups of patients but also within each group The information for these investigations was provided anonymously It was evaluated with descriptive statistics The evaluation of the data shows distinct differences with respect to preventive and therapeutic dental care measures In 2005 35 out of 36 patients 972 had a dental consultation before radiotherapy 1993 65 All 27 dentate patients 100 obtained a splint for fluoride application 1993 none 29 fewer edentulous patients were seen than in 1993 The number of teeth destroyed decreased from 192 1993 to 78 in 2005 Mycoses due to Candida spp and chronic failures in wound healing were rare 55 In the course of the 12 years prophylactic measures such as the application of splints for fluoride treatment were intensified However concepts for the dental care of patients undergoing radiotherapy especially following the radiation should be widened to avoid ruined teeth and long delayed wound healingsThe therapy of malignant tumours in the oral and maxillofacial region is multimodal with curative potential in the nonmetastatic situation including surgery that is followed by adjuvant radiochemotherapy in case of locally advanced tumours UICC III/IVA/B or primary radiochemotherapy A fundamental aim of the radiotherapy is the local control of the tumour The improvement in local control leads to an amelioration of the survival rate in the ideal case 20 28 In the case of locally advanced tumours of head and neck multimodal therapeutic concepts are performed using simultaneous radiochemotherapy with or without surgery 7 19 30All effects of Xrays pathologically influence the ecology of the oral cavity Radiotherapy impedes the restoration of functional rehabilitation 12 Prophylaxis and therapy need a close collaboration between surgeons radiotherapists and dentists 2 4 34As an early radiation effect the radiationinduced mucositis is the most important side effect As late side effects radiationinduced xerostomia often long lasting and radiationinduced caries resulting dental extractions and the risk of osteoradionecrosis ORN are especially significant 12 The severity of mucositis caused by radiotherapy is dependent on the level of oral hygiene 37 Therefore prophylaxis and therapy are important components during radiation Complicated radiomucositis can result in an abruption of the therapy and an important treatment tool has to be abandoned 19 36 41The level of radiationinduced caries due to xerostomia can be limited by optimal concepts of oral hygiene 27 In the case of a lack of oral hygiene an indication for dental extraction occurs The amount of extraction is a matter of controversial debate 3 9 11 16 33 Many authors recommend selective indications for extraction For example Coffin 5 and Horiot et al 18 propose a more conservative strategy to save as many of the patient’s teeth as possible and thus preserve a better quality of the life of the patientDue to an increased fragility of oral mucosa only exactly fitting dentures should be worn during radiation treatment and thereafter exclusively during meals The complication rates caused by defects of the oral mucosa are high Therefore the exclusion of pressure sore beneath partial and total dentures is particularly important 31 38

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