CANCER-DENTAL AND ORAL COMPLICATIONS cont...
Xerostomia....
Xerostomia (dry mouth) changes the ability of the mouth to neutralize acid, clean the teeth and gums, and protect the mouth from infection. Saliva is needed for taste, swallowing, and speech. Xerostomia is the thickening of, or reduction in volume of saliva. Symptoms include dryness, a sore or burning feeling (especially on the tongue), cracked lips, cuts or cracks at the corners of the mouth, changes in the surface of the tongue , and difficulty wearing dentures. An extremely dry mouth will also impair proper speaking, and the swallowing of foods. Saliva contains important protective enzymes which aid in the prevention of tooth decay and periodontal disease. To protect against tooth decay during and after treatments, patients with xerostomia should apply fluoride to the teeth daily to protect them. Besides a reduction in salivary volume, treatments can cause saliva to become thick, stringy and annoying to the patient. Once saliva is thickened or reduced in volume, minerals can be lost from the teeth (demineralization), and needed minerals (calcium, phosphorus) are not redeposited on the teeth. Plaque becomes heavy and thick, and the acids produced after eating sugary foods can cause additional mineral loss. All this contributes to dental decay. It is essential that once salivary function begins to diminish that attention to oral hygiene must be increased. It is not uncommon for post treatment individuals to visit their dental hygienist at rates far more frequently than what is recommended for the general public. Quarterly for cleanings would not be too often, and some patients go even more frequently because even with the most diligent program at home they are unable to prevent the accumulation of plaque and calculus on the teeth. Xerostomia is typically not reversible, and the chronic effects may persist for months or years, with recovery depending on the area radiated, the total dose, and the individual patient. Obviously when the salivary glands are directly in the field of radiation, the condition is unavoidable. New developments in the manner in which radiation is delivered such a IMRT treatments. More about IMRT and radio-protective drugs such as Amifostine may reduce the effects of radiaion induced xerostomia.
Synthetic saliva solutions and saliva substitute lubricants are helpful in many patients with dry mouth, and some favorable reports have been published. Oral Balance, an over-the-counter gel, also available as a liquid which can be carried easily in the pocket, is a good example. In some patients in whom the salivary complaint is related to the "thickness" (excess mucous-type secretions), guaifenesin as a liquid or tablet may help as a mucolytic agent. There are a variety of over the counter products that contain this active ingredient - read labels. During the treatment phase of these moisture changes in the mouth the thickening of saliva and mucous production can be problematic. OTC products such as MUCinex which contain the same active ingredient, may be helpful in this area.
More about saliva.
Management of xerostomia in oral cancer patients during and after treatments Mary Brosky, DMD, University of Minnesota.
Demineralization....
Demineralization of the teeth and the breakdown of tooth structure can also occur as a result of treatment. This is not necessarily the result of the teeth being in the direct field of radiation therapy. Demineralization may also result when the parotid and/or submandibular/sublingual salivary glands are included in the field of radiation, and are damaged. A diminished supply of saliva, or a change in the quality of saliva, particularly of the resting flow from the submanibular/sublingual galnds, deprives the oral cavity of the protective componenets of saliva, and the calcium and phosphate ions necessary to maintain the hydroxyapatite content of tooth enamel and dentin. Demineralization may contribute to dental caries, or hypersensitive teeth.
Scrupulous hygiene must be maintained indefinitely; daily topical fluoride applications are effective as a means of combating the tendency of oral cancer patients to develp dental caries which can be a by-product of demineralization.
LOSS OF TASTE....
With radiation therapy, a loss of taste (dysgeusia) may also occur due to damage of the taste bud cells. These cells occur primarily in the tongue papilla and are very sensitive to radiation. These cells usually are capable of repopulating within four months following treatment, but some permanent impairment may remain. There are essentially four tastes; sweet, sour, bitter, and salty. Patients are unique, and different tastes will return at different rates after treatment, and in different amounts. The degree to which taste returns is highly variable and varies from patient to patient. Xerostomia and mucositis also contribue to dysgeusia.
to be cont....
Xerostomia (dry mouth) changes the ability of the mouth to neutralize acid, clean the teeth and gums, and protect the mouth from infection. Saliva is needed for taste, swallowing, and speech. Xerostomia is the thickening of, or reduction in volume of saliva. Symptoms include dryness, a sore or burning feeling (especially on the tongue), cracked lips, cuts or cracks at the corners of the mouth, changes in the surface of the tongue , and difficulty wearing dentures. An extremely dry mouth will also impair proper speaking, and the swallowing of foods. Saliva contains important protective enzymes which aid in the prevention of tooth decay and periodontal disease. To protect against tooth decay during and after treatments, patients with xerostomia should apply fluoride to the teeth daily to protect them. Besides a reduction in salivary volume, treatments can cause saliva to become thick, stringy and annoying to the patient. Once saliva is thickened or reduced in volume, minerals can be lost from the teeth (demineralization), and needed minerals (calcium, phosphorus) are not redeposited on the teeth. Plaque becomes heavy and thick, and the acids produced after eating sugary foods can cause additional mineral loss. All this contributes to dental decay. It is essential that once salivary function begins to diminish that attention to oral hygiene must be increased. It is not uncommon for post treatment individuals to visit their dental hygienist at rates far more frequently than what is recommended for the general public. Quarterly for cleanings would not be too often, and some patients go even more frequently because even with the most diligent program at home they are unable to prevent the accumulation of plaque and calculus on the teeth. Xerostomia is typically not reversible, and the chronic effects may persist for months or years, with recovery depending on the area radiated, the total dose, and the individual patient. Obviously when the salivary glands are directly in the field of radiation, the condition is unavoidable. New developments in the manner in which radiation is delivered such a IMRT treatments. More about IMRT and radio-protective drugs such as Amifostine may reduce the effects of radiaion induced xerostomia.
Synthetic saliva solutions and saliva substitute lubricants are helpful in many patients with dry mouth, and some favorable reports have been published. Oral Balance, an over-the-counter gel, also available as a liquid which can be carried easily in the pocket, is a good example. In some patients in whom the salivary complaint is related to the "thickness" (excess mucous-type secretions), guaifenesin as a liquid or tablet may help as a mucolytic agent. There are a variety of over the counter products that contain this active ingredient - read labels. During the treatment phase of these moisture changes in the mouth the thickening of saliva and mucous production can be problematic. OTC products such as MUCinex which contain the same active ingredient, may be helpful in this area.
More about saliva.
Management of xerostomia in oral cancer patients during and after treatments Mary Brosky, DMD, University of Minnesota.
Demineralization....
Demineralization of the teeth and the breakdown of tooth structure can also occur as a result of treatment. This is not necessarily the result of the teeth being in the direct field of radiation therapy. Demineralization may also result when the parotid and/or submandibular/sublingual salivary glands are included in the field of radiation, and are damaged. A diminished supply of saliva, or a change in the quality of saliva, particularly of the resting flow from the submanibular/sublingual galnds, deprives the oral cavity of the protective componenets of saliva, and the calcium and phosphate ions necessary to maintain the hydroxyapatite content of tooth enamel and dentin. Demineralization may contribute to dental caries, or hypersensitive teeth.
Scrupulous hygiene must be maintained indefinitely; daily topical fluoride applications are effective as a means of combating the tendency of oral cancer patients to develp dental caries which can be a by-product of demineralization.
LOSS OF TASTE....
With radiation therapy, a loss of taste (dysgeusia) may also occur due to damage of the taste bud cells. These cells occur primarily in the tongue papilla and are very sensitive to radiation. These cells usually are capable of repopulating within four months following treatment, but some permanent impairment may remain. There are essentially four tastes; sweet, sour, bitter, and salty. Patients are unique, and different tastes will return at different rates after treatment, and in different amounts. The degree to which taste returns is highly variable and varies from patient to patient. Xerostomia and mucositis also contribue to dysgeusia.
to be cont....
