Peter Stevenson-Moore

Quality of life and oral function following radiotherapy for head and neck cancer.

Multiple oral complaints occur following radiotherapy for oropharyngeal cancer, but the frequency and severity of symptoms of dysfunction and discomfort are not well understood. The purpose of this investigation was to assess the quality of life, oral function, and oral symptoms following radiotherapy.

Prevention of oral mucositis in radiation therapy: A controlled study with benzydamine hydrochloride rinse

Benzydamine hydrochloride rinse was shown to prevent oral mucositis in radiation therapy. Prevention of mucositis allows reduction in morbidity of one of the therapy limiting complications of radiotherapy for cancer therapy.

Postradiation osteonecrosis of the mandible: A long-term follow-up study

OBJECTIVES The objective of this study was to assess the long-term progress of 26 patients who experienced postradiation osteonecrosis of the jaw between 1975 and 1989. STUDY DESIGN Of 26 patients who had been previously managed with hyperbaric oxygen therapy as a part of their treatment for postradiation osteonecrosis of the jaw, 20 were evaluated to determine their current status of the condition: resolved, chronic persisting (unresolved), or active progressive (symptomatic). RESULTS Two of 20 patients experienced recurrences of the condition. In one of these patients, surgical treatment was identified as the stimulus of postradiation osteonecrosis. In the other patient, the recurrence appeared to be related to periodontal disease activity. In 60% (12 of 20) of the patients, the condition remained resolved, improvement in clinical staging occurred in 10% (2 of 20) (from symptomatic to unresolved or resolved), and 20% (5 of 20) of the patients continued to demonstrate chronic persisting postradiation osteonecrosis at the end of the long-term follow-up period. CONCLUSION This study supports the contention that postradiation osteonecrosis can occur at any time after radiation therapy, and that patients remain at risk up to 231 months after treatment of the cancer and probably indefinitely after radiation therapy. Our findings also suggest that risk of second episodes of the condition after management of an initial episode is low. In addition, our follow-up study revealed that chronic nonprogressive postradiation osteonecrosis can remain stable without extensive intervention including combined hyperbaric oxygen therapy and surgery.

Effects of compliance with fluoride gel application on caries and caries risk in patients after radiation therapy for head and neck cancer

The use of fluoride gel applied in a custom tray once daily has become standard for patients who have xerostomia after undergoing radiation therapy. Compliance may be poor as a result of the inconvenient method of application and because many patients with head and neck cancer have poor health behaviors. Our aim was to investigate the effect of compliance with fluoride gel application on caries and caries risk. Patients were prescribed neutral sodium fluoride gel (5000 ppm) before undergoing radiotherapy Fifty-two patients were willing to visit the dental clinic for dental examination, measurement of saliva, and quantitative culture of Streptococcus mutans and lactobacillus species. Before radiotherapy was performed, decayed, missing, and filled surfaces data were recorded for all patients in the study. Of these patients, 27 used fluoride gel once daily, as directed. Radiation dose, number of fractions, and duration of radiation had a significant inverse effect on postradiotherapy whole resting saliva (p = 0.04, p = 0.01, and p = 0.01) and on whole stimulated saliva (p = 0.02, p < 0.01, and p < 0.01). Patients with a subjective feeling of dry mouth had significantly less saliva production at rest (p = 0.01) and on stimulation (p = 0.01). A trend toward reduction of S. mutans counts was seen in those patients who used their fluoride gel regularly (p = 0.057). High lactobacilli counts were found in the patients with high and low compliance with fluoride gel use. Differences in the mean caries incidence between those who reported compliance with daily fluoride application and those who did not comply were not found significant because of the large SD in the patient groups, although differences in the mean for these groups were seen. The lack of a statistically significant difference may be due to the multiple factors associated with caries. Therefore patient care must be individualized, and patients must be assessed at regular intervals to determine the caries risk and caries activity to provide guidance for maintenance of the dentition.

Benzydamine hydrochloride in prevention and management of pain in oral mucositis associated with radiation therapy

Benzydamine hydrochloride rinse reduced pain associated with radiation mucositis when it was used during the course of radiation therapy. Fewer patients using benzydamine rinse required systemic analgesics. All patients using benzydamine tolerated the rinse well and continued with regular rinsing throughout the course of radiation therapy. Benzydamine hydrochloride is currently undergoing clinical trials in the United States for application for approval from the Food and Drug Administration.

Periodontal attachment loss in patients after head and neck radiation therapy

OBJECTIVE The purpose of this study was to determine the potential impact of head and neck radiation therapy on the progression of periodontal attachment loss. STUDY DESIGN Ten patients who received unilateral radiation fields that included the dentition were assessed before radiation treatment and after irradiation at a mean age of 6.01 years. Complete oral, dental, and periodontal examinations were completed by one examiner. The results were assessed through use of paired t tests. RESULTS More teeth were extracted because of periodontal disease in the field of radiation after irradiation. Remaining teeth in the radiated volume showed an increase in probing depth of 0.82 mm in comparison with 0.40 mm for teeth in the nonradiated region (P = .05). Recession on the facial aspects was 1.88 mm for teeth in the radiated volume and 1.16 mm for teeth in the nonradiated region (P = .001), and recession on the lingual aspects was 2.10 for teeth in the radiated volume and 0.91 for teeth in the nonradiated region (P = .05). Mean total attachment loss was 2.81 mm for teeth in the radiated sites; this compared with 1.43 mm for teeth in the nonradiated sites (P = .003). Increased mobility of teeth in the high-dose fields was seen (P = .02). CONCLUSIONS This study showed that tooth loss and greater periodontal attachment loss occur in teeth that are included within high-dose radiated sites of patients treated with irradiation therapy for cancer. These findings should be considered in preradiation treatment planning.

Chlorhexidine rinse in prevention of dental caries in patients following radiation therapy

Patients who receive cancer radiotherapy, which compromises salivary gland function, may develop xerostomia. These patients are at increased risk to develop rampant dental caries. Streptococcus mutans and species of lactobacillus have been associated with dental caries. Quantitative counts of these organisms demonstrated high caries risk in 85% of patients studied. The use of chlorhexidine rinse to reduce the counts of S. mutans and lactobacillus was studied. A modest reduction in S. mutans was seen, but little effect was demonstrated on lactobacillus counts. Caries activity was shown to be related to lactobacillus count.

The vancouver microstomia orthosis

Eighteen microstomia orthoses are compared with respect to their characteristics, use, and limitations. A new prosthesis, the Vancouver microstomia orthosis, was designed to incorporate the advantages of many of the orthoses and eliminate some drawbacks. Ten adults with microstomia secondary to second- or third-degree circumoral flame burns were fitted with the prosthesis and observed over a 12-month period. In 9 weeks or less, microstomia was corrected with an average gain of 7 mm in the horizontal and 13 mm in the vertical active range of motion. The measures before and after this treatment were statistically significant for increase in both dimensions (paired t-test, p less than .01).

Dynamic orthoses for the management of microstomia.

Microstomia is a complication of facial burns, traumatic injuries, scleroderma, or surgical reconstructions involving the oral aperture. A variety of orthoses for the correction or prevention of microstomia are offered by dentists, occupational therapists, physical therapists, and other specialists. This paper provides an overview of the structural and clinical features of 12 common tissue-borne or tooth-borne microstomia appliances. The review is intended to facilitate the selection of suitable orthoses, and to indicate the need for interdisciplinary management of microstomia patients.

A Comparison of Computed Tomography and Panoramic Radiography in Assessing Malignancy of the Maxillary Antrum

Panoramic and computed tomographic images of 20 patients with antral malignancy were viewed separately and compared to determine the extent of bony destruction of the sinus walls seen in each film type. This study showed that panoramic radiographs can demonstrate antral malignancy at the time of diagnosis in 90% of cases. Panoramic radiographs possess the potential for identifying the need for further diagnostic procedures in evaluating the maxillary antrum. Health care workers should be aware of the value of panoramic radiographs in examining this region.