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Asia-Pacific Journal of Oncology & Hematology


Table 2. Topical Agents used for Palliative Treatment of Xerostomia Sugar-free tablets


Manufacturer


Ascoxal T Salivin


Musidan Prophylin


Astra Zeneca, So Ferrosan AB, Malmo


¨dertalije, Sweden ¨, Sweden


Kali-Chemie AG, Sparte Pharma, Hannover, Germany Prophylactor, Stockholm, Sweden


Saliva substitutes Luborant


Glandosane V A Ora-Lube Orex


Saliva Substitute Salivart


Xero-Lube Saliment Salisynt


Saliva Orthana


Manufacturer


Antigen International Ltd, Croydon, Surrey, UK Dylade Co. Ltd, London, UK


Oral Disease Research Laboratory, TX, USA King’s Speciality Co., Fort Wayne, IN, USA Roxane Laboratory Inc., Columbus, OH, USA Gebauer Co., Cleveland, OH, USA Colgate Oral Pharmaceuticals, NY, USA ¨se, Denmark


Ferrin A/S, Vanlo Remede Pharmaceuticals, Kuopio, Finland


Nycomed International Management GmbH, Zurich, Switzerland


attention to oral hygiene, to the level of cariogenic oral flora, to mineralization of tooth structure, and to saliva production [80–83]. As the main cause of PRON is bacterial invasion to the bone through open mucosa wounds [19, 23, 26], for prevention of PRON, dentists must emphasize the need for adequate oral hygiene [84]. Therefore, caries require strict attention to oral hygiene, to the level of oral flora, to mineralization of tooth structure, and to saliva production. Tooth extraction should be avoided [19, 23] and, when necessary, systemic antibiotics (penicillin or cephalosphorin) may prevent postoperative infections [19]. The presence of oral mucosal ulcers due to ill-fitting dentures must be routinely checked [8, 85]. For the fabrication of new dentures, parameters such as patient compliance, the amount and viscosity of saliva, the presence of recently extracted teeth sockets, and a history of denture use should be taken into consideration [47]. Usually, a waiting period of up to 1– 3 years is suggested [19], but this is not viable for resection prostheses [47]. Rather than conventional removable pros- theses, implants are recommended in appropriate cases in order to avoid denture trauma [26, 86, 87]. Even though very rarely, spontaneous PRON may be observed after radiotherapy [26]. If tooth extraction is requested after radiotherapy, in addition to penicillin or cephalosporin prophylaxis, very meticulous surgery techniques are required [19]. When PRON develops, saline irrigations, electrocoagulation, zinc peroxide paste or neomycin applications, hyperbaric oxygen therapy sequestrectomy, or partial resection of the bone are implemented [26, 88–90]. However, every surgical interven- tion should be performed after consultation with the appropriate specialists in order to prevent any further complications. Rehabilitation of trismus by the application of previously mentioned methods should be continued after radiotherapy as well [26].


Maintenance of a prosthesis is more challenging because a


dry oral environment renders the patient more susceptible to candidal infections [83, 91], mucosal irritation [83], and decreased healing of hard and soft tissues made friable by radiation [92]. The absence of saliva can also lead to a shift to


APJOH 2010; 2:(1). February 2010 112


a more cariogenic diet that the patient perceives as more pleasant in taste and texture. This diet, in concert with a shift in the microflora to more cariogenic flora (Lactobacillus and Streptococcus mutans) [84, 93], decreased carbohydrate clear- ance, decreased buffering and remineralization capacity, creates a predisposition to the tooth breakdown previously described.


In contrast to the developments in cancer therapy mod- alities, the number of patients with cancer therapy complica- tions has changed little. In order to improve the quality of life for this group of patients, the guidelines should be developed after close observation of the long-term results of cancer therapy methods, and the recent guidelines must be applied in practice not only by clinical staff, but also by the patients and their caregivers as well.


Disclosure: The authors declare no conflict of interest.


REFERENCES 1. Silverman S, Jr. Oral cancer—complications of therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:122–126.


2. Specht L. Oral complications in the head and neck radiation patient. Introduction and scope of the problem. Support Care Cancer. 2002;10:36– 39.


3. Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14:199–212.


4. Grandi G, Silva ML, Streit C, Wagner JC. A mobilization regimen to prevent mandibular hypomobility in irradiated patients: an analysis and comparison of two techniques. Med Oral Patol Oral Cir Bucal. 2007;12: E105–E109.


5. National Cancer Institute Report no. 208/10577. Oral complications of chemotherapy and head/neck radiation.


6. National Institute of Health. National Institute of Dental and Craniofacial Research. Oral complications of cancer treatment: what the oncology team can do? http://www.nidcr.nih.gov/OralHealth/Topics/CancerTreatment/ OralComplicationsCancerOncology.htm, 2009 (accessed September 30, 2009).


7. Silverman S, Jr. Diagnosis and management of oral mucositis. J Supp Oncol. 2007;5:13–21.


8. National Institute of Health. National Institute of Health consensus development conference statement: oral complications of cancer therapies: diagnosis, prevention, and treatment. J Am Dent Assoc. 1989; 119:179–183.


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