DentaltownUK July 2017 - 16

Because saliva acts as a natural buffer in the mouth, bathing and
lubricating the teeth and oral tissues, reduced salivary flow leaves
patients prone to an increased risk for dental decay.

Xerostomia

Trismus

One of the most common manifestations
of radiation therapy to the head and neck,
xerostomia, may pose a significant challenge
to restorative dentists.
Radiation therapy to the head and neck
region may result in not only a reduction
in salivary flow, but also a change in the
type of saliva produced. Often, patients
who have undergone high-dose head and
neck radiation therapy report noticing that
their saliva is ropey and thick, which means
many of saliva's protective effects are no
longer present.
The extent of hyposalivation and
xerostomia is linked to the dosage of received
radiation, as well as the location of the field
of radiation. Because saliva acts as a natural
buffer in the mouth, bathing and lubricating
the teeth and oral tissues, reduced salivary
flow leaves patients prone to an increased
risk for dental decay. (Xerostomia also is
associated with taste alterations, difficulty
swallowing and difficulty speaking.)

Often presenting three to six months
after radiation therapy, trismus signifies a
limited or reduced opening of the jaw. The
degree of trismus varies, depending on the
location and dosage of radiation, as well as
the patient's age and medical history.
Trismus may also result from surgical
resections. Trismus can be extremely
debilitating if it results in not only an impaired
ability to maintain oral hygiene, but also a
difficulty in chewing food.

Treatment considerations: Treating
xerostomic patients can be a challenge because
they're at increased risk for developing caries.
It's often recommended that these patients
be placed on a sodium fluoride 1.1 percent
prescription-strength toothpaste.
A lso, ora l-hygiene instruction is
paramount, and a detailed discussion of
the risks of developing caries in the setting
of reduced salivary flow is crucial.

Treatment considerations: Performing
restorative dental treatment on patients
suffering from trismus can be extremely
difficult and may present several problems
to patients, including impaired ability to
maintain oral hygiene and difficulty eating
and speaking.
Ideally, jaw exercises that encourage
maintaining the vertical dimension of
opening should be reviewed with patients
before they undergo treatment. Referrals to
physical therapists and speech pathologists
are often recommended to help prevent
patients from developing trismus. At-home
jaw exercises should be reviewed with patients
and encouraged, in addition to therapy with
a speech pathologist and a physical therapist.
I n a dd it ion to c on sid e r i n g t he
manifestations of head and neck radiation
therapy, dental clinicians must also consider
any defects that may have resulted from head
or neck surgery.

Maxillary defects and
palatal obturators
Depending on the location of the tumor,
maxillectomies are sometimes indicated.
These surgical procedures may involve total
or partial surgical resection of the maxilla.
Palatal obturators are often fabricated to
restore speech, to enhance a patient's ability
to eat, and to restore the boundaries between
the nasal and oral cavity. Additionally,
obturators replace missing teeth.
Treatment considerations: A thorough
dental evaluation before the surgery should
include a detailed discussion about active
dental or periodontal infections, oral-hygiene
instruction, the side effects associated
with the proposed cancer treatment, and
compliance with frequent follow-up visits.
Active communication and coordination
with the patient's head and neck surgeon
and oncology team must be established.
Pretreatment prophylaxis and treatment of
active odontogenic and periodontal infections
should be completed before the patient
undergoes any cancer therapy.
At the presurgical visit, initial impressions
of the maxilla and mandible should be taken
for fabrication of a surgical obturator. Because
surgical obturators are placed at the time of
surgery, their fabrication should be discussed
with the head and neck team.
Approximately two weeks after surgery,
surgical dressings are removed and an interim
obturator is fabricated while the patient is
healing. The obturator is constantly modified
and relined throughout the healing process.

Earn CE credits-online, anytime
To take Dr. Lauren Levi's online course about the oral and
dental sequelae of cancer therapy and earn 1.5 credit hours
of continuing education, go to dentaltown.com/ce.

16

JULY 2017 // dentaltownuk.com
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Table of Contents for the Digital Edition of DentaltownUK July 2017
