Download Conclusion The oral health status of patients after cancer treat

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
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 (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 osteoradionecrosis 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 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 before cancer treatment and of those 17 received a treatment, of
which tooth extraction was most often performed (in 59% of the
cases; Figure 1).
Dental"treatment"before"cancer"therapy"
no"treatment"necessary"
filling"
every#3#months#
3"
tooth"extrac0on"
13"
6#
infrequently#
7#
never#
15#
0%#
20%#
40%#
60%#
80%#
100%#
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).
Oral#hygiene#
5#
2#
11#
20%"
0%#
40%"
60%"
80%"
20%#
40%#
60%#
80%#
11#
moderate#
17#
severe#
0%#
20%#
40%#
60%#
80%#
100%#
Figure 4. Prevalence of periodontal disease. Disease severity was classified
according to CDC/AAP criteria (Eke 2012; based on the data of 36 patients; natural numbers are presented in the bar).
Conclusion
The oral health status of patients after cancer treatment for squamous cell carcinoma in the upper aerodigestive tract presented to an extremely high degree
the necessity of treatment for oral diseases, such as
caries and periodontitis. Regarding the risks associated 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 professionals, 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.
100%#
References
100%"
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).
0#
mild#
18#
7"
0%"
8#
no#
7#
once#per#year#
insufficient#
Severity#of#periodon::s#
3#
every#6#months#
modest#
9"
par0al"/"full"denture"
Frequency#of#professional#oral#hygiene#sessions#
good#
7"
endodon0c"treatment"
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 consultation of a dentist before cancer treatment presented no significant effect on the oral
health status after cancer treatment.
very#good##
5"
professional"oral"hygiene"
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 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%.
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.