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Management of Oral Complications from Radiation and Chemotherapy The oral examination reveals: very dry, erythematous oral mucosal tissues with areas of erosion extending through the epitheial layers. Especially affected is the tongue, which is also fissured and atrophic with loss olf papillae covered with a thin white coating. The gingivae and periodontium are quite healthy except for some erythema all around the associated with the cancer and its therapy include chronic xerostomia, taste, altered bone, oral infections and Chief complaint: very sore, burning
mouth which is very dry with painful sores and teeth. Patient has also lost much of his sense of taste and has difficulty eating and use of daily fluoride gel applications). Also, early detection of oral soft tissue glandular tissue in the field of radiation ago. He had a surgical resection of the left *Dr. Rhodus is Professor and Director,
Division of Oral Medicine, School of Dentistry, and Adjunct Professor, Department of Otolaryngology, School of Medicine at the University of Minnesota. caries, especially after teeth have been synthetic saliva solutions alone are not satisfactory for relief of the complaints of quality of life. Clearly, saliva is an liquids. As a result, nutritional intake Table One. Management of Salivary Dysfunction* I. Moisture/Lubrication
± Rx Dexamethasone (Decadron Elixir)
Drink/sip water, liquids (that lack fermentable ± Rx Triamcinolone 0.1% (in hydrocortisone acetate)
Avoid ethanol, tobacco, caffeine, and hot, spicy, ± Rx Clotrimazole (Mycelex) 60-mg troches
Use xylitol candy/gum, Salix or Numoisyn ± Rx Nystatin and triamcinolone ointment
Artificial OTC Salivas: Oasis, Salivart, Moi-Stir, III. Prevention of Caries–Periodontal Disease
Mouthkote (some patients need multiple articles).
For Oral Balance, apply 1 ⁄ 2 tsp 5 to 6 times daily Rx Pilocarpine HCl 2% (Salagen)† 5 mg, tid or
qid daily, or Rx Cevimeline (Evoxac)† 30 mg caps
Regular hygiene recalls and dental prophylaxis II. Soft Tissue Lesions–Soreness
Mechanical brushes, waterpik, NaHCO rinses OTC Oral Balance and Biotene mouthwash.
Rx Diphenhydramine (Benadryl) + Maalox +
Fluoride varnish
nystatin elixir‡ (± Sucralfate) (± 0.5% viscous +Rx Neutral NaF 1.0%–trays (Prevident 5000)
+Rx Chlorhexidine gluconate (Peridex, Periguard)
*Salivary gland dysfunction, hyposalivation, or xerostomia should be managed by the diagnosis and according to the signs, symptoms, and severity of its manifestations in the oral cavity. Decreases in the quantity, and alterations in the composition of, beneficial constituents of saliva render the patient subject to many problems. The strategies for management will vary from individual to individual as to severity and are divided into the above three major areas.
†Caution in use in patients who have chronic obstructive pulmonary disease (COPD) and patients at risk for myocardial infarction (MI).
‡Rx: Benadryl 25 mg/10 ml + nystatin 100,000 IU/ml + Maalox 4 ml; eq 15 ml.
§Rx: Decadron Elixir 0.5%/5 ml. Dispense 100 ml. Sig: 1 tsp. tid swish-swallow.
adjusted. Ill-fitting dentures should be the oral cavity, patients may still need adjunctive artificial saliva in order to Tooth Sensitivity. During and
Prosthodontics. Patients should
secreted saliva. The topical application the first six months after completion of Osteoradionecrosis. Osteo-
Muscle Trismus. Radiation
osteoradionecrosis). Once patients start Eisbruch A et al. The prevention and treatment of radiotherapy-induced xerostomia. Semin Radiat Oncol 2003;13(3):302-8.
Epstein JB, GM, Caldwell J. Postradiation osteonecrosis of the mandible: a long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:657-62.
Jemal. Cancer Statistics, 2006. CA: A Cancer Journal for Clinicians. 2006;56(2):100-130.
diagnosis. Risk is greatest in posterior LeVeque. A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation- induced xerostomia in head and neck cancer patients. J Clin Oncol 1995;114:1,141-49.
Little JW et al. Dental Management of the Medically Compromised Patient. CV Mosby- Elsevier Robbins. Oral Care of the Patient Receiving Chemotherapy. Oral cancer: the dentist’s role in diagnosis, management, rehabilitation, and prevention. Chicago: Quintessence Publishing, 2000.
Rhodus, NL. Dysphagia in post-irradiation therapy head and neck cancer patients. J Cancer Rhodus, N.L., Oral cancer: leukoplakia and squamous cell carcinoma. Dent Clin North Am, Silverman, Oral Cancer. Hamilton, Ontario: BC Decker Inc., 1998.
10. Simone, Oncology. 21 ed. Cecil textbook of medicine, ed. Goldman. 2000, Philadelphia: 11. Suntharalingam, Principles and complications of radiation therapy. Oral cancer: the dentist’s role in diagnosis, management, rehabilitation, and prevention. Chicago: Quintessence Publishing, 2000.

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NHS Overview and Scrutiny Bulletin No. 31 1 August, 2008 If you would like to receive further information please telephone or email the appropriate contact officer responsible. Alternatively contact Paul Wickenden on 01622 694486 or e-mail [email protected] . For further information on items in this section please contact Tristan Godfrey, Tel: (01622) 694196, Freecall

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