Timing of development of osteoradionecrosis post head and neck radiotherapy: does a safe time interval exist for dental extraction?

INTRODUCTION: Risk factors for developing osteoradionecrosis (ORN) are well known, but less is known about factors influencing the interval between radiotherapy and the onset of ORN. Also, it is unknown whether there is any specific period post-radiotherapy with a reduced probability of ORN when irradiated teeth require extraction. PURPOSE: The primary aim of this study was to identify factors influencing the interval in developing ORN in the following subgroups of patients: (1) patients who spontaneously developed ORN, (2) surgical-intervention-related ORN with a particular focus on patients after mandibulectomy. The secondary aim was to attempt to identify a possible time for safer dental intervention after primary treatment. MATERIALS AND METHODS: The authors retrospectively analysed 1608 head and neck cancer (HNC) patients treated in a single centre. Time intervals were measured from the end of radiotherapy to the development of ORN and further analysed in the subgroups listed above. RESULTS: In all, 141 patients (8.8%) developed intra-oral ORN. Median time from radiotherapy to ORN development in the whole cohort was 9 months. Median interval for spontaneous ORN was 8 months, 6.5 months for intervention-related ORN, and 15 months for patients post-mandibulectomy. In patients who required dental extraction preradiotherapy, median interval of ORN onset was 5 months. CONCLUSION: In our study, a slightly higher proportion of patients with intervention developed ORN earlier in comparison with spontaneous ORN. The period from 12-18 months after radiotherapy was identified as having the highest probability of developing ORN in patients after mandibulectomy. A time for safer dental intervention after primary treatment was not identified.

Exploring the integration of dentistry within a multidisciplinary palliative care team: does bedside dental care improve quality of life and symptom burden in inpatient palliative care patients?

BACKGROUND: Despite the significant impact of oral problems on the quality of life of palliative care patients, comprehensive studies are lacking. This study is the first of its kind to address this gap by including both a dental examination and an intervention and assessing quality of life using the EORTC QLQ OH 15 questionnaire. OBJECTIVES: The objective of this study is to explore the impact of incorporating dentists into inpatient palliative care, with a focus on enhancing quality of life and alleviating symptom burden. METHODS: In this monocentric study, data were gathered from a palliative care unit over an 8-month period. At the beginning of the multidisciplinary treatment, T0, patients underwent both a dental examination and interviews utilizing established questionnaires, the EORTC QLQ-C30 (core, general) and OH 15 (oral health). A week later, at T1, patients underwent a follow-up examination and interview. The QLQ-C30 and OH15 are widely recognized instruments developed by the European Organisation for Research and Treatment of Cancer (EORTC) for evaluating health related quality of life in cancer patients. RESULTS: A total of n = 103 patients (48.5% women) were enrolled in the study. The median duration since their last dental visit was 1 year, and the dental condition at T0 was desolate. At T1, statistically and clinically significant changes in oral quality of life and symptom burden were observed. Noteworthy changes were noted in the OH-QoL score (median 63 vs. 92, p < 0.001), sticky saliva (median 33 vs. 0, p < 0.001), sensitivity to food and drink (median 33 vs. 0, p < 0.001), sore mouth (median 33 vs. 0, p > 0.001), and poorly fitting dentures (median 33 vs. 0 p < 0.001). Additionally, improvements were observed in xerostomia candidiasis and mucositis. CONCLUSION: The study highlights the powerful contribution of integrating a dentist in inpatient palliative care. With very little dental effort and simple ward and bedside treatments, significant improvements in the oral symptom burden of critically ill palliative patients can be achieved. This contributes to improved care status, relief of distressing symptoms, and ultimately improved quality of life. The results strongly support the consideration of dental support as an integral part of palliative care units.

Bacteraemia of oral origin in children-A Systematic review and network meta-analysis.

OBJECTIVES: To systematically review the prevalence of bacteraemia, triggered by dental intervention and home oral hygiene practices, in children. The network meta-analysis (NMA) quantitatively compared the risk of bacteraemia triggered by dental extractions and home and professional cleaning procedures. MATERIALS AND METHODS: Clinical trials with the outcome "bacteraemia in children" were searched. The NMA was performed using the frequentist weighted least-squares approach comparing the odds ratios (OR) of different interventions. RESULTS: Among 11 of 13 studies, dental treatment was performed under general anaesthesia. In 2,381 patients, bacteraemia occurred in 38.7%-56% patients following single-tooth extractions, in 22%-46% after manual toothbrushing (MTB), and in 26%-78% after power toothbrushing (PTB). When MTB was set as the reference (OR 1), rubber cup polishing showed a slightly higher risk (OR 1.26) of bacteraemia. PTB presented a higher risk (OR 1.79-2.27) than with single-tooth extractions (OR 1.55) but lower than that with multiple extractions (OR 2.55). CONCLUSION: Daily use of MTB and routine professional cleaning were associated with the lowest risk of developing bacteraemia in children with gingivitis, almost as much as with a single-tooth extractions. Improved plaque control with PTB increased the risk of bacteraemia. There is limited evidence on gingivitis-free and systemically-diseased children.

Effect of dental intervention on improvements in metabolic syndrome patients: a randomized controlled clinical trial.

BACKGROUND: Metabolic syndrome (MetS), caused by the accumulation of visceral fat, is considered a major cause of cardiovascular disease. This randomized controlled trial aimed to clarify the effect of dental intervention, including prosthodontics and/or periodontal treatment, combined with dietary and exercise guidance on MetS. METHODS: In total, 112 patients who met the Japanese waist circumference criteria of MetS were recruited. The intervention group (ITG) received dental intervention along with dietary and exercise guidance, while the control group (CTG) received dietary and exercise guidance alone. Three outcome measurements were obtained before intervention (BL), 1 month after intervention (1M), and 3 months after intervention (3M). RESULTS: Body water rate (p = 0.043) was significantly higher in ITG than in CTG at 1M. Simultaneously, fasting blood sugar level (p = 0.098) tended to be lower in ITG than in CTG. Lean mass (p = 0.037) and muscle mass (p = 0.035) were significantly higher and body weight (p = 0.044) significantly lower in ITG than in CTG at 3M. Body mass index (p = 0.052) tended to be lower in ITG than in CTG. CONCLUSIONS: Dental intervention combined with lifestyle guidance may improve anthropometric status and reduce the risk of MetS. TRIAL REGISTRATION: University Hospital Medical Information Network Center Unique UMIN000022753. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000026176 .

Self-Esteem and Oral Condition of Institutionalized Abused Children in Japan.

OBJECTIVE: Abused children have been reported to have low self-esteem. The aim of this study was to investigate the effects of dental intervention on self-esteem, oral condition, and concern for oral health in abused children admitted to a child protection service facility. STUDY DESIGN: We examined the oral condition of 65 children (34 boys, 31 girls; aged 2-15 years), instructed them in tooth-brushing. Self-esteem was examined using Pope's five-scale test for children. Before discharge, the children completed questionnaires on concern about their oral health. RESULTS: The findings revealed the reasons for admission were child abuse and neglect (n=45), domestic violence against the mother (n= 20), special needs (n=11), delinquency (n=7), school refusal (n=2), and other reasons (n=3). Thirty-five of the 65 residents (54%) needed treatment for caries. Of these, 24 (69%) were abused children and 11 (31%) were admitted due to other reasons. Mean self-esteem score differed significantly between the resident children (n=43) and an outpatient control group (n=102) (59.16±14.54 vs 73.92±16.81, respectively; p<0.01). CONCLUSION: Although the abused children had low self-esteem, after dental intervention, positive answers regarding oral health were obtained. The findings suggest that dental interventions might be effective for helping to improve the self-esteem of abused children.

Effect of preradiation dental intervention on incidence of osteoradionecrosis in patients with head and neck cancer: A systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC). TYPES OF STUDIES REVIEWED: The authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects models were used to calculate pooled relative risk estimates and hazard ratios. When meta-analysis was not possible, study-level measures of association and narrative summaries of the evidence were reported. RESULTS: Twenty-two studies were included. From the pooled, unadjusted analysis, patients undergoing pre-RT extractions may have a 55% increased risk of experiencing ORNJ (relative risk, 1.55; 95% CI, 0.85 to 2.86; very low certainty); the unadjusted pooled hazard ratio was 3.19 (95% CI, 0.99 to 10.31; very low certainty), corresponding to a possible increased hazard of developing ORNJ (very low certainty). Findings for other pre-RT procedures manipulating bone or tissue relied on limited, observational studies with low or very low certainty evidence. CONCLUSIONS: Mostly very low certainty evidence suggests that patients with HNC who need pre-RT dental intervention may have an increased risk of developing ORNJ compared with those who do not. PRACTICAL IMPLICATIONS: Maintaining optimal oral health may help reduce the need for urgent pre-RT dental treatment, potentially reducing ORNJ risk and minimizing delay of oncologic treatment in patients with HNC.

Eating Disorders in the Adolescent Patient.

Eating disorders such as anorexia nervosa, female athlete triad, bulimia nervosa, obesity, and binge eating initially emerge during adolescence. These disorders are present primarily in females, but males may also present with these conditions. Dentistry has a pivotal role in the management of patients with such diet-related disorders. Because dentists examine their patients at frequent intervals and may be the health care professionals with whom patients feel more comfortable discussing eating disorders, dentists must have knowledge of the etiology, diagnostic criteria, systemic effects, and intraoral manifestations of eating disorders. In addition, the dental professional may be the first health care provider to identify the condition and refer the patient appropriately to medical colleagues for subsequent treatment. This chapter provides dentists with current and relevant information to recognize, diagnose, and integrate dental treatment for their adolescent patients who may exhibit manifestations of an eating disorder.

Effects of Oral Management on Elderly Patients with Pneumonia.

OBJECTIVES: In this study, we examined the factors influencing the presence or absence of dental intervention in patients with pneumonia in an acute-care hospital, focusing on oral intake and its status. DESIGN: Observational study. SETTING: Teikyo University School of Medicine, Mizonokuchi Hospital. PARTICIPANTS: Patients ≥65 years of age who were admitted to the Teikyo University School of Medicine, Mizonokuchi Hospital between January 1, 2018 and December 31, 2019 with pneumonia who were referred to the Department of Rehabilitation with suspected dysphagia were included in the study. Fifty patients who underwent dental intervention were compared with 50 controls who had received no dental interventions prior to the opening of the dental department. MEASUREMENTS: Time series matching was retrospectively performed using the Oral Health Assessment Tool (OHAT). From the medical records, age at admission, sex, pneumonia severity classification (age, dehydration, respiratory failure, orientation disturbance, and blood pressure [A-DROP] score), body mass index, Charlson's Comorbidity Index, OHAT, functional oral intake scale (FOIS) score at admission and discharge, and the length of hospital stay were retrieved; FOIS level ≥4 was defined as established oral intake. RESULTS: The number of patients in the control group before matching was 179. Twelve patients with missing information and seven patients who died in the hospital were excluded from this study. Multivariable logistic regression analysis showed that dental intervention (odds ratio 3.0, p = 0.014) was associated with the establishment of oral intake at discharge. Multiple logistic regression analysis showed that dental intervention was a significant factor for FOIS at discharge (p = 0.002) and the length of hospital stay (p = 0.039). CONCLUSION: Oral management with dental intervention was associated with establishing oral intake and reducing hospital stay in patients with pneumonia, regardless of pneumonia severity or comorbidities.

Oral health-related quality of life improves in employees with disabilities following a workplace dental intervention.

This pilot study evaluated a dental intervention for employees with disabilities by measuring changes in self-rated oral health, dental behaviours and oral health-related quality of life (OHRQol). Consenting employees with disabilities (≥18years) at two worksites in South Australia underwent dental examinations at baseline, three and six months. Referrals were arranged as needed to public dental clinics. At one and two months a dental hygienist provided group oral health education to the employees. Employees' demographics, self-rated oral health, dental behaviours and OHRQol were collected via face-to-face interviews. Of the 39 referred employees, 28 (72%) of them completed the recommended treatment. Self-rated oral health improved and there were significant reductions in the prevalence of oral health impact on quality of life (percentage of employees reporting 1+ items fairly/very often) from 27% to 11% (McNemar's test, p<0.05); the extent of impact (mean number of items reported fairly/very often) from 1.3 to 0.6 and the severity of impact (mean of summed OHIP item scores) from 3.6 to 1.8 (paired t-tests, p<0.01). As this pilot study indicates that enabling urgent referral for treatment and regular oral health education can improve OHRQol and self-rated oral health among employees with disabilities, a larger study with a control group should be undertaken.

Actualización odontológica en la atención del niño con síndrome de down / Update dental care for the patient with down syndrome

El síndrome de Down (SD) es la mayor condición genética que se asocia con retardo mental y con características físicas específicas. Además de las mismas, se manifiestan condiciones sistémicas e intelectuales que pueden comprometer la salud bucal y el manejo de la situación odontológica. El conocimiento de estos aspectos, al igual que de las alteraciones orofaciales y el desarrollo de las estructuras del sistema estomatognótico, son necesarios para la planificación de un programa efectivo de salud bucal.

Down syndrome (DS) is the most commonly identified genetic from of mental retardation and the leading cause of specific birth defects. Besides physical characteristic features, there are also systemic and cognitive conditions that may affect oral health and dental management is DS. Knowledge of these aspects, as well as of the orofacial manifestations and the development of the oral structures in the syndrome is necessary to plan an effective oral health programme.