Impact of oral rehabilitation on patients with head and neck cancer: A study using the Liverpool Oral Rehabilitation Questionnaire and the Oral Health Impact Profile-14.

STATEMENT OF PROBLEM: The treatment of oral cancers affects oral functions and quality of life (QOL). Dental rehabilitation is a major step toward enhancing quality of life after controlling the disease. The effects of the disease, treatment, and rehabilitation need to be evaluated to assess oral health-related QOL. The Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3) and Oral Health Impact Profile-14 (OHIP-14) are specific assessment questionnaires of oral rehabilitation. PURPOSE: The purpose of this study was to assess the impact of oral rehabilitation on patients with head and neck cancer by using the LORQv3 and OHIP-14 questionnaires and to discover and document specific patient-derived problems related to the issues of oral rehabilitation. MATERIAL AND METHODS: The LORQv3 and OHIP-14 questionnaires were administered to 60 participants with oral cancer, who were in need of oral rehabilitation. They were asked to rate their dental problems on a Likert scale before fabrication of their prostheses (baseline) and at the 3-month follow-up visit after prosthetic rehabilitation. Paired comparison was done using the Wilcoxon signed rank test according to the distribution, and Cronbach alpha was used to assess internal consistency. Subscale scores were determined by mean value (α=.05). RESULTS: For the LORQv3 questionnaire, a 10% to 27% improvement was found in the domain of oral function, and a 20% improvement in orofacial appearance, with improvement in patient satisfaction with the prosthesis. Using the OHIP-14 questionnaire, a 45% to 67% improvement was generally seen in all domains. CONCLUSIONS: After assessment using the LORQv3 and OHIP-14 questionnaires, prosthetic rehabilitation was seen to contribute to the betterment of patients with head and neck cancer.

Osteoradionecrosis of the jaws: A retrospective cohort study.

Introduction: Radiotherapy (RT) combined with chemotherapy and surgery is the indicated treatment for head and neck cancers. Even with the advent of modern technological advances in RT and improved oral hygiene awareness, osteoradionecrosis (ORN) still remains as one of the most debilitating side effects of RT. Methodology: This is a retrospective review assessing 72 patients aged over 18 years of age reporting in the Dental Department, for treatment of ORN from April 2010 to July 2019. Each patient was clinically examined and treated according to standard protocol. The stage of ORN was noted at the diagnosis and at follow-up. The demographic data, the tumor characteristics, and the treatment of patients were evaluated using descriptive statistics. Results: At the time of diagnosis, 84.7% of the study population was found to have Epstein Type II chronic persistent nonprogressive lesions and 11.1% of the cohort had Type III active progressive lesions. Statistically significant correlation (P = 0.00) was found for ORN grade at diagnosis and at follow-up. ORN being a chronic pathology, stabilization of the disease was observed in 72.3% of cases. The resolution of the necrotic lesion and down staging of the disease was seen only in 2.8% of patients. Conclusion: ORN is mainly a chronic long standing pathology which is difficult to treat completely. Stabilization of symptoms and preventing further spread of the necrotic lesion should be the ultimate aim of the treatment to improve the quality of life of the patients.

Study of Quality of Life in Patients with Soft Tissue Reconstruction Following Mandibulectomy.

PURPOSE: To study the effect of mandibulectomy with soft tissue reconstruction on quality of life (QOL) and functions of speech and swallowing. METHODOLOGY: Quality of life of 66 patients was evaluated by using EORTC QLQ-C30 and EORTC-HN35 questionnaires. Speech was evaluated objectively by Dr. Speech software version 4 and subjectively by a single speech therapist along with swallowing. Patients were evaluated preoperatively and 6 months after treatment. RESULTS: Out of 66 patients, 57 followed up postoperatively. Comparison of preoperative and postoperative QOL, speech, and swallowing was done by using paired 't' test or Wilcoxon signed-rank test as per distribution. When evaluated by EORTC QLQ-C30 and EORTC-HN35, statistically significant difference was found in the domains of physical function, fatigue, nausea-vomiting, dyspnea and appetite loss, pain, nutrition, swallowing speech and dry mouth. Significant difference was found in speech (maximum intensity) and most of the domains of swallowing. CONCLUSION: In EORTC QLQ-C30 questionnaire, all functional scales showed deterioration with maximum in physical function. Symptom scales showed worsening but significant improvement was found in pain when evaluated by EORTC-HN35. However, the global health status/QL was found to be improved marginally.

Rehabilitation of large maxillary defect with two-piece maxillary obturators.

The insertion and removal of an obturator in large maxillary defects with or without trismus is difficult. Fabrication of a two-piece obturator in such cases overcomes this problem. This article describes rehabilitation of large maxillary defects with two piece maxillary obturator of three types. All these obturators have a maxillary plate and a bulb component, which are approximated together by various techniques namely, silicone cover, embedded magnets, and press studs. Prosthetic rehabilitation of large maxillary defects with two-piece obturators offers the possibility of adequate oral rehabilitation by fabricating light weight prosthesis, which is easy to use. The bulb covers the undercut areas of the defect enhancing the facial contour and retention. It facilitates easy examination of underlying tissues, recreation of the anatomic barrier between the oral and nasal cavities and restoration of the function and esthetics. Thus, it adds to the quality of life.

Osseointegrated supported prosthesis and interdisciplinary approach for prosthodontic rehabilitation of a young patient with ectodermal dysplasia.

Anhidrotic ectodermal dysplasia is a triad of hypodontia or anodontia, hypotrichosis, and hypohydrosis, associated with other problems that result from the defective development of structures of ectodermal origin (Freire-Maia, Pinheiro (1988)). Early and extensive dental treatment is needed keeping in mind the effect on the craniofacial growth. Due to rapid growth of the jaws, the patients are rehabilitated using removable prostheses (Tarjan et al. (2005)). Hence for a young patient in this case report, the placement of endosseous osseointegrated implants was delayed till adulthood. Finally a definitive fixed tooth-supported and osseointegrated implant supported fixed partial denture therapy was used to rehabilitate the patient satisfactorily after she had completed her growth (Sweeney et al. (2005)). A review of the current literature relevant to several aspects of syndromic hypodontia, patient selection, and implant planning is discussed.