Should oral foci of infection be removed before the onset of radiotherapy or chemotherapy?

Pretreatment dental screening aims to locate and eliminate oral foci of infection in order to eliminate local, loco-regional, or systemic complications during and after oncologic treatment. An oral focus of infection is a pathologic process in the oral cavity that does not cause major infectious problems in healthy individuals, but may lead to severe local or systemic inflammation in patients subjected to oncologic treatment. As head and neck radiotherapy patients bear a lifelong risk on oral sequelae resulting from this therapy, the effects of chemotherapy on healthy oral tissues are essentially temporary and reversible. This has a large impact on what to consider as an oral focus of infection when patients are subjected to, for example, head and neck radiotherapy for cancer or intensive chemotherapy for hematological disorders. While in patients subjected to head and neck radiotherapy oral foci of infection have to be removed before therapy that may cause problems ultimately, in patients that will receive chemotherapy such, so-called chronic, foci of infection are not in need of removal of teeth but can be treated during a remission phase. Acute foci of infection always have to be removed before or early after the onset of any oncologic treatment

The pricing behaviour of firms in the euro area : new survey evidence

This study investigates the pricing behaviour of firms in the euro area on the basis of surveys conducted by nine Eurosystem national central banks. Overall, more than 11,000 firms participated in the survey. The results are very robust across countries. Firms operate in monopolistically competitive markets, where prices are mostly set following mark-up rules and where price discrimination is a common practice. Our evidence suggests that both time- and state-dependent pricing strategies are applied by firms in the euro area: around one-third of the companies follow mainly time-dependent pricing rules while two-thirds use pricing rules with some element of state-dependence. Although the majority of firms take into account a wide range of information, including past and expected economic developments, about one-third adopts a purely backward-looking behaviour. The pattern of results lends support to the recent wave of estimations of hybrid versions of the New Keynesian Phillips Curve. Price stickiness arises both at the stage when firms review their prices and again when they actually change prices. The most relevant factors underlying price rigidity are customer relationships - as expressed in the theories about explicit and implicit contracts - and thus, are mainly found at the price changing (second) stage of the price adjustment process. Finally, we provide evidence that firms adjust prices asymmetrically in response to shocks, depending on the direction of the adjustment and the source of the shock: while cost shocks have a greater impact when prices have to be raised than when they have to be reduced, reductions in demand are more likely to induce a price change than increases in demand.price setting, nominal rigidity, real rigidity, inflation persistence, survey data.

The Pricing Behaviour of Firms in the Euro Area: New Survey Evidence

This study investigates the pricing behaviour of firms in the euro area on the basis of surveys conducted by nine Eurosystem national central banks. Overall, more than 11,000 firms participated in the survey. The results are very robust across countries. Firms operate in monopolistically competitive markets, where prices are mostly set following mark-up rules and where price discrimination is a common practice. Our evidence suggests that both time- and state-dependent pricing strategies are applied by firms in the euro area: around one-third of the companies follow mainly time-dependent pricing rules while two-thirds use pricing rules with some element of state-dependence. Although the majority of firms take into account a wide range of information, including past and expected economic developments, about one-third adopts a purely backward-looking behaviour. The pattern of results lends support to the recent wave of estimations of hybrid versions of the New Keynesian Phillips Curve. Price stickiness arises both at the stage when firms review their prices and again when they actually change prices. The most relevant factors underlying price rigidity are customer relationships – as expressed in the theories about explicit and implicit contracts – and thus, are mainly found at the price changing (second) stage of the price adjustment process. Finally, we provide evidence that firms adjust prices asymmetrically in response to shocks, depending on the direction of the adjustment and the source of the shock: while cost shocks have a greater impact when prices have to be raised than when they have to be reduced, reductions in demand are more likely to induce a price change than increases in demand.

Foci of infection and oral supportive care in cancer patients

Radiotherapie in het hoofd-halsgebied en hoge doses chemotherapie gaan gepaard met schade aan gezonde weefsels in (de omgeving van) de mond. Om de kans op het ontstaan van neveneffecten van de kankerbehandeling tot een minimum te beperken, is het noodzakelijk voorafgaande aan de behandeling een oraal focusonderzoek uit te voeren. Daarnaast blijken aanvullende mondverzorgende maatregelen belangrijk om bijwerkingen van de kankerbehandeling op het gebit, de mondslijmvliezen en het kaakbot zoveel mogelijk te beperken. Dergelijke maatregelen blijken niet alleen noodzakelijk tijdens de kankerbehandeling, maar veelal ook nog jaren daarna. Dit betekent dat naast de zorgverleners die deel uitmaken van oncologische behandelteams ook steeds meer de mondzorgverleners in de eerstelijn met deze patiënten te maken zullen krijgen.Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.</p

Foci of infection and oral supportive care in cancer patients

Radiotherapie in het hoofd-halsgebied en hoge doses chemotherapie gaan gepaard met schade aan gezonde weefsels in (de omgeving van) de mond. Om de kans op het ontstaan van neveneffecten van de kankerbehandeling tot een minimum te beperken, is het noodzakelijk voorafgaande aan de behandeling een oraal focusonderzoek uit te voeren. Daarnaast blijken aanvullende mondverzorgende maatregelen belangrijk om bijwerkingen van de kankerbehandeling op het gebit, de mondslijmvliezen en het kaakbot zoveel mogelijk te beperken. Dergelijke maatregelen blijken niet alleen noodzakelijk tijdens de kankerbehandeling, maar veelal ook nog jaren daarna. Dit betekent dat naast de zorgverleners die deel uitmaken van oncologische behandelteams ook steeds meer de mondzorgverleners in de eerstelijn met deze patiënten te maken zullen krijgen.Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.</p

Foci of infection and oral supportive care in cancer patients

Radiotherapie in het hoofd-halsgebied en hoge doses chemotherapie gaan gepaard met schade aan gezonde weefsels in (de omgeving van) de mond. Om de kans op het ontstaan van neveneffecten van de kankerbehandeling tot een minimum te beperken, is het noodzakelijk voorafgaande aan de behandeling een oraal focusonderzoek uit te voeren. Daarnaast blijken aanvullende mondverzorgende maatregelen belangrijk om bijwerkingen van de kankerbehandeling op het gebit, de mondslijmvliezen en het kaakbot zoveel mogelijk te beperken. Dergelijke maatregelen blijken niet alleen noodzakelijk tijdens de kankerbehandeling, maar veelal ook nog jaren daarna. Dit betekent dat naast de zorgverleners die deel uitmaken van oncologische behandelteams ook steeds meer de mondzorgverleners in de eerstelijn met deze patiënten te maken zullen krijgen.Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.</p

Foci of infection and oral supportive care in cancer patients

Radiotherapie in het hoofd-halsgebied en hoge doses chemotherapie gaan gepaard met schade aan gezonde weefsels in (de omgeving van) de mond. Om de kans op het ontstaan van neveneffecten van de kankerbehandeling tot een minimum te beperken, is het noodzakelijk voorafgaande aan de behandeling een oraal focusonderzoek uit te voeren. Daarnaast blijken aanvullende mondverzorgende maatregelen belangrijk om bijwerkingen van de kankerbehandeling op het gebit, de mondslijmvliezen en het kaakbot zoveel mogelijk te beperken. Dergelijke maatregelen blijken niet alleen noodzakelijk tijdens de kankerbehandeling, maar veelal ook nog jaren daarna. Dit betekent dat naast de zorgverleners die deel uitmaken van oncologische behandelteams ook steeds meer de mondzorgverleners in de eerstelijn met deze patiënten te maken zullen krijgen.Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.</p

Foci of infection and oral supportive care in cancer patients

Radiotherapie in het hoofd-halsgebied en hoge doses chemotherapie gaan gepaard met schade aan gezonde weefsels in (de omgeving van) de mond. Om de kans op het ontstaan van neveneffecten van de kankerbehandeling tot een minimum te beperken, is het noodzakelijk voorafgaande aan de behandeling een oraal focusonderzoek uit te voeren. Daarnaast blijken aanvullende mondverzorgende maatregelen belangrijk om bijwerkingen van de kankerbehandeling op het gebit, de mondslijmvliezen en het kaakbot zoveel mogelijk te beperken. Dergelijke maatregelen blijken niet alleen noodzakelijk tijdens de kankerbehandeling, maar veelal ook nog jaren daarna. Dit betekent dat naast de zorgverleners die deel uitmaken van oncologische behandelteams ook steeds meer de mondzorgverleners in de eerstelijn met deze patiënten te maken zullen krijgen.Radiation therapy in the head and neck area and treatment with high dose chemotherapy entail damage to healthy tissue in the mouth. In order to reduce to a minimum the chances of these side effects of cancer treatment developing, it is necessary to carry out oral foci tests prior to oncological therapy. In addition supplementary oral and dental care measures seem to be important in order to limit the side effects of oncological therapy on the teeth, salivary glands and jaw as much as possible. This supportive oral care is not only necessary during, but also for years after the oncology treatment. Therefore not only dental professionals affiliated to oncology teams will have to take care of cancer patients, but also family dentists and dental hygienists.</p

A PhD completed 9. The value of oral foci screening in oncology patients

In both patients who undergo radiotherapy because of a tumour in the head and neck region and patients who are treated with high doses of chemotherapy because of haematological disorders, prior to treatment an oral foci screening is carried out. The aim of this focus investigation is to identify oral abnormalities, the so-called oral foci. Such foci can lead to oral problems during or post-treatment. A careful oral foci screening, conforming to protocol, appears to be very relevant for patients who have to undergo head and neck radiotherapy. Particular attention must be devoted to the evaluation of the perodontium, because the chance of disorders affecting the bone-healing that appear post-radiotherapy in the head and neck region is increased in patients with periodontitis. In patients with a haematological disorder, asymptomatic, chronic foci do not require treatment prior to or during the oncological treatment because such oral foci do not increase an extra risk of infectious complications, despite what was hitherto believed

Haematopoietic stem cell transplantation and oral complications

De ontwikkeling van nieuwe procedures heeft ertoe geleid dat een hematopoëtische stamceltransplantatie tegenwoordig ook kan worden toegepast bij patiënten die vroeger niet hiervoor in aanmerking kwamen, zoals ouderen. Tevens leiden deze ontwikkelingen tot verschuivingen in het spectrum van complicaties als gevolg van hematopoëtische stamceltransplantatie. In dit artikel komen de belangrijkste principes van hematopoëtische stamceltransplantatie aan de orde en de verschillende orale complicaties die hierbij kunnen optreden: mucositis, infecties, bloedingen, graft-versus-hostziekte, xerostomie, hyposialie, smaakverandering, secundaire tumoren, osteoporose, osteonecrose en groei- en ontwikkelingsstoornissen. Tot slot wordt aandacht besteed aan de rol van mondzorgverleners bij een hematopoëtische stamceltransplantatie.New haematopoietic stem cell transplantation procedures make the treatment available to patients who previously did not qualify, such as the elderly. In addition, the spectrum of oral complications associated with haematopoietic stem cell transplantation has altered as a result of the recent developments. This article is a review of the main principles of haematopoietic stem cell transplantation and provides information on oral complications which may develop, such as mucositis, infections, bleeding, graft-versus-host disease, xerostomia, hyposalivation, altered taste, secondary tumors, osteoporosis, osteonecrosis and growing and developing disturbancies. Finally, the role of dental care providers in cases of haematopoietic stem cell transplantation is addressed.</p