Skip to main content

Advertisement

Log in

Oral Management of Patients Undergoing Head and Neck Cancer Treatment

  • REVIEW PAPER
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Oral cancer accounts for around 30 percent of all cancers in India. These cancers are usually managed either by surgery, radiotherapy, chemotherapy or a combination of these modalities. Dental oncologists play an integral part in the multidisciplinary team, including surgeons, radiation and medical oncologists, nurses, physician assistants, nutritionists, psychologists and social workers to efficiently manage cancer patients. Oral complications associated with cancer therapy can range from minor mucositis or infections to severely debilitating conditions such as osteonecrosis of jaws, which can disrupt the ongoing cancer therapy and jeopardize the overall quality of life of the patient. This highlights the primary role of a dentist in the efficient identification and management of potential oral foci of infection and subsequent prevention of the onset of these complications. This necessitates accurate, evidence-based knowledge and extensive training of dental oncologists to provide state-of-the-art management strategies. This article aims to review oral management before, during and after therapy in patients undergoing treatment for cancers affecting the head and neck region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Coelho KR (2012) Challenges of the oral cancer burden in India. J Cancer Epidemiol. https://doi.org/10.1155/2012/701932

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sroussi HY, Epstein JB, Bensadoun RJ et al (2017) Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med 6:2918–2931. https://doi.org/10.1002/cam4.1221

    Article  PubMed  PubMed Central  Google Scholar 

  3. Barrowman RA, Wilson PR, Wiesenfeld D (2011) Oral rehabilitation with dental implants after cancer treatment. Aust Dent J 56:160–165. https://doi.org/10.1111/j.1834-7819.2011.01318.x

    Article  CAS  PubMed  Google Scholar 

  4. Ariani N, Visser A, van Oort RP et al (2013) Current state of craniofacial prosthetic rehabilitation. Int J Prosthodont 26:57–67. https://doi.org/10.11607/ijp.3220

    Article  PubMed  Google Scholar 

  5. Geramipanah F, Fallahi Sichani S, Mirmohammadrezaei S, Ghodsi S (2016) Practical guidelines for fabricating mandibular guide flange prostheses: a new technique for measuring the flange angulation. Prosthet Orthot Int 40:528–531. https://doi.org/10.1177/0309364615574160

    Article  PubMed  Google Scholar 

  6. Jansma J, Vissink A, Spijkervet FK, Roodenburg JL, Panders AK, Vermey A, Szabó BG, Gravenmade EJ (1992) Protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy. Cancer 70:2171–2180

    Article  CAS  PubMed  Google Scholar 

  7. Andrews N, Griffiths C (2001) Dental complications of head and neck radiotherapy: Part 2. Aust Dent J 46:174–182. https://doi.org/10.1111/j.1834-7819.2001.tb00278.x

    Article  CAS  PubMed  Google Scholar 

  8. Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 64:379–390. https://doi.org/10.1016/0030-4220(87)90136-8

    Article  CAS  PubMed  Google Scholar 

  9. Starcke EN, Shannon IL (1977) How critical is the interval between extractions and irradiation in patients with head and neck malignancy? Oral Surg Oral Med Oral Pathol 43:333–337. https://doi.org/10.1016/0030-4220(77)90317-6

    Article  CAS  PubMed  Google Scholar 

  10. Matsuzaki H, Tanaka-Matsuzaki K, Miyazaki F et al (2017) The role of dentistry other than oral care in patients undergoing radiotherapy for head and neck cancer. Jpn Dent Sci Rev 53:46–52. https://doi.org/10.1016/j.jdsr.2016.09.003

    Article  PubMed  Google Scholar 

  11. Lalla RV, Sonis ST, Peterson DE (2008) Management of oral mucositis in patients who have cancer. Dent Clin North Am 52(1):61–77. https://doi.org/10.1016/j.cden.2007.10.002

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rastogi M, Khurana R, Revannasiddaiah S et al (2017) Role of benzydamine hydrochloride in the prevention of oral mucositis in head and neck cancer patients treated with radiotherapy (>50 Gy) with or without chemotherapy. Support Care Cancer 25:1439–1443. https://doi.org/10.1007/s00520-016-3548-9

    Article  PubMed  Google Scholar 

  13. Chitapanarux I, Tungkasamit T, Petsuksiri J et al (2018) Randomized control trial of benzydamine HCl versus sodium bicarbonate for prophylaxis of concurrent chemoradiation-induced oral mucositis. Support Care Cancer 26:879–886. https://doi.org/10.1007/s00520-017-3904-4

    Article  PubMed  Google Scholar 

  14. Zheng Z, Zhao X, Zhao Q et al (2021) The effects of early nutritional intervention on oral mucositis and nutritional status of patients with head and neck cancer treated with radiotherapy. Front Oncol 10:595632. https://doi.org/10.3389/fonc.2020.595632

    Article  PubMed  PubMed Central  Google Scholar 

  15. Al-Nuaimi DSA, Al-Rawaq KJ, Noori AGM, Fattah MAN (2019) Acute xerostomia in head and neck radiotherapy. Int J Otorhinolaryngol Head Neck Surg 5:262–268

    Article  Google Scholar 

  16. Nutting CM, Morden JP, Harrington KJ et al (2011) PARSPORT trial management group. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136. https://doi.org/10.1016/S1470-2045(10)70290-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhang Y, Guo CB, Zhang L et al (2012) Prevention of radiation-induced xerostomia by submandibular gland transfer. Head Neck 34:937–942. https://doi.org/10.1002/hed.21859

    Article  PubMed  Google Scholar 

  18. Epstein JB, Stevenson-Moore P (1992) A clinical comparative trial of saliva substitutes in radiation-induced salivary gland hypofunction. Spec Care Dentist 12:21–23. https://doi.org/10.1111/j.1754-4505.1992.tb00401.x

    Article  CAS  PubMed  Google Scholar 

  19. Redding SW, Zellars RC, Kirkpatrick WR et al (1999) Epidemiology of oropharyngeal candida colonization and infection in patients receiving radiation for head and neck cancer. J Clin Microbiol 37:3896–3900

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Nicolatou-Galitis O, Athanassiadou P, Kouloulias V et al (2006) Herpes simplex virus-1 (HSV-1) infection in radiation-induced oral mucositis. Support Care Cancer 14(7):753–762. https://doi.org/10.1007/s00520-005-0006-5

    Article  PubMed  Google Scholar 

  21. Albuquerque DF, de Souza TE, Amado FM, Arakawa C, Chinellato LE (2010) Evaluation of halitosis and sialometry in patients submitted to head and neck radiotherapy. Med Oral Patol Oral Cir Bucal 15:e850–e854. https://doi.org/10.4317/medoral.15.e850

    Article  PubMed  Google Scholar 

  22. Chai WL, Ngeow WC, Ramli R, Rahman RA (2006) Managing complications of radiation therapy in head and neck cancer patients: Part II. Management of radiation-induced caries. Singapore Dent J. 28:4–6

    PubMed  Google Scholar 

  23. Lopes CCA, Soares CJ, Lara VC, Arana-Chavez VE, Soares PB, Novais VR (2018) Effect of fluoride application during radiotherapy on enamel demineralization. J Appl Oral Sci 27:e20180044. https://doi.org/10.1590/1678-7757-2018-0044

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. de Amorim DMG, Veríssimo AH, Ribeiro AKC et al (2021) Effects of ionizing radiation on surface properties of current restorative dental materials. J Mater Sci Mater Med 32:69. https://doi.org/10.1007/s10856-021-06543-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. de Araújo DA, da Mota MV, Carvalho BF (2021) Tratamento endodôntico em pacientes submetidos a radioterapia: revisão de literatura. Res Soc Dev. 10(7):e1010716127. https://doi.org/10.33448/rsd-v10i7.16127

    Article  Google Scholar 

  26. Astradsson T, Laurell G, Ahlberg A, Nikolaidis P, Johansson H, Ehrsson YT (2018) Trismus in patients with head and neck cancer and 5-year overall survival. Acta Otolaryngol 138:1123–1127. https://doi.org/10.1080/00016489.2018.1511059

    Article  PubMed  Google Scholar 

  27. Shao CH, Chiang CC, Huang TW (2020) Exercise therapy for cancer treatment-induced trismus in patients with head and neck cancer: a systematic review and meta-analysis of randomized controlled trials. Radiother Oncol 151:249–255. https://doi.org/10.1016/j.radonc.2020.08.024

    Article  PubMed  Google Scholar 

  28. Lee R, Yeo ST, Rogers SN et al (2018) Randomised feasibility study to compare the use of Therabite® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 56:283–291. https://doi.org/10.1016/j.bjoms.2018.02.012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. van der Geer SJ, Reintsema H, Kamstra JI, Roodenburg JLN, Dijkstra PU (2020) The use of stretching devices for treatment of trismus in head and neck cancer patients: a randomized controlled trial. Support Care Cancer 28:9–11. https://doi.org/10.1007/s00520-019-05075-7

    Article  PubMed  Google Scholar 

  30. He Y, Ma C, Hou J, Li X et al (2020) Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible. Int J Oral Maxillofac Surg 49:411–419. https://doi.org/10.1016/j.ijom.2019.06.015

    Article  CAS  PubMed  Google Scholar 

  31. Korambayil PM, Ambookan PV, Pillai S, Karangath RR, George D (2020) Role of hyperbaric medicine for osteoradionecrosis and post irradiation wounds: an institutional experience. Indian J Surg Oncol 11:469–474. https://doi.org/10.1007/s13193-020-01128-0

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dieleman FJ, Meijer GJ, Merkx MAW (2021) Does hyperbaric oxygen therapy play a role in the management of osteoradionecrosis? a survey of Dutch oral and maxillofacial surgeons. Int J Oral Maxillofac Surg 50:273–276. https://doi.org/10.1016/j.ijom.2020.06.014

    Article  CAS  PubMed  Google Scholar 

  33. Dai T, Tian Z, Wang Z, Qiu W, Zhang Z, He Y (2015) Surgical management of osteoradionecrosis of the jaws. J Craniofac Surg 26:e175–e179. https://doi.org/10.1097/SCS.0000000000001445

    Article  PubMed  Google Scholar 

  34. Sindhu SK, Bauman JE (2019) Current concepts in chemotherapy for Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 31(1):145–154. https://doi.org/10.1016/j.coms.2018.09.003

    Article  PubMed  PubMed Central  Google Scholar 

  35. Akashi M, Kishimoto M, Kusumoto J, Yakushijin K, Matsuoka H, Komori T (2018) Delayed socket healing after dental extraction in patients undergoing myelosuppressive chemotherapy for hematological malignancy: incidence and risk factors. J Oral Maxillofac Surg 76:2057–2065. https://doi.org/10.1016/j.joms.2018.05.023

    Article  PubMed  Google Scholar 

  36. Riley P, McCabe MG, Glenny AM (2016) Oral cryotherapy for preventing oral mucositis in patients receiving cancer treatment. JAMA Oncol 2:1365–1366. https://doi.org/10.1001/jamaoncol.2016.2680

    Article  PubMed  Google Scholar 

  37. McCaul LK (2012) Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy. Dent Update 39:135–138

    Article  PubMed  Google Scholar 

  38. Campisi G, Mauceri R, Bertoldo F et al (2020) Medication-related osteonecrosis of jaws (MRONJ) prevention and diagnosis: Italian consensus update 2020. Int J Environ Res Public Health 17:5998. https://doi.org/10.3390/ijerph17165998

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nifosì AF, Zuccarello M, Nifosì L, Hervas Saus V, Nifosì G (2019) Osteonecrosis of the jaw in the era of targeted therapy and immunotherapy in oncology. J Korean Assoc Oral Maxillofac Surg 45:3–8. https://doi.org/10.5125/jkaoms.2019.45.1.3

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Krishnakumar Thankappan.

Ethics declarations

Conflict of interest

None.

Data availability

This is a review article and hence no data were collected.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Ethical approval.

Being a literature review, no formal ethical approval needed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nair, A.H., Patel, T., Nair, A.R. et al. Oral Management of Patients Undergoing Head and Neck Cancer Treatment. J. Maxillofac. Oral Surg. (2023). https://doi.org/10.1007/s12663-023-01911-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12663-023-01911-w

Keywords

Navigation