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Review completed
Accepted
: 13‑01‑14
: 18‑03‑14
: 04‑04‑14
ORAL HEALTH STATUS OF ORAL CANCER PATIENTS SEEKING CARE
FROM GOVERNMENT HOSPITAL, JAIPUR, RAJASTHAN
Chitreddy Uma Reddy, * Subhashgouda Patil, ** Sopan Singh, ***
Savita Deora, † Jitendra Sharma, †† Ashish Sharma †††
* Professor & Head, Department of Oral medicine and Radiology, Surendra Dental College and Research Institute, Sriganganagar,
Rajasthan, India
** Senior Lecturer, Department of Public Health Dentistry, H.K.E.S S Niljalingappa Institute of Dental Sciences and Research,
Gulbarga, Karnataka, India
*** Senior Lecturer, Department of Public Health Dentistry, Institution: College of Dental Sciences, Amargarh, Gujarat, India
† Senior Lecturer, Department of Periodontology, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
†† Senior Lecturer, Department of Periodontology, Rajasthan Dental College and Hospital, Jaipur, Rajasthan, India
††† Senior Lecturer, Department of Public Health Dentistry, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
________________________________________________________________________
ABSTRACT
Purpose: To assess the oral health status of
patients with oral cancer in a tertiary care
centre. Materials and methods: A cross
sectional descriptive study was conducted
among 46 study participants with oral cancer
(mean age 59±11years) at the oncology and
radiology department of SMS medical college
and hospital, Jaipur, Rajasthan, India. World
Health Organisation Oral Health Assessment
Form 1997 was used to assess the oral health
status of the study participants. Results: Out of
86 oral cancer patients recruited only 46
participants could satisfy the inclusion criteria
(40 males, 6 females). Most patients 20
(51.2%) had stage II (T2N0M0) of oral cancer.
Majority of study participants 27 (67.2%) had
poor oral hygiene. CPI Code 3 was seen in 28
(70%) of the subjects. Majority of study
participants 25 (62.5%) had Loss of
Attachment Code 2. The mean DMFT of the
study participants was 12.45±3.53. Mean
number of missing teeth among the study
participants was 6.07±3.57. Conclusion: Due
to lack of awareness about dental hygiene,
main concentration on the treatment of cancer
and also absence of a dentist in the cancer
ward, continuing radiotherapy sessions and
other conditions like lack of motivation, severe
pain, limited jaw opening, contribute to the
worsening of oral conditions of the patients.
Oral health education and follow-up services
must be considered to help patients manage
the problems created by the oral cancer and its
treatment.
IJOCR Apr - Jun 2014; Volume 2 Issue 4
KEYWORDS: Oral health; oral cancer; dental
caries; periodontitis
INTRODUCTION
Oral cancer is the most common cancer in India
and according to Dr Geoff Craig "people are
dying of oral cancer because of ignorance”. There
are about 7,00,000 new cases of cancers every
year in India out of which tobacco related cancers
are about 3,00,000. Simple changes in lifestyle
and regular screening can have immense health
benefits.[1] In 2003, Indian Council of Medical
Research (ICMR) reported that oral cancer is very
common in India. There has been a substantial
increase in the incidences of oral sub-mucous
fibrosis; especially among youngsters; which has
further increased the incidence of the oral
cancer.[2] Oral and oropharyngeal cancers remain
one of the more common cancers in the South
and South East Asian countries, as opposed to
Western society, where it accounts for only about
1 – 4% of the of reported cancers incidence.[3] For
example, the incidence of oral cancer in India is
high, constituting about 12% of all cancer in men
and 8% in women;[4] mortality rate is equally high
in this population, ranking number one in men
and number three in women.[5] Oral and
oropharyngeal cancers therefore qualify as major
public health problem, not only in India, but also
globally. Regional Cancer Centre (RCC) Kerala
reported about 14% oral cancer patients out of
which 17.0 and 10.5% cases were in males and
females, respectively.[6] A significant number of
oral cancer patients have been reported in Agra,
Allahabad, Mainipuri, Varanasi and Moradabad
belt of Uttar Pradesh.[7]
7
Oral Health Status Of Oral Cancer
Reddy CU, Patil SH, Singh S, Deora S, Sharma J, Sharma A
Table I: Stage of oral cancer in the study participants
STAGES OF ORAL CANCER
AGE GROUP
TOTAL
STAGE III
STAGE 1(T1N0M0)
STAGE II(T2N0M0)
(T3N0M0:T1orT2orT3N1M0)
8
5
2
15
35-44years
20.5%
12.8%
5.1%
38.5%
9
15
0
24
65-74years
23.1
38.5
0.0%
61.5%
17
20
2
39
TOTAL
43.6%
51.2%
5.1%
100.0%
Table II: Oral hygiene status of oral cancer patients
ORAL HYGIENE STATUS
STAGE GROUP
TOTAL
GOOD
FAIR
POOR
0
9
13
22
35-44 YEARS
0.0%
19.6%
28.3%
47.8%
0
7
17
24
65-74YEARS
0.0%
15.2%
37.0%
52.2%
0
16
30
46
TOTAL
0.0%
34.8%
65.2%
100.0%
Table III: CPI status of the oral cancer patients in different age groups
PERIODONTAL STATUS
AGE GROUP
TOTAL
CPI CODE 0
CPI CODE I
CPI CODE II
CPI CODE III
CPI CODE IV
35-44
YEARS
65-74YEARS
TOTAL
0
0
5
15
2
22
0.0%
0
0.0%
0
0.0%
1
2.2%
1
10.9%
5
10.9%
10
32.6%
15
32.6%
30
4.3%
3
6.5%
5
47.8%
24
52.2%
46
Although radiotherapy plays an important role in
the management of patients with head and neck
cancer, it is also associated with several undesired
reactions. Frequently, the salivary glands, oral
mucosa, and jaws will inevitably be included in
the radiotherapy field. Changes induced by
exposure to radiation may occur during and after
completion of therapy, including mucositis,
candidiasis, osteoradionecrosis, and radiation
caries.[8] Oral health in oral cancer patients is very
important due to manifestations such as
mucositis,
hypo
salivation,
taste
loss,
osteoradionecrosis,
radiation
caries,
and
[9]
trismus. Main purpose of the present study is to
investigate the oral health in a group of patients
with oral cancer and precancerous lesions.
MATERIALS AND METHODS
The present cross sectional descriptive study was
conducted at the oncology and radiology
department of SMS Medical College and
Hospital, Jaipur, Rajasthan, India, during the
months of September-October 2009.The doctors
in charge of the routine OPD, who had been
briefed about the study, were responsible for the
recruitment of the patients. Ethical clearance was
IJOCR Apr - Jun 2014; Volume 2 Issue 4
obtained from ethical committee of Darshan
Dental College, Udaipur, India. Informed consent
was obtained from the study participants. All
patients visiting the department were approached
sequentially. Edentulous patients, patients with
less than 14 teeth and mouth opening of less than
25mm were excluded from the study. Jaw
opening was measured, with veneer callipers,
from the incisal edge of an upper central incisor
to the opposing central incisor according to
previous definitions. Subjects with less than 25
mm opening were classified as having trismus.[10]
The dental clinical examination was conducted by
a single calibrated examiner, Intra examiner
variability, kappa statistics was found to be 0.88.
The type and site of lesion (Cancer or
precancerous) was recorded. Staging of the cancer
was done using TNM classification.[11] Oral
hygiene status of the subjects was recorded using
Simplified Oral Hygiene Index.[12] The WHO Oral
Health Assessment Form[13] was used to assess the
periodontal status of the study participants.
DMFT index[14] is used to assess the number of
missing, filled and decayed teeth. Descriptive
statistics were used to describe the data.
8
Oral Health Status Of Oral Cancer
AGE GROUP
35-44 YEARS
65-74 YEARS
TOTAL
AGE
GROUP
35-54
YEARS
55-74
YEARS
LOA
CODE 0
Reddy CU, Patil SH, Singh S, Deora S, Sharma J, Sharma A
Table IV: Loss of attachment of the oral cancer patients
LOA CODE
LOA CODE
LOA CODE
LOA CODE
I
II
III
IV
TOTAL
0
1
9
8
4
22
0.0%
2.1%
19.6%
17.3%
8.6%
47.8%
0
0.0%
0
2
4.3%
3
8
17.3%
17
8
17.3%
16
6
13.0%
10
24
52.2%
46
0.0%
6.4%
36.9%
34.8%
21.8%
Table V: DMFT status of subjects in different age groups
MEAN
MEAN
NUMBER OF
MEAN
STANDARD
DECAYED
MISSING
SAMPLES
DMFT
DEVIATION
TEETH
TEETH
100%
MEAN
FILLED
TEETH
22
11.00
3.53
5.00±1.75
5.14±2.19
0.91±1.11
24
12.21
4.18
5.63±2.10
6.17±3.57
0.41±0.65
RESULTS
Out of 86 oral cancer patients recruited only 40
participants could satisfy the inclusion criteria (36
males, 4 females). Their mean age was 59±11
years; ranging from 35 years to 75 years. Among
the 20 study participants in age group 35-44
years, most of the study participants 11 (55%)
were suffering from stage I oral cancer. And in
age group 65-74 years majority of study
participants that is 15 (65.4%) were having stage
II oral cancer [Table I]. Majority of study
participants {13 (28%)} in age group 35-44 years
had poor oral hygiene status and in age group 6574 years; 17 (37%) had poor oral hygiene status
[Table II]. No subject was assessed as having
“healthy” periodontal conditions (CPI code 0) in
both the age groups. Majority of study
participants in both the age group that is 15
(32.6%) study participants in 35-44 years age
group, and 15 (32.6%) in 65-74 years age group
were having CPI CODE III [Table III]. No
subject was assessed as having loss of attachment
0-3mm (LOA code 0) in both the age groups.
Most of the study participants in both the age
groups were having loss of attachment of 6-8mm
(LOA code 2) [Table IV]. The mean DMFT of
the study participants was 11.00±3.53 in 35-44
years age group and 12.21±4.18 in 65-74 years
age group. The major component was represented
by the missing component in both age groups
(5.14±2.19, 6.17±3.57) [Table V].
DISCUSSION
The intention of the study was to provide
systemic information on oral health status in the
IJOCR Apr - Jun 2014; Volume 2 Issue 4
patients having precancerous lesion or had been
diagnosed with oral cancer and undergoing
treatment. This would help to educate the patients
and the concerning doctors to take measures to
improve the oral hygiene and can be used as a
supportive therapy in the treatment of oral cancer.
In the present study on oral cancer patients, mean
DMFT was 11.00±3.53 as compared to the mean
DMFT in nasopharyngeal carcinoma (NPC)
samples was 8.03 ± 6.11 and the mean missing
teeth in the present study was 6.17±3.57 as
compared to mean missing teeth in NPC patients
was 1.2±1.8.[9] As compared to this, mean DMFT
in cancer patients was 11.89±8.26 and mean
missing teeth were 2.06±3.36 in study[15] done by
Mónica Paula López Galindo et al inoncological
patients before chemotherapy. In present study
the decayed component of the oral cancer patients
was 5.00±1.75 and 5.63±2.10 in both the age
groups as compared to the study[14] done by Lo,
E.C.M. in which the decayed component was
2.39±2.31.In the study done[15] by Monica Paula
López Galindo et al., the decayed component was
7.55±7.52. In the present study no patient was
caries free, because of the poor oral hygiene and
abundant amount of deposited plaque. Similarly
in the study[16] done by Pow E.N.H. et al., only 5
samples were caries free.In present study
maximum subjects had CPI code 3. The CPI
findings[7] for the NPC patients reveal that
maximum percentage (90.9%) of study
participants had CPI code 2 and 3. Most of the
subjects had 4-5mm pockets as compared to the
survey[17]
of
Hong
Kong
adult
9
Oral Health Status Of Oral Cancer
oral health in 1991 by Holmgren.et al., were most
of the patients had shallow and deep pockets of
more than 6mm. In the present study majority of
study participants had poor oral hygiene status as
compared to study[13] conducted by Mónica Paula
López Galindo et al., in which majority of study
participants had good oral hygiene status. Due to
continued radiotherapy sessions there was
increase number of carious teeth. With decrease
in amount of saliva and salivary flow rate and
severe pain, Subjects with precancerous lesions
and oral cancer are not able to take care of their
oral hygiene leads to increased plaque and
calculus accumulation leading to poor periodontal
status.
CONCLUSION
Due to lack of awareness about dental hygiene,
main concentration on the treatment of cancer and
also absence of a dentist in the cancer ward,
continuing radiotherapy sessions and other
conditions like lack of motivation, severe pain,
limited jaw opening, contribute to the worsening
of oral conditions of the patients. Oral health
education and follow-up services must be
considered to help patients manage the problems
created by the oral cancer and its treatment.
CONFLICT OF INTEREST & SOURCE OF
FUNDING
The author declares that there is no source of
funding and there is no conflict of interest among
all authors.
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