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(searched for: Dental Management of Head and Neck Radiotherapy: A Literature Review)
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Anthony Challita, Raymond Challita, Ronald Challita, Sayde Sokhn, Mona Zeitouny
Dental Research and Oral Health, Volume 3, pp 52-61; doi:10.26502/droh.0020

Abstract:
Objective: To reveal the importance of dental care for Head and Neck Cancer (HNC) patients and the dentist role in treating these patients. Data source and selection: Two online databases (PubMed and Google Scholar) were searched (June 2019). All studies that were analyzed with access to full text in English language were included. Data synthesis: The selected articles shows the importance of the dentist intervention pre, per and post radiation therapy that helps to ease the symptoms which appear due to radiation and may delay their appearance. The dentist’s knowledge in the physiology of cancer and radiation treatment is essential and really important for the success of the whole treatment and amelioration of patient’s quality of life. Conclusion: A good knowledge by the dentist and a caring, cooperant patient improves the patient’s quality of life and reduces the severity of the side effects.
Mithra N Hegde, Ananiya John
Journal of Health and Allied Sciences NU, Volume 8, pp 028-033; doi:10.1055/s-0040-1708771

Abstract:
Amongst all the different varieties of cancers diagnosed across the world around 6% is found to be head and neck cancer and radiotherapy is the choice of treatment. Head and neck radiotherapy cause several changes in dentition, saliva, oral microflora and food habits of the patient thus increasing the risk of radiation-induced dental caries a common, yet serious complication. This paper analyses the literature pertaining to radiation-induced caries and discusses the predisposing factors, etiology, structural changes in the tooth, clinical features of radiation caries and management. To review this, the Pubmed and Scopus database was searched using the keywords “radiation-induced caries”, “xerostomia”, “effects of radiology” and “head and neck tumors”, “osteoradionecrosis”, “management of radiation caries”, “structural changes in teeth after radiotherapy”, “prevention of radiation caries”. Radiation caries is a rampant form of caries commonly seen within the first 3 months after the radiotherapy. Thus, early dynamic involvement of the dentist in the preventive and therapeutic strategies are important. Furthermore, educating and motivating patients about the risk factors, maintenance of oral hygiene, stimulation of salivary flow, fluoride use, and nutritional orientation are essential to decrease the incidence of radiation caries and eventually enhances the quality of life of patients.
Milena Suemi Irie, Eduardo-Moura Mendes, Juliana-Simeão Borges, Luis-Gustavo-Gonzalez Osuna, Gustavo-Davi Rabelo, Sciprofile linkCarlos José Soares
Medicina Oral Patología Oral y Cirugia Bucal, Volume 23; doi:10.4317/medoral.22474

Abstract:
To review and discuss important topics regarding periodontal treatment pre- and post-radiotherapy for head and neck cancer in human patients; to discuss the references for adequate techniques, the appropriate moment for tooth extractions and periodontal management; and to discuss the prevention of osteoradionecrosis. Thirty-nine studies including original studies, randomized clinical trials (RCTs) and reviews were searched in online databases MEDLINE (PubMed) and the Cochrane library. No year of publication restriction was applied. Language was restricted to English, and the following Medical Subject Heading terms were used: radiotherapy, radiation therapy and periodontal treatment. Studies regarding periodontal treatment and tooth extraction that involved clinical management of irradiated patients were selected. The treatment of periodontal diseases before radiotherapy is mainly required to avoid future dental extraction and to reduce the development of osteoradionecrosis. Periodontal treatment in irradiated patients mostly includes scaling and root planing, extraction of condemned teeth and topical and systemic antimicrobial therapy. Tooth removal should be planned at least 14 days before the first day of radiation treatment. Particular care and mouthwashes should be taken during and after radiation. The management of irradiated patients represents a challenge for health professionals, including dentists. It is important to establish recommendations for clinicians concerning dental and periodontal management in irradiated patients before, during and after treatment. Key words:Head and neck cancer, radiotherapy, periodontal treatment, periodontitis.
Critical Reviews in Oncology/Hematology, Volume 102, pp 47-54; doi:10.1016/j.critrevonc.2016.03.012

Abstract:
Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements).
Chris Davis, Justin Sikes, Parshan Namaranian, George Laramore, Sciprofile linkJasjit K. Dillon, Press Enter Key For Correspondence Information
Journal of Oral and Maxillofacial Surgery, Volume 74, pp 830-835; doi:10.1016/j.joms.2015.10.014

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Critical Reviews in Oncology/Hematology, Volume 97, pp 131-142; doi:10.1016/j.critrevonc.2015.08.010

Abstract:
Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community. A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities. The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia.
Sciprofile linkDeborah B. McGuire, On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO), Janet S. Fulton, Jumin Park, Carlton G. Brown, M. Elvira P. Correa, June Eilers, Sharon Elad, Sciprofile linkFaith Gibson, Loree K. Oberle-Edwards, et al.
Supportive Care in Cancer, Volume 21, pp 3165-3177; doi:10.1007/s00520-013-1942-0

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Oral and Maxillofacial Surgery, Volume 14, pp 81-95; doi:10.1007/s10006-010-0205-1

Abstract:
The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review. Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilizes or gradually worsens and is notoriously difficult to manage. Because most cases occur in patients who were dentulous in the mandible at tumor onset, proper dental management is the single most important factor in prevention. Complete dental clearance before treatment is no longer necessary. Controversy exists regarding the management of osteoradionecrosis of the maxillofacial skeleton because of the variability of this condition. The treatment of osteoradionecrosis has included local wound care, antibiotic therapy, surgical procedures, and the administration of hyperbaric oxygenation. Recently, new methods of treatment were introduced, according to the new theory about its pathophysiology.
Dh Koga, Jv Salvajoli, Fa Alves
Published: 18 December 2007
by Wiley
Oral Diseases, Volume 14, pp 40-44; doi:10.1111/j.1601-0825.2006.01351.x

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Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Volume 103; doi:10.1016/j.tripleo.2006.11.013

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