Oral health status of patients after cancer treatment for
squamous cell carcinoma in the upper aero-digestive tract
Stefanie Loidl1, Kristina Bertl2,3, Ulana Kotowski4, Gregor Heiduschka4, Dietmar Thurnher4, Berit Schneider-Stickler1
1 Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria 2 Division of Oral Surgery, Bernhard Gottlieb School of Dentistry, Medical University of Vienna, Austria
3 Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden 4 Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
Objective
Treatment for head and neck cancer is associated with severe oral complications, such as reduced salivary flow rate, mucositis, or deve-lopment or exacerbation of caries and/or periodontitis (Mosel 2011). Periodontitis represents a chronic inflammatory process, which is regarded as a risk factor for cancer development as well as after cancer treatment as a risk factor for development of osteoradione-crosis of the jaw (Katsura 2008). The present study aimed to assess oral health status and dentist consultation habits of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract.
Methods
Thirty-eight patients (27 male / 11 female, age range 21 to 79 years) participated in the present cross-sectional study. All participants were asked on dental treatment before and after cancer treatment, daily oral hygiene, habits (e.g. smoking and alcohol consumption), education, income, and family status. The decayed, missing, and filled teeth (DMF-T) index, and clinical (plaque control record (PCR; O’Leary 1972), community periodontal index of treatment needs (CPITN; Ainamo 1982), disease severity according to CDC/AAP cri-teria (Eke 2012) and radiological (alveolar bone loss) periodontal pa-rameters were determined.
Results
Twenty-two of 38 patients consulted a dentist for a check-up befo-re cancer tbefo-reatment and of those 17 befo-received a tbefo-reatment, of which tooth extraction was most often performed (in 59% of the cases; Fi-gure 1).
Although 71% of the patients consulted a dentist within the last year, 90% of the examined patients presented the necessity of dental treatment at time-point of evaluation; 75% had at least one decayed tooth, with an average of 4 decayed teeth. The average DMF-T-index was 25.5. A professional oral hygiene session was never performed in 40% (Figure 2) of the patients and the mean PCR was 65% (Figure 3). Seventy-two percent showed a CPITN of 3 or 4 (Figure 4) and 31% of the patients presented moderate and 47% severe periodontitis. A mean alveolar bone loss of 4.3mm was determined. The consul-tation of a dentist before cancer treatment presented no significant effect on the oral health status after cancer treatment.
Conclusion
The oral health status of patients after cancer
treat-ment for squamous cell carcinoma in the upper
ae-ro-digestive tract presented to an extremely high
degree the necessity of treatment for oral
disea-ses, such as caries and periodontitis. Regarding
the risks associated with these oral diseases after
cancer treatment, e.g. in severe cases the
develop-ment of osteoradionecrosis of the jaw, the
multi-disciplinary teams in cancer care might profit by
the regular inclusion of dental professionals, who
are experienced in the dental treatment of cancer
patients. This cooperation could improve the
den-tal treatment before, as well as the sustainment of
oral health after cancer treatment.
References
Ainamo J, et al. (1982) International dental journal 32(3):281-91; Eke PI, et al. (2012) Journal of peri-odontology 83(12):1449-54; Katsura K, et al. (2008) Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105(6): 731-8; Mosel DD, et al. (2011) Oral diseases 17(6): 550-9; O‘Leary TJ, et al. (1972) Journal of periodontology 43(1):38.
Figure 1. Type of dental treatment performed before starting cancer treatment
(based on the data of 22 patients, who visited a dentist before cancer treatment; natural numbers are presented in the bar).
7" 13" 3" 9" 7" 5" 0%" 20%" 40%" 60%" 80%" 100%" par0al"/"full"denture" tooth"extrac0on" endodon0c"treatment" filling" professional"oral"hygiene" no"treatment"necessary" Dental"treatment"before"cancer"therapy" 15# 7# 6# 7# 3# 0%# 20%# 40%# 60%# 80%# 100%# never# infrequently# once#per#year# every#6#months# every#3#months# Frequency#of#professional#oral#hygiene#sessions# 18# 11# 2# 5# 0%# 20%# 40%# 60%# 80%# 100%# insufficient# modest# good# very#good## Oral#hygiene# 17# 11# 0# 8# 0%# 20%# 40%# 60%# 80%# 100%# severe# moderate# mild# no# Severity#of#periodon::s#
Figure 2. Frequency of professional oral hygiene sessions since cancer treatment
(based on the data of 38 patients; natural numbers are presented in the bar).
Figure 3. Oral hygiene assessment based on the plaque control record (O’Leary
1972; based on the data of 36 patients; natural numbers are presented in the bar). The following judgement was applied: very good <25%, good 25-39%, modest 40-49%, and insufficient >70%.
Figure 4. Prevalence of periodontal disease. Disease severity was classified
ac-cording to CDC/AAP criteria (Eke 2012; based on the data of 36 patients; natural numbers are presented in the bar).
