Oral health status of patients after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract (San Francisco)

Abstract

Objective Treatment for head & neck cancer is associated with severe oral complications, such as reduced salivary flow rate, mucositis, or development or exacerbation of oral diseases (caries and periodontitis). Especially periodontitis represents a chronic inflammatory process, which is regarded as a risk factor for cancer development as well as after cancer treatment as a risk factor for development of osteoradionecrosis of the jaw. The aim of the present study was to determine the oral health status of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract. It was evaluated, whether the patients consulted a dentist prior to cancer treatment and, whether dental treatment was sustained after cancer treatment. Methods Thirty-eight patients (27 male / 11 female, age range 21 to 79 years) of the Department of Otorhinolaryngology (Medical University of Vienna) gave their written consent to participate in the present cross-sectional study. All of the participants were asked on dental treatment before and after cancer treatment, daily oral hygiene, habits, such as smoking and alcohol consumption, education, income, and family status. The decayed, missing and filled teeth (DMF-T) index, clinical (plaque control record (according to O’Leary, PCR), community periodontal index of treatment needs (CPITN), disease severity according to CDC/AAP criteria) and radiological (alveolar bone loss) periodontal parameters were determined. Results Twenty-two of 38 patients consulted a dentist for a check-up before cancer treatment and of those 17 received a treatment, of which tooth extraction was most often performed (in 59% of the cases). Although 71% of the patients consulted a dentist within the last year, 90% of the examined patients presented the necessity of dental treatment at time-point of evaluation; 75 % had at least one decayed tooth, with an average of 4 decayed teeth. The average DMF-T-index was 25.5. Seventy-two percent showed a CPITN of 3 or 4 and 31 % of the patients presented moderate and 47 % severe periodontitis. Mean alveolar bone loss was 4.3mm. A professional dental cleaning session was never performed in 40% of the patients and the mean PCR was 65%. The consultation of a dentist before cancer treatment presented no significant effect on the oral health status after cancer treatment. Conclusion The oral health status of patients at least 6 months after cancer treatment for squamous cell carcinoma in the upper aero-digestive tract presented to an extremely high degree the necessity of treatment for oral diseases, such as caries and periodontitis. Regarding the risks associated with these oral diseases after cancer treatment, such as the development of osteoradionecrosis of the jaw, the multidisciplinary teams in cancer care should include dental professionals, who are well schooled in the treatment of cancer patients. This might improve the dental treatment before as well as the sustainment of oral health after cancer treatment