Bodil Fagerberg-Mohlin

Microflora in oral ecosystems in subjects with radiation-induced hyposalivation

AIM To analyse the microbial flora in specific oral sites in 13 dentate subjects, 6-8 months after completed radiation therapy (RT group) and in 13 matched controls. MATERIAL AND METHODS The microflora on the tongue, buccal mucosa, vestibulum, supragingival plaque and subgingival region was analysed using duplicate sampling and cultivation technique. A clinical examination was also performed. RESULTS Candida albicans was found in one or more sites in 54% of the RT subjects and in 15% of the controls. In three RT subjects, C. albicans was found at all four sites analysed. An unexpected finding was that enterococci were found in all RT subjects and in high number in 38%. None of the controls harboured enterococci. In supragingival plaque, Lactobacillus spp. were detected in 92% of the RT subjects and the number and proportion of Lactobacillus spp. were extremely high compared with the controls. Mutans streptococci were detected in high numbers in 31% of the RT subjects, while they were not detected in 23%. CONCLUSION The microbial results explain why some RT subjects have an increased susceptibility to oral diseases and stress that site-specific microbial analysis is an important diagnostic tool when planning oral health preventive care for RT subjects.

Exercise intervention for the treatment of trismus in head and neck cancer.

Abstract Background. The aim of this study was to investigate the impact of structured exercise with jaw mobilizing devices on trismus and its effect on trismus symptomatology and health-related quality of life (HRQL) in head and neck (H&N) cancer patients. Material and methods. Fifty patients with H&N cancer and trismus, i.e. maximum interincisal opening (MIO) ≤ 35 mm participated in a structured intervention program with jaw exercise. The patients in the intervention group underwent a 10-week exercise program with regular follow-up. A control group comprising of 50 patients with trismus and H&N cancer were matched to the intervention group according to gender, tumor location, tumor stage, comorbidity and age. HRQL and trismus-related symptoms were assessed. Results. The mean MIO improvement was 6.4 mm (4.8–8.0) and 0.7 (−0.3–1.7) mm in the intervention group and control group respectively, three months post-intervention commencement (p < 0.001). The intervention group demonstrated a statistically significant improvement in Role functioning, Social functioning and Global quality of life (EORTC QLQ C30) and in all Gothenburg Trismus Questionnaire (GTQ) domains, i.e. jaw-related problems (p < 0.001), eating limitation (p < 0.05) and muscular tension (p < 0.001). Conclusion. We found that a structured jaw exercise program was effective and improved the mouth opening capacity significantly. The objective effect on trismus (MIO) was also reflected in the patient-reported outcome questionnaires where the patients who underwent the structured exercise program after cancer treatment reported improvements in HRQL and less trismus-related symptoms compared to the control group.

Development and validation of the Gothenburg Trismus Questionnaire (GTQ)

OBJECTIVES To develop and validate a comprehensive, self-administered questionnaire for patients with limited ability to open the mouth, trismus. MATERIALS AND METHODS We derived the Gothenburg Trismus Questionnaire (GTQ) from empirical evidence in the medical literature and interviews with medical experts as well as patients. The draft version was tested in a pilot study (n=18). Patients with a maximal incisal opening (MIO) of ⩽35mm were included. The study comprised patients with benign jaw-related conditions (n=51), patients treated for head and neck (H&N) cancer (n=78) and an age- and gender-matched control group without trismus (n=129). RESULTS The GTQ instrument was well accepted by the patients, with satisfactory compliance and low rates of missing items. After item reduction, due to items not being conceptually relevant and/or low factor loadings, the GTQ demonstrated high internal consistency (Cronbachs alpha 0.72-0.90), good construct validity and known-group validity. CONCLUSION We developed a trismus-specific self-administered questionnaire, the GTQ, that showed good psychometric properties. We suggest this questionnaire, that has clear clinical relevance, to be adopted and used in clinical practice and in research, acting as a screening tool as well as an endpoint in intervention and jaw physiotherapy/rehabilitation studies.

Treating trismus: A prospective study on effect and compliance to jaw exercise therapy in head and neck cancer

Trismus after head and neck cancer is a symptom associated with pain and negatively affected health‐related quality of life. The purpose of this study was to compare two different jaw exercise devices and the compliance to exercise.

Microflora in oral ecosystems and salivary secretion rates – A 3-year follow-up after radiation therapy to the head and neck region

OBJECTIVE Results indicate that late improvements of radiation therapy (RT) in the head and neck region may diminish the long-term effects on salivary glands and oral microflora. The aim was therefore to analyze salivary secretion rates and oral microflora over time in RT subjects. DESIGN Twelve dentate subjects (28±2 teeth) and 12 controls were included. A clinical examination was performed and the salivary secretion rates were determined. Microbial samples, analyzed using cultivation technique, were collected from the soft tissues, supragingival plaque and gingival crevice region. RESULTS Compared with the controls, the RT group (n=11) had 3 years post RT higher numbers and proportions of lactobacilli (p<0.001 and p<0.01) and Candida albicans (p<0.01 and p<0.05) in the supragingival plaque, higher numbers of enterococci in the vestibulum in the molar region and on the tongue (p<0.05 for both), a lower total count (p<0.001) and lower numbers of streptococci, Streptococcus salivarius and Fusobacterium nucleatum (p<0.01) on the tongue. Although both stimulated and unstimulated salivary secretion rates were increased over time, the proportion of microorganisms associated with oral health decreased, and microorganisms associated with oral disorders increased. Despite a comparable oral hygiene, it was only the 27% who had a stimulated salivary secretion rate ≥1.0ml/min and a buffering capacity ≥6.0, where a recovery of the flora could be seen. CONCLUSION The results indicate that regaining a normal, stimulated salivary secretion rate and buffering capacity are prerequisites to regaining an oral flora associated with good oral health.

Explorative study on quality of life in relation to salivary secretion rate in patients with head and neck cancer treated with radiotherapy

Radiotherapy (RT) to the head and neck region often results in oral complications. In this explorative study, the pretreatment and posttreatment (6 months and 12 months) quality of life (QOL) was analyzed for patients with head and neck cancer. The associations between QOL and salivary secretion rates were analyzed.