Kate Scheer: Mouth Cancer and Dentistry

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Kate Scheer looks at oral cancer: dental considerations

Oral cancer currently affects 1 in 55 men as well as 1 in 108 women within the UK. Cancers of the head and neck have increased by around a quarter over the last decade [1].

For cancers of the larynx, oropharynx, oral cavity, salivary glands, tongue and sinuses, around half of British patients survive for five years (other head and neck cancers – such as hypopharyngeal – give a worse prognosis) [2]. The main risk factors for most head and neck cancers are: smoking, alcohol consumption, and the human papillomavirus (predominantly strains 16 and 18) [3].

Patients with oral cancer are typically treated with radiotherapy and ablative surgery, with chemotherapy sometimes necessitated if the cancer spreads to the neck or beyond. If caught early on, often only relatively minor surgical treatment may be required. This underscores the value of vigilance during routine dental examinations, with dentists being well placed to notice adverse changes in the mouth that could indicate cancer [4,5]. ,

Unfortunately, the overwhelming majority of patients receiving radiotherapy for cancers of the head and neck, and around 40% of patients undergoing chemotherapy, are likely to develop oral complications.

These can include: xerostomia, dysgeusia, mucositits, adverse changes to the periodontal ligament, radiation induced caries, a weakened immune system resulting in greater susceptibility to infection, cosmetic changes, and functional impairment (dysphagia, trismus, speech problems, etc.) [6,7,8,9}. , , ,

The application of radiotherapy can potentially affect any of the hard or soft tissues in the region (and indeed the oral flora); salivary glands are often damaged, enamel can become demineralised making it more susceptible to acid erosion, vascularisation can be permanently impacted, destruction of collagen can potentially result in secondary fibrosis, and so on [10].

The incidence and magnitude of radiotherapy-induced effects vary on an individual basis, but generally increase in accord with the level of radiation received during treatment, which can vary substantially [11,12]. ,

Patients must continue to do their best to maintain their oral hygiene during treatment, to give themselves the best chance of avoiding dental complications. However, both the disease and its treatment can result in substantial damage to oral tissues, causing defects and abnormalities that can affect dental function and aesthetics.

Tooth loss can occur, for instance – the treatment of which can be especially challenging due to some of the aforementioned complications that may be present, and the disruption and impairment of the healing process that radiotherapy causes.
Changes to the anatomy of the oral cavity can compromise or thwart attempts to rehabilitate the patient using conventional dentures, and there is some evidence to suggest that maladaptive prostheses significantly increase the risk of subsequent osteoradionecrosis. Dental implants can potentially be the most effective means of restoring aesthetics and function for such patients [13,14]. ,

However, while the overall success rate of dental implants for these patients remains high, radiotherapy can adversely affect the osseointegration process, thereby increasing the chance of failure. The changes to hard and soft tissues caused by radiotherapy (and surgery) – particularly regarding the vascularisation of the bone – can lead to long-lasting impairment of the body’s healing processes within the affected site.

This could lead to tissue dehiscence and osteoradionecrosis [15,16]. , Consequently, implants placed in irradiated bone are significantly more likely to fail than those placed in non-irradiated patients. The elevation in risk is quite variable across different studies. However, while patients who have undergone radiotherapy are indeed significantly more likely to face complications, treatment is successful in approximately 9 out of 10 cases, with implants surviving for at least five years [17].

It has been occasionally put forward that implants may increase the chance of oral cancer developing around them due to chronic low-level inflammation. Thankfully, meta-analysis has confirmed that there is no direct link between dental implants and cancer. Study authors have noted that it can be difficult to distinguish between some oral cancers and peri-implantitis, which can necessitate a biopsy. It should also be noted that oral cancer and edentulism have certain common risk factors, such as smoking, alcohol consumption and poor oral hygiene [18,19.20]. , ,

The success of dental implants is contingent on the bone-implant interface, where osseointegration takes place. Sound primary implant stability minimises movement at this critical interface, helping to pave the way for osseointegration to proceed smoothly. Where excessive movement does occur, this can lead to fibrous bone formation – weakening the potential interface and reducing long-term secondary stability [21].

Cancers of the head and neck are a serious threat to patients’ lives. Dental professionals are often uniquely placed to be the first to alert patients of this threat. Even when successfully put into remission, these patients can be faced with numerous health and psychological consequences. While such cases can be complex and challenging with regard to rehabilitating form and function, dental practitioners can have a massive and enduring impact on cancer survivors’ well-being.

Author


Kate Scheer is a Marketing Executive at W&H. She says: ”Implant stability is an important diagnostic measurement for gauging the success of implant procedures in both the short and long term. The Osstell range of products from W&H, including the BeaconTM, offers an outstanding, non-invasive means of accurately measuring primary and secondary implant stability readings. They provide easy-to-understand ISQ values that can help with diagnosis and predicting implant success or failure.”

References:
1] Cancer Research UK. Head and neck cancer statistics. Cancer Research UK. Click HERE.  April 25, 2019.

2] Cancer Research UK. Head and neck cancer survival statistics. Cancer Research UK. Click HERE.  April 25, 2019.

3] Maldonado N., Prosdocimi F., Schmidt A., Sampaio R., Sani Jr A., Roman-Torres C. Oral Changes after radiotherapy in patients with head and neck cancer. Journal of Medical Biomedical and Applied Sciences. 2018; 6(2). http://www.jmbas.in/index.php/jmbas/article/view/90/59 April 25, 2019.

4] Pompa G., Saccucci M., Di Carlo G., Brauner E., Valentini V., Di Carlo S., Gentile T., Guarino G., Polimeni A. Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study. BMC Oral Health. 2015; 15(5). http://www.biomedcentral.com/1472-6831/15/5 April 25, 2019.

5] NHS. Treatment – mouth cancer. NHS. https://www.nhs.uk/conditions/mouth-cancer/treatment/# April 25, 2019.

6] Huassain Q., Awan K. Role of dental profession in oral cancer prevention and diagnosis. The Journal of Contemporary Dental Practice. 2016; 17(12): 963-964.click HERE April 25, 2019.

7] Maldonado N., Prosdocimi F., Schmidt A., Sampaio R., Sani Jr A., Roman-Torres C. Oral Changes after radiotherapy in patients with head and neck cancer. Journal of Medical Biomedical and Applied Sciences. 2018; 6(2). http://www.jmbas.in/index.php/jmbas/article/view/90/59 April 25, 2019.

8] Hameed M., Zafar K., Ghafoor R. Management of oral complications in irradiated head and neck cancer patients – literature review. International Journal of Surgery: Short Reports. 2018; 3(1): 15-21. Click HERE  April 25, 2019.

9] Ray-Chaudhuri A., Shah K., Porter R. Radiotherapy: oral management of patients who have received radiotherapy to the head and neck region. Vital. 2013; 10: 30-36. https://www.nature.com/articles/vital1650 April 25, 2019.

10] Gupta N., Rawat S., Grewal M., Garg H., Chauhan D., Ahlawat P., Tandon S., Khurana R., Pahuja A., Mayank M., Devnani B. Radiation-induced dental caries, prevention and treatment – a systematic review. National Journal of Maxillofacial Surgery. 2015; 6(2): 160-166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922225/ April 25, 2019.

11] Maldonado N., Prosdocimi F., Schmidt A., Sampaio R., Sani Jr A., Roman-Torres C. Oral Changes after radiotherapy in patients with head and neck cancer. Journal of Medical Biomedical and Applied Sciences. 2018; 6(2). http://www.jmbas.in/index.php/jmbas/article/view/90/59 April 25, 2019.

12] Barnett G., West C., Dunning A., Elliot R., Coles C., Pharoah P., Burnet N. Normal tissue reactions to radiotherapy: towards tailoring treatment dose by genotype. Nature Reviews Cancer. 2009; 9(2): 134-142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670578/ April 25, 2019.

13] Pompa G., Saccucci M., Di Carlo G., Brauner E., Valentini V., Di Carlo S., Gentile T., Guarino G., Polimeni A. Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study. BMC Oral Health. 2015; 15(5). http://www.biomedcentral.com/1472-6831/15/5 April 25, 2019.

14] Irie M., Mendes E., Borges J., Osuna L., Rabelo G., Soares P. Periodontal therapy for patients before and after radiotherapy: a review of the literature and topics of interest for clinicians. Medicina Oral Patologia Oral y Cirugia Bucal. 2018; 23(5): e524-539. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167093/ April 25, 2019.

15] Pompa G., Saccucci M., Di Carlo G., Brauner E., Valentini V., Di Carlo S., Gentile T., Guarino G., Polimeni A. Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study. BMC Oral Health. 2015; 15(5). http://www.biomedcentral.com/1472-6831/15/5 April 25, 2019.

16] Kuhnt T., Stang A., Wienke A., Vordermark D., Schweyen R., Hey J. Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer. Radiation Oncology. 2016; 11(101). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967325/ April 25, 2019.

17] Pompa G., Saccucci M., Di Carlo G., Brauner E., Valentini V., Di Carlo S., Gentile T., Guarino G., Polimeni A. Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study. BMC Oral Health. 2015; 15(5). http://www.biomedcentral.com/1472-6831/15/5 April 25, 2019.

18] Pinchasov G., Haimov H., Druseikaite M., Pinchasov D., Astramskaite I., Sarikov R., Juodzbalys G. Oral cancer around dental implants appearing in patients with/without a history of oral or systemic malignancy: a systematic review. Journal of Oral & Maxillofacial Research. 2017; 8(3): e1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676311/ April 18, 2019.

19] Kailembo A., Preet R., Williams J. Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO study on global AGEing and adult health (SAGE). BMC Oral Health. 2017; 17: 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964081/ April 18, 2019.

20] Brabyn P., Naval L., Zylberberg I., Muñoz-Guerra M. Oral squamous cell carcinoma after dental implant treatment. Revista Española de Cirugía Oral y Maxilofacial. 2018; 40(4): 176-186. https://www.sciencedirect.com/science/article/pii/S1130055818300066 April 25, 2019.

21] Zanetti E., Pascoletti G., Cali M., Bignardi C., Franceschini G. Biosensors. 2018; 8(3): 68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165397/ April 18, 2019.