Joe B. Drane

Prevention of Xerostomia-Related Dental Caries in Irradiated Cancer Patients

Three caries preventative regimens: oral hygiene ; oral hygiene and topical fluoride; and oral hygiene, topical fluoride, and sucrose restriction were evaluated in patients with cancer given xerostomia-producing radiotherapy. The oral hygiene-fluoride gel combination was remarkably effective in protecting these high risk patients from caries, regardless of the cariogenicity of the diet.

Management of problems of the teeth and jaw in patients undergoing irradiation

The patient with cancer of the head and neck who is to undergo radiation therapy often presents with complex dental problems. When the mode of treatment for the lesion has been selected, the time allowed for various elective dental procedures is usually minimal. The stage of the tumor, as well as regional or distant metastasis, should influence the extent of any dental procedures to be performed before beginning therapy. More definitive dental procedures can be performed for those patients with early and more favorable lesions; but, because of the extreme need for immediate radiotherapy, more conservative dental care is recommended for those with advanced lesions or those with metastatic problems.

Interrelations of Oral Microorganisms, Immunoglobulins, and Dental Caries Following Radiotherapy

Of 42 head and neck cancer patients with radiotherapy-induced xerostomia, 36 survived to permit a postirradiation caries evaluation. Twenty-three developed an average of 17.6 caries lesions and 13 had no new lesions within 30 months postirradiation. All caries-inactive patients had been initially assigned to daily self-application of a 1% sodium fluoride gel. The preirradiation caries experience and the oral microbial profile were comparable in both groups. After tumoricidal irradiation, the mean plaque increase of Streptococcus mutans was 25 times greater in the caries-active than in the caries-inactive group. Postirradiation caries was also associated with increased plaque Lactobacillus sp, Candida sp, and Streptococcus sp, and serum IgD and IgG concentrations. Conversely, plaque Staphylococcus sp, Streptococcus salivarius, and Veillonella sp and saliva IgA concentrations were significantly higher in the caries-inactive than in the caries-active group. Both groups demonstrated decreases in plaque Streptococcus sanguis, Neisseria sp, Fusobacterium sp, and Bacteroides sp.

Maxillofacial prosthesis and its role as a healing art

Abstract The application of maxillofacial prosthesis has been discussed with examples to illustrate this highly specialized field of prosthetic dentistry. Oral and facial deformities which may be either acquired or congenital are seen in a large segment of the population. These unfortunate persons require the services of a maxillofacial prosthodontist. Every dentist with a little training and interest is fully qualified to undertake this type of work and help the afflicted by replacing anatomic deficiencies, restoring physiologic functions, correcting impaired speech, improving esthetics, and, in so doing, building up the patients morale. The field of maxillofacial somatoprosthesis has been, until recently, an unheralded section of the prosthodontic service in dentistry. It is a sincere hope that more institutions will provide this type of service and that more dentists will take an interest and realize the importance of this branch of dentistry as a healing art.

Prosthetic evaluation of patients who have received irradiation to the head and neck regions

Abstract The dentist must understand the effect of radiation on oral tissues, as well as the possible complications, before contemplating dentures for patients who have received radiotherapy to the head and neck region. Generally, no dentures should be constructed for a minimum of one year following irradiation. A thorough review must be made of the nature of the patients radiation therapy. A meticulous oral examination must be performed, the dentures must be constructed in a nontraumatic manner using certain special precautions, and an active follow-up system must be established. The patient must completely understand the nature of the program, and the possible complications that may develop.

Mandibular replacements—A review of embedded implants

Abstract It is difficult to make conclusive observations from a group of patients with such diverse diseases and surgical procedures. Also, it is important to realize that the procedures performed for three patients whose implants were in place at death were considered successful. Any condemnation of implants on the basis of these figures, however, must be viewed in light of the cosmetic and functional defects that would have resulted with no attempt at reconstruction. Perhaps even the implants with short success rates were important as temporary splints to prevent total fragmental collapse or deviation.

Reproducing the vertical-lateral defect space in obturator construction

A method of incorporating vertical and horizontal tissues in an obturator impression using an open palate impression tray is presented. The laboratory technique of obturator construction from this impression allows for a definitive (heat-cured) or interim (cold-cured) prosthesis for an edentulous or dentulous patient.

Prosthetic support of the visual apparatus following maxillectomy and orbital floor resection

A review of the literature reveals little concerning prosthetic support of the visual apparatus following radical resection of the orbital floor. Three methods of obtaining support of the visual apparatus using intraoral restorations have been reviewed.

Use of silicone rubber in intranasal prostheses

Abstract The retentive and esthetic qualities of a silicone prosthesis are very satisfactory for patients with intranasal defects. Silicone rubber retains its flexibility indefinitely, and replacement prostheses seldom are required. However, the availability of a master mold makes reproduction a simple matter when it is necessary. Patients who have had intranasal prostheses made of both acrylic resin and silicone prefer silicone appliances because of their increased retentive qualities, their softness which causes less trauma, and the satisfactory skin tone which may be obtained.

Maxillofacial prosthetics departments in dental schools and medical centers

Abstract 1. Maxillofacial prosthetics is a specialized branch of dentistry. 2. The types of maxillofacial defects are listed. 3. Maxillofacial prosthetics as a separate department and/or its relationship to other departments in both dental schools and medical centers has been explained. 4. The objectives of maxillofacial prosthetics have been listed. 5. Minimal physical facilities including a system of records have been suggested.