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Clinical evaluation of the effects of radiotherapy on oralmucosa and gingiva

Published online by Cambridge University Press:  01 December 2008

M. Taheri ,
K. Sohrabi ,
M.H. Salehi  and
M.H. Najafi
M. Taheri
Affiliation:
Department of Periodontics, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
K. Sohrabi*
Affiliation:
Dental Research Center, Mashhad University of Medical sciences, Mashhad, Iran
M.H. Salehi
Affiliation:
Department of Radiation Oncology, Ghaem Hospital Center, Mashhad University of Medical Sciences, Iran
M.H. Najafi
Affiliation:
Department of Periodontics, Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
*
Correspondence to: K. Sohrabi, Research Center, Mashhad Dental School, Mashhad, Iran. E-mail: k1sohrabi@gmail.com
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Abstract

Introduction: The use of radiotherapy, alone or in conjunction with surgical resection, is common in treating head and neck tumours. However, ionising radiation induces unavoidable changes in the surrounding normal tissues, causing severe complications. Therefore, we decided to study different effects of radiotherapy on gingiva and oral mucosa.

Methods and Materials: This prospective analytical study was performed on 30 patients with head and neck cancers referred to the radiotherapy department of Ghaem Hospital from March to October 2006. Data were collected by means of interviews, clinical examinations and patients’ medical file investigation. The impact of different dosages of radiation on gingiva and oral mucosa was investigated. Data analysis was performed using general linear model (GLM), Cochran and multivariate analysis of variance (MANOVA) tests via SPSS V. 11.5 software.

Results: A direct relationship between increase in radiation dosage, irritation of oral mucosa, ulcer development and mucositis was observed. But there was no significant relationship between NUG (necrotising ulcerative gingivitis) and perlèche and radiation dosage. Periodontal index (PI), gingival index (GI) and papillary bleeding index (PBI) were increased, but due to limited time of study (6–7 weeks), no change in gingival recession was observed. Plaque index (PLI) decreased during treatment process because of oral hygiene instructions.

Conclusion: The oral and periodontal health status of head and neck cancer patients before and during radiotherapy has been described in this article. The authors believe that prevention or reduction of side-effects of radiation should be an integral part of treatment as they may have tremendous effect on the patient's quality of life. This study supports the need for dental assessment and treatment planning before radiation therapy.

Keywords

Radiotherapymucositiscanceroral health statuscandidiasis.
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 7 , Issue 4 , December 2008 , pp. 195 - 204
Copyright
Copyright © Cambridge University Press 2008

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References

Little, JW, Falace, DA, Miller, CS, Rhodus, NL. Cancer. In: Little, JW, Falace, DA, Miller, CS, Rhodus, NL (eds). Dental management of the medically compromised patient. 6th edition.St Louis: Mosby, 2002: 387, 403–406.Google Scholar
Gellrich, N, Suarez, M, Bremerich, A.Characteristics of oral cancer in a central European population defining the dentist's role. J Am Dent Assoc 2003; 134:307–310.CrossRefGoogle Scholar
Neville, BW, Damm, DD, Allen, CM, Bouquot, JE. Epithelial pathology. In: Neville, BW, Damm, DD, Allen, CM, Bouquot, JE (eds). Oral and maxillofacial pathology, 2nd edition. Philadelphia: Saunders, 2002: 356.Google Scholar
Silverman, S. Complications of treatment. In: Silverman, S (ed). Oral Cancer. 4th edition. Hamilton: B.C. Decker, 1998, pp. 91–92.Google Scholar
Newman, MG, Takei, HH, Carranza, FA.Carranza's Clinical Periodontology. 10th edition. St Louis: Saunders, 2006, pp. 186–187, 391, 663.Google Scholar
White, SC, Pharoah, MJ. Radiation biology. In: White, SC, Pharoah, MJ(eds). Oral radiology principles and interpretation. 5th edition. St Louis: Mosby, 2004: 34–36.Google Scholar
Vissink, A, Jansma, J, Spijkervet, FK, Burlage, FR, Coppes, RP.Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 2003; 14:199–212.CrossRefGoogle ScholarPubMed
Vissink, A, Burlage, FR, Spijkervet, FK, Jansma, J, Coppes, RP.Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med 2003; 14(3):213–225.CrossRefGoogle ScholarPubMed
Epstein, JB. Oral cancer. In: Greenberg, MS, Glick, M (eds). Burket's oral medicine diagnosis & treatment. 10th edition. Hamilton: B.C. Decker, 2003: 217–220.Google Scholar
Jham, BC, Reis, PM, Miranda, EL, Lopes, RC, Carvalho, AL, Scheper, MA, Freire, AR.Oral health status of 207 head and neck cancer patients before, during and after radiotherapy. Clin Oral Investig 2008; 12:19–24.CrossRefGoogle ScholarPubMed
Ohrn, KE, Wahlin, YB, Sjoden, PO. Oral status during radiotherapy and chemotherapy: a descriptive study of patient experiences and the occurrence of oral complications. Support Care Cancer 2001; 9:247–257.Google ScholarPubMed
Berger, KM, Kilroy, TJ. Adverse effects of treatment: oral complications. In: Devita, VT, Hellman, S, Rosenberg, SA (eds). Cancer: principles & practice of oncology. 6th edition. Philadelphia: Lippincott Williams & Wilkins, 2001: 2881–2882.Google Scholar
Tonetti, MS, Pini-Prato, G, Cortellini, P.Effect of cigarette smoking on periodontal healing following GTR in infrabony defects. A preliminary retrospective study. J Clin Periodontol, 1995; 22 (3):229–234.CrossRefGoogle ScholarPubMed
Schwarz, F, Bieling, K, Latz, T, Nuesry, E, Becker, J.Healing of intrabony peri-implantitis defects following application of a nanocrystalline hydroxyapatite (Ostim) or a bovine-derived xenograft (Bio-Oss) in combination with a collagen membrane (Bio-Gide ). A case series. J Clin Periodontol 2006;33 (7):491–499.CrossRefGoogle ScholarPubMed
Schidot, M, Hermund, NU.Management of oral disease prior to radiation therapy. Support Care Cancer 2002;10:40–43.CrossRefGoogle Scholar
Hugoson, A, Koch, G, Göthberg, C, Helkimo, AN, Lundin, SA, Norderyd, O, Sjödin, B, Sondell, K.Oral health of individuals aged 3–80 years in Jönköping, Sweden during 30 years (1973–2003). I. Review of findings on dental care habits and knowledge. Swed Dent J 2005;29(4):125–138.Google ScholarPubMed
Mumghamba, EG, Manji, KP, Michael, J.Oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath among young mothers, Tanzania. Int J Dent Hyg 2006;4 (4):166–173.CrossRefGoogle ScholarPubMed
Bonan, PR, Lopes, MA, Pires, FR, Almedia, OP. Dental management of low socioeconomic level patients before radiotherapy of head and neck with special emphasis on the prevention of osteoradionecrosis. Braz Dent J 2006; 17:336–342.CrossRefGoogle ScholarPubMed
Lockhart, PB, Clark, J.Pretherapy dental status of patients with malignant conditions of head and neck. Oral Surg Oral Med Oral Pathol 1994; 77:236–241.CrossRefGoogle ScholarPubMed
Borowski, E, Benhamon, E, Pico, JL, Laplanche, A, Margainaud, JP, Hayat, M.Prevention and treatment of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation. A randomized controlled trial of comparing two protocols of dental care. Eur J Cancer B Oral Oncol 1994; 30B:93–97.CrossRefGoogle ScholarPubMed
Scully, C, Epstein, JB.Oral health care for cancer patients. Eur J Cancer B Oral Oncol 1996; 32B:281–292.CrossRefGoogle Scholar
Adamietz, IA, Rahn, R, Böttcher, HD, Schäfer, V, Reimer, K, Fleischer, W.Prophylaxe der radiochemotherapeutisch bedingten Mukositis. Strahlenther Onkol 1998; 174:149–155.CrossRefGoogle Scholar
Denham, JW, Peters, LJ, Johansen, J, et al. Do acute mucosal reactions lead to consequential late reactions in patients with head and neck cancer? Radiother Oncol 1999;52:157–164.CrossRefGoogle ScholarPubMed
Kielbassa, AM, Hinkelbein, W, Hellwig, E, Meyer-Lückel, H.Radiation-related damage to dentition. Lancet Oncol 2006;7:326–335.CrossRefGoogle ScholarPubMed
Lievens, Y, Haustermans, K, Van den Weyngaert, D, Van den Bogaert, W, Scalliet, P, Hutsebaut, L, Fowler, J, Lambin, P.Dose sucralfate reduce the acute side-effects in head and neck cancer treated with radiotherapy? A double-blind randomized trial. Radiother Oncol 1998;47:149–153.CrossRefGoogle ScholarPubMed
Sutherland, SE, Browman, GP.Prophylaxis of oral mucositis in irradiated head and cancer patients: a proposed classification scheme of interventions and meta-analysis of randomized controlled trials. Int J Radiat Oncol Biol Phys 2001;49:917–930.CrossRefGoogle ScholarPubMed
Sabater Recolons Mdel, M, López, J, Rodríguez de Rivera Campillo, ME, Chimenos Küstner, E, Conde Vidal, JM.Buccodental health and oral mucositis. Clinical study in patients with hematological diseases. Med Oral Patol Oral Cir Bucal 2006;11:E497–E502.Google ScholarPubMed
Redding, SW, Zellars, RC, Kirkpatrick, WR, McAtee, RK, Caceres, MA, Fothergill, AW, Lopez-Ribot, JL, Bailey, CW, Rinaldi, MG, Patterson, TF.Epidemiology of oropharyngeal Candida colonization and infection in patients receiving radiation for head and neck cancer. J Clin Microbiol 1999;37:3896–3900.CrossRefGoogle ScholarPubMed
Marx, RE, Jonson, RP.Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 1987;64:379–390.CrossRefGoogle ScholarPubMed
Markitziu, A, Zafiropoulos, G, Tsalikis, L, Cohen, L.Gingival health and salivary function in head and neck irradiated patients. Oral Surg Oral Med Oral Pathol 1992; 73:427–433.CrossRefGoogle ScholarPubMed
Epstein, JB, Lunn, R, Le, N, Stevenson-Moore, P.Periodontal attachment loss in patients after head and neck radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:673–677.CrossRefGoogle ScholarPubMed
Galler, C, Epstein, JB, Guze, KA, Buckles, D, Stevenson-Moore, P.The development of osteoradionecrosis from sites of periodontal disease activity. J Periodontol 1992;63:310–316.CrossRefGoogle ScholarPubMed
Ang, KK, Garden, AS. Overview. In: Ang, KK, Garden, AS(eds). Radiotherapy for head and neck cancers: instructions and techniques. 2nd edition, Philadelphia: Lippincott William & Wilikins, 2002: 3–10.Google Scholar
Galler, C, Epstein, JB, Guze, KA, Buckles, D, Stevenson-Moore, P.The development of osteoradionecrosis from sites of periodontal disease activity. J Periodontol 1992; 63:310–316.CrossRefGoogle ScholarPubMed
Russel, AL.A system of classification and scoring for prevalence surveys of periodontal disease. J Dent Res 1956; 35:350.CrossRefGoogle Scholar
Silness, J, Löe, H.Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22:121–135.CrossRefGoogle Scholar
Löe, H, Silness, J.Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;533–551.CrossRefGoogle ScholarPubMed
Saxer, UP, Mühlemann, HR.Motivation and education. SSO Schweiz Monatsschr Zahnheikd 1975; 85:905–919.Google ScholarPubMed