Objective
Treatment for head and neck cancer is associated with severe oral complications, such as reduced salivary flow rate, mucositis, or development or exacerbation of caries and/or periodontitis (Mo-sel 2011). Periodontitis represents a chronic inflammatory pro-cess, which is regarded as a risk factor for cancer development as well as after cancer treatment as a risk factor for development of osteoradionecrosis of the jaw (Katsura 2008). The present stu-dy 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 ye-ars) participated in the present cross-sectional study. All parti-cipants 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 deca-yed, 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 ac-cording to CDC/AAP criteria (Eke 2012) and radiological (alveolar bone loss) periodontal parameters were determined.
Results
Twenty-two of 38 patients consulted a dentist for a check-up be-fore cancer treatment and of those 17 received a treatment, of which tooth extraction was most often performed (in 59% of the cases; Figure 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 ave-rage 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 mo-derate and 47% severe periodontitis. A mean alveolar bone loss of 4.3mm was determined. The consultation of a dentist befo-re cancer tbefo-reatment pbefo-resented 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
aero-digestive tract presented to an extremely high degree
the necessity of treatment for oral diseases, such as
caries and periodontitis. Regarding the risks
associa-ted with these oral diseases after cancer treatment, e.g.
in severe cases the development of osteoradionecrosis
of the jaw, the multidisciplinary teams in cancer care
might profit by the regular inclusion of dental
profes-sionals, who are experienced in the dental treatment
of cancer patients. This cooperation could improve the
dental 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 periodontology 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.
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
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
treat-ment (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%, mo-dest 40-49%, and insufficient >70%.
Figure 4. Prevalence of periodontal disease. Disease severity was classified
according to CDC/AAP criteria (Eke 2012; based on the data of 36 patients; na-tural numbers are presented in the bar).
