CANCER....DENTAL AND ORAL COMPLICATIONS
The likelihood is high that aggressive cancer treatment will have toxic effects on normal cells as well as cancer cells. The gastrointestinal tract, including the mouth, is particularly prone to damage. This is true whether the treatment is radiation or chemotherapy. Most patients being treated for head and neck cancer will experience some oral complications, and while most of these are manageable, complications can sometimes become severe enough that treatment must be completely stopped. In addition, surgical solutions to tumor removal may lead to oral and nutritional problems as well.
The most common oral problems occurring after radiation and chemotherapy are mucositis (an inflammation of the mucous membranes in the mouth), infection, pain and bleeding. Other possible complications might include dehydration and malnutrition, commonly brought on by difficulties in swallowing (dysphagia). Radiation therapy to the head and neck may injure the glands that produce saliva (xerostomia), or damage the muscles and joints of the jaw and neck (trismus). These treatments may also cause hypovascularization (reduction in blood vessels and blood supply) of the bones of the maxilla or mandible (the bones of the mouth). In addition, treatments may affect other forms of dental disease (caries, or soft tissue complications), or even cause bone death (osteonecrosis).
By identifying patients at risk for oral complications, health care providers are able to start preventive measure before cancer therapy begins, reducing the occurrence of problems brought about by different treatment modalities. The most important risk factors leading to problems are oral or dental disease that already exists, and poor oral care during cancer therapy. Other risk factors include the type of cancer, the chemotherapy type and schedule used, the area irradiated and how much radiation is given, how low blood counts are decreased and for how long, the patient's age, and the general condition of the patient's health pre-treatment.
Pre-existing oral conditions may increase the risk of infection or other problems. Problems such as calculus and tartar on the teeth, broken teeth, the condition and quality of existing dental repairs such as crowns or fillings, periodontal disease, and appliances such as bridges, partial dentures or other removable fixtures can make therapy more difficult later on. Bacteria and fungi can live in the mouth, and may develop into an infection when the immune system is not working well, or when white blood cell counts are low. Both of these factors can be caused by the treatment methods used. Where the gums (gingiva) or other soft tissues are irritated, tissues can thin and waste away, causing sores in the mouth. These complications can result in a significant reduction in the quality of life for the patient.
One way in which radiation therapy kills cancer cells, is by shrinking blood vessels in the affected area. Fast growing tumor cells require more oxygen and nutrients than normal cells, and they are"oxygen starved" to death. Additionally, both radiation therapy to the head and neck and chemotherapy drugs affect the ability of cells to divide, an efficient manner in which to kill cancer cells. This however, also makes it difficult for tissues in the mouth to repair themselves in the treated sites. Therefore, people being treated with radiation therapy for head and neck tumors, frequently have side effects associated with the radiation itself, or with the decreased blood flow. The mucus membranes, or soft tissues inside our mouth and throat, are tender to this lifesaving treatment; salivary glands are especially sensitive as well. The damage to these tissues and glands depends on the amount and kind of radiation used, the total dose, and the size of the area irradiated. Damage caused by radiation therapy affects the tissues for the rest of the patient's life. These hard and soft tissues are more easily damaged after treatment has been completed, and normal methods of cell repair do not work as well once cells have been exposed to radiation. It is of extreme importance that the patient's dentist is aware and educated in the issues regarding radiation therapy. The special dental considerations surrounding post-treatment care last forever.
CHEMOTHERAPY ISSUES...
Chemotherapy kills cancer cells by taxing some aspects of their life cycles more than it taxes the life cycle of most normal cells. however normal cells in the body can be susceptible to the stress of chemotherapy. When the white blood cell count is lowest, oral tissues are most prone to damage. The mouth is able to recover only when the white blood cell count returns to normal. The lips, tongue, floor of the mouth, inside by the cheeks, and soft palate (the upper back of the mouth) are more affected by chemotherapy drugs than are the hard palate (the upper front of the mouth) and the gingiva surrounding the teeth. Some chemotherapy drugs are more likely to cause problems in the mouth, especially when they are given in high doses, in repeating schedules, or when given simultaneously with radiation therapy. Spicy foods, abrasive foods, and alcohol should be avoided so as not to agggravate the sore tissues, and water should be consumed in high volume to maintain the mostness of tissues and the body's fluid balance. During and shortly after chemotherapy, an oncologist should be consulted before any dental care is performed. With white blood counts and clotting factors at low levels, dental treatment should be postponed until after a blood test confirms a return to normal levels. Chemotherapy can also lead to neurotoxicity, a persistent, deep pain that mimics a toothache, but that has no dental or mucosal source.
to be continued......
The most common oral problems occurring after radiation and chemotherapy are mucositis (an inflammation of the mucous membranes in the mouth), infection, pain and bleeding. Other possible complications might include dehydration and malnutrition, commonly brought on by difficulties in swallowing (dysphagia). Radiation therapy to the head and neck may injure the glands that produce saliva (xerostomia), or damage the muscles and joints of the jaw and neck (trismus). These treatments may also cause hypovascularization (reduction in blood vessels and blood supply) of the bones of the maxilla or mandible (the bones of the mouth). In addition, treatments may affect other forms of dental disease (caries, or soft tissue complications), or even cause bone death (osteonecrosis).
By identifying patients at risk for oral complications, health care providers are able to start preventive measure before cancer therapy begins, reducing the occurrence of problems brought about by different treatment modalities. The most important risk factors leading to problems are oral or dental disease that already exists, and poor oral care during cancer therapy. Other risk factors include the type of cancer, the chemotherapy type and schedule used, the area irradiated and how much radiation is given, how low blood counts are decreased and for how long, the patient's age, and the general condition of the patient's health pre-treatment.
Pre-existing oral conditions may increase the risk of infection or other problems. Problems such as calculus and tartar on the teeth, broken teeth, the condition and quality of existing dental repairs such as crowns or fillings, periodontal disease, and appliances such as bridges, partial dentures or other removable fixtures can make therapy more difficult later on. Bacteria and fungi can live in the mouth, and may develop into an infection when the immune system is not working well, or when white blood cell counts are low. Both of these factors can be caused by the treatment methods used. Where the gums (gingiva) or other soft tissues are irritated, tissues can thin and waste away, causing sores in the mouth. These complications can result in a significant reduction in the quality of life for the patient.
One way in which radiation therapy kills cancer cells, is by shrinking blood vessels in the affected area. Fast growing tumor cells require more oxygen and nutrients than normal cells, and they are"oxygen starved" to death. Additionally, both radiation therapy to the head and neck and chemotherapy drugs affect the ability of cells to divide, an efficient manner in which to kill cancer cells. This however, also makes it difficult for tissues in the mouth to repair themselves in the treated sites. Therefore, people being treated with radiation therapy for head and neck tumors, frequently have side effects associated with the radiation itself, or with the decreased blood flow. The mucus membranes, or soft tissues inside our mouth and throat, are tender to this lifesaving treatment; salivary glands are especially sensitive as well. The damage to these tissues and glands depends on the amount and kind of radiation used, the total dose, and the size of the area irradiated. Damage caused by radiation therapy affects the tissues for the rest of the patient's life. These hard and soft tissues are more easily damaged after treatment has been completed, and normal methods of cell repair do not work as well once cells have been exposed to radiation. It is of extreme importance that the patient's dentist is aware and educated in the issues regarding radiation therapy. The special dental considerations surrounding post-treatment care last forever.
CHEMOTHERAPY ISSUES...
Chemotherapy kills cancer cells by taxing some aspects of their life cycles more than it taxes the life cycle of most normal cells. however normal cells in the body can be susceptible to the stress of chemotherapy. When the white blood cell count is lowest, oral tissues are most prone to damage. The mouth is able to recover only when the white blood cell count returns to normal. The lips, tongue, floor of the mouth, inside by the cheeks, and soft palate (the upper back of the mouth) are more affected by chemotherapy drugs than are the hard palate (the upper front of the mouth) and the gingiva surrounding the teeth. Some chemotherapy drugs are more likely to cause problems in the mouth, especially when they are given in high doses, in repeating schedules, or when given simultaneously with radiation therapy. Spicy foods, abrasive foods, and alcohol should be avoided so as not to agggravate the sore tissues, and water should be consumed in high volume to maintain the mostness of tissues and the body's fluid balance. During and shortly after chemotherapy, an oncologist should be consulted before any dental care is performed. With white blood counts and clotting factors at low levels, dental treatment should be postponed until after a blood test confirms a return to normal levels. Chemotherapy can also lead to neurotoxicity, a persistent, deep pain that mimics a toothache, but that has no dental or mucosal source.
to be continued......
