Dental Problems

• oral mucositis
• acute oral infections
• xerostomia
• gingivitis
• decreased salivary flow
• impaired mandible movements (trismus)

Solutions

• saliva substitute prescriptions (spray, mouthwash, gel, lozenges)
• non foaming , non sodium laurate toothpaste
• alcohol free mouthwashes
• NSAID benzydamine spray (Difflam)
• 0.2% chlorhexidine gluconate, alcohol free
• octanidol (octenidine)
• 3% sodium bicarbonate
• Nystatin 100000 U/ml (against Candydiasis)
• Miconazole cream (fungal infections)
• Supersaturated Calcium Phosphate spray (SCP)
• Episil – Swedish formula, oily consistency, great for mucositis prevention, allows other drugs absorption via thin film onto oral mucosa, the only contraindication: allergy to soy
• Proxident gel, spray
• Gengigel (hyaluronic acid) and Chlosite can bring a significant relief for patients who suffer from oral ulcerations
• Lozenges for xerostomia, eg. salivex

If patient undergoing chemotherapy requires extraction (even simple) – to get a second opinion, ideally from oncologist/haematologist before any invasive procedure.

Risk of post-operative complications due to compromised immune system, low level of platelets count. Increased risk of post-operative infection, excessive bleeding, systemic involvement.

Training appliance for gradual TMJ re-mobilization highly advisable.

Therabite device to allow gradual mouth opening improvement

Antibiotic cover may be justified in some cases to prevent from subsequent infections.

Case: Bone marrow transplantation (BMT) for acute leukemia. Risk of graft versus host disease. Oral manifestations: mucosal lesions, multiple gingival ulcerations, mucous oedema, xerostomia, gingival bleeding. Management: ultra soft TB for regular cleaning during acute phase, wet sponge sweepers topped with moisturizers, benzydamine oromucosal spray 0.15%, SCP.

Case: extensive maxilla resection due to malignant tumour, exposed maxillary bone structures partially. Need of special upper denture. Technical difficulties with F/- construction as not too much supportive bone left. Requested second opinion from consultant in restorative dentistry and additional advice from clinical lab technician.

Early radiotherapy by the age of 3-4 may severely affect teeth development, particularly impair the proper roots development of anterior teeth

What is the most optimal time for dental extractions (including multiple) for the patient who has just finished combined radiotherapy and chemotherapy within head and neck region? Are they any guidelines? Without doubts, the alveolar bone metabolism can be disturbed due to mainly radiation effect, increasing risk of osteoradionecrosis (ORN). Better to carry out extractions one by one or multiple ‘in one go’?