More than 30,000 new cases of oral or pharyngeal cancer were diagnosed in 2001. Treatment for these patients commonly involves radiation therapy to reduce the size of the tumor without destruction of the surrounding tissue. Potential complications from the therapy include: xerostomia, caries, candidiasis, dysguesis (inability to taste), oral mucositis, osteoradionecrosis, trismus, and nutritional deficiencies. The effects of radiation therapy may be irreversible, and permanent loss of salivary flow can result in caries, candidiasis, attrition, burning in the mouth, difficulty with chewing, and nutritional deficiencies. Also, severe mucositis can be so painful that it can interrupt radiation therapy and therefore affect the patient’s survival.
Patient management must begin prior to institution of radiation therapy with a complete pretreatment examination. This examination should include medical history, dental history, current medicines, allergies, and assessment of the TMJ, incisal opening measurements, and a complete intraoral evaluation of the hard and soft tissues. Both panorex and full mouth x-rays should be taken to evaluate periodontal status. Recommendations for treatment, as well as the adverse effects of the therapy, should be discussed with the patient.
Oral moisturizers, saliva substitutes, acupuncture, xylitol gum, and specific drug therapy such as Amifostine can be employed to reduce xerostomia and its consequences. Fluoride carriers should be constructed prior to radiation to be used before, during, and after therapy. Diet should be evaluated to eliminate sugars and increase the uptake of proteins needed by the body for repair and healing. Water intake should be increased to help with dry mouth and reduce dehydration. Optimal patient management before, during, and after radiation treatment is aided when the dentist has an understanding of likely oral complications.
(Source: General Dentistry, Nov/Dec, 2003)
