J Korean Assoc Oral Maxillofac Surg.  2011 Jun;37(3):169-175. 10.5125/jkaoms.2011.37.3.169.

The experimental study of oral care for early radiation therapy in the head and neck cancer patients

Affiliations
  • 1Department of Oral & Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea. yudh@yonsei.ac.kr
  • 2Department of Radiation Oncology, Wonju College of Medicine, Yonsei University, Wonju, Korea.
  • 3Department of Oral Pathology, School of Dentistry, Yangsan Campus of Pusan National University, Yangsan, Korea.

Abstract

BACKGROUND
Teeth requiring extraction before radiotherapy in head & neck cancer patients should be removed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it was not uncommon for the radiotherapist and cancer patient to feel an urgent need to process with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy, were considered and applied based on the experimental study.
MATERIALS AND METHODS
Eighteen dogs were processed for histopathologic wound healing. The effect of the primary endodontic treatment and extraction before early radiotherapy was examined.
RESULTS
No specific complication, such as, post-extraction wound infection, radiation osteitis and osteoradionecrosis, were encountered despite the early radiotherapy.
CONCLUSION
Based on the experimental study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for the early radiotherapy in head and neck cancer patients.

Keyword

Head and neck neoplasms; Radiotherapy; Tooth extraction; Wound healing

MeSH Terms

Animals
Dental Care
Dogs
Head
Head and Neck Neoplasms
Humans
Osteitis
Osteoradionecrosis
Tooth
Tooth Extraction
Wound Healing
Wound Infection

Figure

  • Fig. 1. Radiotherapy view by use of Linear Accelerator unit.

  • Fig. 2. Artificial periapical inflammation formation view by primary endodontic care with crown cut, pulp extirpation, canal enlargement, canal opening and insertion of contaminated cotton point.

  • Fig. 3. Histopathologic finding of moderate periapical inflammation.(H/E stains, ×40)

  • Fig. 4. Standard periapical view of severe periapical abscess.

  • Fig. 5. Histopathologic finding of severe periapical abscess. (H/E stains, ×100)

  • Fig. 6. Combined view of the healing of normal and infected extraction wounds.

  • Fig. 7. Histopathologic finding of normal extraction wound healing.(H/E stains, ×40)

  • Fig. 8. Histopathologic finding of infected extraction wound healing.(H/E stains, ×40)


Reference

References

1. Goo KS. Experimental study for the initiation of irradiation effects on the tooth extraction wounds in rats. J Korean Assoc Oral & Maxillofac Surg. 1979; 5:45–60.
2. Kim YG. Dental care of oral cancer patients. Journal of Korean Dental Association. 1986; 24:587–95.
3. Laskin DM. Oral and maxillofacial surgery, Vol II. 1st ed.Saint Louis: CV Mosby;1985. p. 42–7.
4. Lederman M. Complications of radiation therapy for cancer of the head and neck. In:Conley JJ, ed. Complications of head and neck surgery. 1st ed.Philadelphia: W.B. Saunders;1979. p. 329–52.
5. Sonis ST, Fazio RC and Fang L. Principles and practice of oral medicine. 2nd ed.Philadelphia: WB Saunders;1995. p. 406–11.
6. Peterson LJ, Ellis III E, Hupp JR, Tucker MR. Contemporary oral and maxillofacial surgery. 3rd ed.Saint Louis: CV Mosby;1998. p. 425–36.
7. Cohen S, Burns RC. Pathways of the pulp. 8th ed.Seoul: Shin Hung International Publication;2003. p. 65–6.
8. Grossman LI. Endodontic practice. 8th ed.Philadelphia: Lea & Febiger;1974. p. 151–68.
9. Lim SS. Clinical endodontics. 1st ed.Seoul: Medical and Dental Publishing;1994. p. 1–15.
10. Kim GW, Kim KW, Kim SG, Kim YK, Kim YK, Kim JR, et al. Oral and maxillofacial infections. 1st ed.Seoul: JeeSung Publishing;2007. p. 265–88.
11. Lee EW. Experimental study for irradiation effects on the jaw and tooth extraction wounds in rats. Yonsei J Dental Sci. 1981; 1:214–24.
12. Little JW, Falace DA. Dental management of the medically compromised patients. 5th ed.Saint Louis: CV Mosby;1997. p. 460–82.
13. Kim MG, Kim YK, Kim YG, Rew DM, Lee JH, Cha IH, et al. Oral cancer. 1st ed.Seoul: Jee Sung Publishing;2002. p. 498–805.
14. The Korean Association of Oral and Maxillofacial Surgeons. Textbook of oral and maxillofacial surgery. 2nd ed.Seoul: Medical & Dental Publishing;2005. p. 460–73.
15. Kim JB, Nam KY, Chung WG, Noh HJ, Jang SO, Yoo JH, et al. A clinical study on the care of oral complications in the admission patients with major malignant tumors. J Korean Assoc Maxillofac Plastic Reconstruc Surg. 2004; 26:53–60.
16. Rew SY, Park MS. Retrospective study of the oral cancer patients: a statistical analysis of 89 cases. J Korean Assoc Oral Maxillofac Surg. 1996; 22:643–58.
17. Suh GH, Kim OH. Clinical studies of malignant tumors in oral and maxillofacial region. J Korean Assoc Maxillofac Plast Reconstruc Surg. 1990; 12:82–95.
18. Baek JY, Choi SW, Lee EW, Choi EC, Cha IH. A clinical study of malignant tumors of the maxilla. J Korean Assoc Oral Maxillofac Surg. 2000; 26:391–5.
19. Kim YG, Yoo HS, Kwak JG, Kim GY. A clinical study of the osteoradionecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg. 1993; 19:177–84.
20. Cho BH, Min SK, Oh SH, Lee DK, Kim YG. Retrospective study on the influencing factors of survival rate after treatment of oral cancer. J Korean Assoc Maxillofac Plast Reconstruc Surg. 2002; 24:211–7.
21. Kim YI. Radiation therapy. 1st ed.Seoul: Shin Kwang Publication;1984. p. 10–36.
22. Hur J. Radiation Biology. Seoul: Ko Moon Sa Publication;1987. p. 51–158.
23. Marx RE, Johnson RP. Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol. 1987; 64:379–90.
Article
24. Peterson DE. Prevention of oral complications in cancer patients. Prev Med. 1994; 23:763–5.
Article
25. Markitziu A, Horn Y, Ulmansky M. Effect of single versus fractionated doses of x-radiation on developing molars in rats. J Dent Res. 1974; 53:637–40.
Article
26. Sweeney WT, Richard PE, Seymour HL. Histologic effect of fractionated doses of selectively applied 60Co irradiation on the teeth of Albino rats. J Dent Res. 1977; 56:1403–7.
Article
27. Daly TE. Dentistry for the irradiated head and neck cancer patient. Cancer Bull. 1979; 29:74–80.
28. Mossman KL, Henkin RI. Radiation-induced changes in taste acuity in cancer patients. Int J Radiat Oncol Biol Phys. 1978; 4:663–70.
Article
29. Nikoskelainen J. Oral infections related to radiation and immunosuppressive therapy. J Clin Periodontol. 1990; 17:504–7.
Article
30. Peterson DE, D'Ambrosio JA. Nonsurgical management of head and neck cancer patients. Dent Clin Nor Am. 1994; 38:425–45.
31. Shklar G. Oral cancer: the diagnosis, therapy, management, and rehabilitation of the oral cancer patient. Philadelphia: WB Saunders;1984. p. 138–43.
32. Carl W, Schaaf NG, Sako K. Oral surgery and the patient who has radiation therapy for head and neck cancer. Oral Surg Oral Med Oral Pathol. 1973; 36:651–6.
33. Regezi JA, Courtney RM, Kerr DA. Dental management of patients irradiated for oral cancer. Cancer. 1976; 38:994–1000.
Article
34. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg. 1983; 41:351–7.
Article
35. Topazian RG, Goldberg MH. Management of infections of the oral and maxillofacial regions. 1st ed.Philadelphia: WB Saunders;1981. p. 258–65.
36. Kim KW, Kim GS. Guideline of oral cancer care. 1st ed.Seoul: Oral Cancer Institute of Korean Assoc Oral & Maxillofac Surg;2008. p. 67–72.
37. Kimura Y, Yonaga K, Murakosi M, Yokoyama K, Watanabe H, Matsumoto K. Effects on periradicular periodontal tissues of root canal irradiation with Er: YAG Laser in rats. Photomed and Laser Surg. 2004; 22:335–41.
38. Choi SI, Cho ES, Lee SW. Expression of COX-2 & VEGF in dental periapical lesions. Korean J Oral Maxillofac Pathol. 2006; 30:53–60.
39. Chavez JA, Adkinson CD. Adjunctive hyperbaric oxygen in irradiated patients requiring dental extractions: outcomes and complications. J Oral Maxillofac Surg. 2001; 59:518–24.
Article
40. Shafer WG, Hine MK, Levg BM. A textbook of oral pathology. 4th ed.Philadelphia: WB Saunders;1983. p. 594–608.
Full Text Links
  • JKAOMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr