HJAR Sep/Oct 2024

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2024 49 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas valuable tool also serves as a fundamental aspect of preoperative care that should not be overlooked. n REFERENCES 1 Kwak, E.J.; Kim, D.J.; Choi, Y.; et al. “Impor- tance of oral health and dental treatment in or- gan transplant recipients.” International Dental Journal 70, issue 6 (December 2020): 477-481. https://doi.org/10.1111/idj.12585 2 Arigbede, A.O.; Babatope, B.O.; Bamidele, M.K. “Periodontitis and systemic diseases: A literature review.” Journal of Indian Society of Periodon- tology 16, No. 4 (October 2012): 487-91. DOI: 10.4103/0972-124X.106878 3 Yallowitz, A.W.; Decker, L.C. “Infectious Endocar- ditis.” StatPearls, updated April 24, 2023. https:// www.ncbi.nlm.nih.gov/books/NBK557641/ 4 American Heart Associaiton. “Prevention of Viridans Group Streptococcal Infective Endo- carditis.” AHA Scientific Statement, May 18, 2021. DOI: 10.1161/CIR.0000000000000969 5 Farquhar, D.R.; Divaris, K.; Mazul, A.L.; et al. “Poor oral health affects survival in head and neck cancer.” Oral Oncology 73 (October 2017): 111-117. DOI: 10.1016/j.oraloncology.2017.08.009 6 Lustberg, M.B. “Management of neutropenia in cancer patients.” Clinical Advances in Hematol- ogy Oncology 10, No. 12 (December 2012):825-6. PMID: 23271355 7 Kwak, E.J.; Kim, D.J.; Choi, Y.; et al. “Importance of oral health and dental treatment in organ transplant recipients.” International Dental Jour- nal 70, No. 6 (December 2020): 477-481. DOI: 10.1111/idj.12585 8 Vuorinen, M.; Mäkinen, T.; Rantasalo, M.; et al. “Incidence and risk factors for dental pathol- ogy in patients planned for elective total hip or knee arthroplasty.” Scandinavian Journal of Sur- gery 108, No. 4 (December 2019): 338-342. DOI: 10.1177/1457496918816911 9 Devi, S.; Singh, N. “Dental care during and af- ter radiotherapy in head and neck cancer.” Na- tional Journal Maxillofacial Surgery 5, No. 2 (July-December 2014): 117-25. DOI: 10.4103/0975- 5950.154812 10 Poulopoulos, A.; Papadopoulos, P.; Andreadis, D. “Chemotherapy: oral side effects and dental interventions -a review of the literature.” Stoma- tological Disease and Science 1 (June 28, 2017): 35-49. DOI: 10.20517/2573-0002.2017.03 11 Orphanidou, C.; Biggs, K.; Johnston, M.E.; et al. “Prophylactic Feeding Tubes for Patients with Lo- cally Advanced Head-And-Neck Cancer Under- going Combined Chemotherapy and Radiother- apy-Systematic Review and recommendations for Clinical Practice. Current Oncology 18, issue 4 (Aug. 1, 2011): 191-201. DOI: 10.3747/co.v18i4.749 12 Dholam, K.P.; Somani, P.P.; Prabhu, S.D.; Ambre, S.R. “Effectiveness of Fluoride Varnish Applica- tion as Cariostatic and Desensitizing Agent in Ir- radiated Head and Neck Cancer Patients.” Inter- national Journal of Dentistry 2013, issue 1 (June 13, 2013): 824982. DOI: 10.1155/2013/824982 13 Prasad, M.; Manjunath, C.; Murthy, A.K.; et al. “In- tegration of oral health into primary health care: A systematic review.” Journal of Family Medicine and Primary Care 8, No. 6 (June 2019): 1838-1845. DOI: 10.4103/jfmpc.jfmpc_286_19 14 National Institute of Dental and Craniofacial Research. “Oral Health in America: Advances and Challenges.” NIDCR (Bethesda, MD), Na- tional Institutes of Health, U.S. Department of Health and Human Services, 2021. Accessed July 2024. https://www.ncbi.nlm.nih.gov/books/ NBK578297/ the patient to tolerate treatment and receive nourishment. 11 If the radiotherapy is utilized, the area radiated is further compromised and essential functions are restricted. Informing and educating patients regard- ing treatment options before, during, and after treatment is of utmost importance. Pa- tients need to know that these life-saving therapies include overall health, in which oral health plays a key role. First and fore- most is obtaining good oral health status before therapy begins. Ridding the oral cav- ity of any disease or infection is paramount. The good news is that there are many tools and preventive measures available. Fluoride trays are made for orofacial can- cers, especially for patients receiving ra- diotherapy. Mucositis is very painful and managed with various rinses and mouth- washes that contain anesthetics. Artificial saliva products assist in mastication and swallowing food. Topical oral ointments can be applied, as well as observing a soft diet for the first several weeks and strictly avoiding use of alcohol and tobacco prod- ucts. Post-therapy, topical fluorides, fluoride rinses, and numerous oral aids are available to ease discomfort. 12 Medical-dental collaboration is evident in all areas of patient care, and this collabora- tion between these disciplines is highlighted in the World Health Organization’s recom- mended approach to primary healthcare. 13 Oral health doesn’t just affect the mouth, it affects overall health, well-being, a person’s self-esteem and respect, and the ability to become employed. 14 Empowering people to take charge of their own health includes informing and educating patients on all treatment options. Although an OHC does not guarantee the patient will be disease and infection free well into the future, it does state their cur- rent oral health status and leads to a bet- ter outcome versus not obtaining one. This therapy is planned and doses reach certain levels, osteoradionecrosis can occur when the radiation field includes the orofacial complex. If teeth are beyond restoration, it is best to extract teeth immediately to avoid an extraction later, as these sites do not heal well, depending on the radiation dose. If infection does occur in the radiation sites, bone will die from lack of blood supply, and these osseous particles slough away, which results in a debilitating condition. 9 OHC is important for treatment for pros- tate and breast cancer, when therapy in- cludes the class of bisphosphonates. This drug class has the potential to induce os- teonecrosis of the jaw given at certain doses. A positive element of the OHC is that it gives dental professionals the opportunity to not only inform but educate the patient on what to expect and how to manage the oral side effects of the various therapies. 10 Because many of these patients are immu- nocompromised, these therapies bring an array of potential oral side effects. Making the patient aware of these possible condi- tions assists them in being prepared. In addition to osteoradionecrosis, there are numerous side effects as a result of che- motherapy, radiation treatment, and sur- gery. These differ and range dependent on the type or combination of therapies. Among these are oral mucositis, alteration or loss of taste, xerostomia, oral infections, dental caries, mucosal fibrosis and atrophy, dif- ficulty in swallowing or chewing, difficulty in speaking, muscle trismus, malnutrition, oral candidiasis, oral bleeding, and edema. Perhaps the worst type of oral manifesta- tion to manage regarding therapies is with oral cancer. Because the oral cavity is the gateway for eating and drinking, this essen- tial function is compromised significantly by any combination of chemotherapy, radiation, or surgery. Many times, a feeding tube must be placed for the first fewweeks in order for