HJAR Nov/Dec 2020

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2020 45 cavity requires dental clearance before ra- diation therapy can begin. When doses reach a certain level and the radiation lines are in the field of the orofacial complex, osteora- dionecrosis can occur. 9 Osteoradionecro- sis is a condition characterized by tissue dehiscence and bone death. Bone tissue dies due to the lack of blood supply, and this ischemic necrosis develops due to the amount of radiation doses used to treat the cancer. Teeth must be in excellent condition if radiation includes any of these areas. If infection occurs in these areas after radia- tion, bone will die from lack of blood supply, and these osseous particles slough away, resulting in a very debilitating condition. 9 In some circumstances, patients lose large portions of their mandibles and/or maxillas. Reconstructive dentistry may be required, but it is dependent on how much bone is present. It is contraindicated to extract teeth after radiation, since the potential of osteo- radionecrosis is a risk. As discussed in a previous article on medication and oral health, bisphospho- nates were reviewed for treating cancers for breast, prostate and multiple myeloma. Tak- ing this class of drugs also warrants dental be no infection occurring, which would compromise this treatment regimen. Many times, the dentist is the first healthcare pro- fessional who discovers acute leukemia, as the oral manifestations are evident. 6 These manifestations can present as gingival bleeding, hyperplasia, opportunistic infec- tions or bone alterations in the oral cav- ity. Often, the patient reports the inability to brush thoroughly because of extreme discomfort. If a bone marrow transplant is planned, oral infection could assist in re- jection of the transplant and cause failure of this life-saving therapy. 7 For the patient who has poor dental health, it is paramount to obtain a healthy oral cavity. When time is critical and therapy proceeds before the necessary dental treatment is completed, this can result in disastrous outcomes. Chemotherapy decreases neutrophils, which make up the majority of white blood cells that fight infection and heal damaged tissue. 8 Harmful bacteria, fungi and viruses thrive as neutropenia occurs, and intraoral infections occur since these bacteria are able to flourish. Radiation to the head and neck for can- cers of the maxilla, mandible, throat or oral Niki Carter, DMD Dental Director Delta Dental of Arkansas clearance, since this drug’s action on osteo- clast cells impairs bone healing and remod- eling, thus it increases the risk of developing osteonecrosis of the jaws. 10 There are numerous other types of can- cers and illnesses that require dental clear- ance and the necessity for good oral health. Organ transplants, osteoporosis, cardiac surgery and multiple types of cancer thera- pies necessitate a positive dental clearance letter. Side effects of chemotherapy, radia- tion and surgery can be challenging as well as debilitating. 11 Besides the potential os- teonecrosis risk, other side effects include oral mucositis, alteration or loss of taste, xerostomia, oral infections, dental caries, mucosal fibrosis and atrophy, difficulty in swallowing or chewing, difficulty in speak- ing, muscle trismus, malnutrition, oral can- didiasis, oral bleeding and edema. Conceivably the worst type of oral man- ifestation to manage regarding therapies is oral cancer. Since the oral cavity is the gateway for eating and drinking, this simple function is impaired greatly by any combi- nation of chemotherapy, radiation and/or surgery. Often a feeding tube is placed for the first fewweeks in order for the patient to “ Many times, the dentist is the first healthcare professional who discovers acute leukemia, as the oral manifestations are evident. ”