Chemotherapy

[Anonymous]

Oral complications of cancer chemotherapy have been recognized for many years. Candidiasis, mucositis, chemo-therapy-induced mucosal ulcerations, and altered salivary function are all well-documented side effects of chemotherapeutic agents.1 In 1983, osteonecrosis associated with head and neck cancer patients who had received radiation to the jaws was first described. The pathological changes seen in osteoradionecrosis are believed to be due to a decrease in vascularity resulting in tissue hypoxia secondary to radiation injury of the blood vessels. Osteoradionecrosis of the mandible occurs with a much greater frequency than in the maxilla, most likely due to the solitary mandibular blood supply provided by the inferior alveolar artery. It is well-known that the presence of active carious lesions and/or periodontal disease, as well as post-radiation dental extractions and surgical manipulation, increase the risk for development of osteoradionecrosis.

        

[Drsumitra]

The most common oral complications related to cancer therapies are mucositis, infection, salivary gland dysfunction, taste dysfunction, and pain. These complications can lead to secondary complications such as dehydration, dysgeusia, and malnutrition. In myelosuppressed cancer patients, the oral cavity can also be a source of systemic infection. Radiation of the head and neck can irreversibly injure oral mucosa, vasculature, muscle, and bone, resulting in xerostomia, rampant dental caries, trismus, soft tissue necrosis, and osteonecrosis.

Severe oral toxicities can compromise delivery of optimal cancer therapy protocols. For example, dose reduction or treatment schedule modifications may be necessary to allow for resolution of oral lesions. In cases of severe oral morbidity, the patient may no longer be able to continue cancer therapy; treatment is then usually discontinued. These disruptions in dosing caused by oral complications can directly affect patient survivorship.

Management of oral complications of cancer therapy includes identification of high-risk populations, patient education, initiation of pretreatment interventions, and timely management of lesions. Assessment of oral status and stabilization of oral disease before cancer therapy are critical to overall patient care. Care should be both preventive and therapeutic to minimize risk for oral and associated systemic complications.

        

[Drsumitra]

Oral Disease Stabilization Before Chemotherapy and/or Hematopoietic Stem Cell Transplantation

Data provided by oncology team to dental providers:
Underlying disease:
Cancer: type, stage, prognosis.
Aplastic anemia status, complete blood count (CBC).
Other.
Type of transplant:
Autologous.
Allogeneic donor types:
Matched related and unrelated.
Mismatched related.
Mismatched unrelated.
Syngeneic.
Hematopoietic stem cell source:
Bone marrow.
Peripheral stem cells.
Cord blood stem cells.
Conditioning regimen:
Myeloablative.
Reduced-intensity conditioning (including nonmyeloablative regimens).
Planned date of transplant.
Conditioning regimen:
Chemotherapy.
Total-body irradiation.
Radioactive antibodies.
Current hematologic status and immunologic status.
Present medications.
Other medical considerations:
Cardiac disease (including murmurs).
Pulmonary disease.
Indwelling venous access line.
Coagulation status.
Splenectomy.
Data provided by dental providers to oncology team:
Dental caries (number of teeth and severity, including designation of number of teeth that should be treated before cancer treatment begins).
Endodontic disease:
Teeth with pulpal infection.
Teeth with periapical infection.
Periodontal disease status.
Number of teeth requiring extraction.
Other urgent care required.
Time necessary to complete stabilization of oral disease.

        

[Author]

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