UTCAT2223, Found CAT view, CRITICALLY APPRAISED TOPICs

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Title

Patients Undergoing Chemotherapy And/or Radiotherapy Are At A Greater Risk Than Healthy Controls For caries, DMFT, Plaque Index Increase And Gingival Index increase.

Clinical Question

In patients receiving therapy for head and neck cancer, is there an increase risk for of dental or oral disease compared to non-cancer patients?

Clinical Bottom Line

Patients that underwent chemo- or radiotherapy had a 21-37% prevalence of caries. This may be in part due to an increased plaque index and gingival index as compared to non-cancer patients. Fluoride use appears to reduce the level of caries, while the benefits of chlorhexidine rinse are not clear.  This information is supported by a systematic review of 46 studies and proves that patients undergoing chemotherapy and/or radiotherapy are at a greater risk than healthy controls for caries, DMFT, plaque index increase and gingival index increase.

Best Evidence

(you may view more info by clicking on the PubMed ID link)

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
#1) 20449756	Catherine/2010	Cancer patients undergoing chemotherapy and/or radiotherapy	Systematic Review of 46 observational studies (24 were cohort, 8 were case control and 14 were cross-sectional).
Key results	DENTAL caries prevalence overall = 28.1% (Chemotherapy = 37.3%, Radiotherapy = 24%, Both = 21.4%) DMFT = Overall = 9.19 (SD, 7.98, n= 457), Post-chemotherapy= 4.5 (SD, 2.88, n= 132), Post-radiotherapy = 17.01 (SD, 9.14, n=157); healthy controls = 4.4 (SD, 4.07, N=275)PLAQUE INDEX= Overall = 1.38 (AD, 0.25, n=189); Post-chemotherapy =1.46 (SD, 0.23, n=162) Healthy controls = 0.91 (SD, 0.12, n=152) Gingival Index - 1.02 (SD, 0.15; n=162); healthy controls = 0.76 (SD, 0.10; n=152)

Evidence Search

"Neoplasms"[Mesh] AND "Periodontal Diseases"[Mesh] AND systematic[sb]

Comments on
The Evidence

The researchers did a comprehensive, detailed search using PubMed and EMBASE. Each of the 64 chosen articles was independently evaluated and assessed for validity. This article was not a systematic review of randomized controlled studies and there was no meta-analysis done, weakening the level of evidence. The study results may be skewed somewhat by differences in the application of pre-therapy dental management and by unique effects with children included in the studies reviewed. It is also important to note that this review was not limited to head and neck cancer patients.

Applicability

This article is extremely applicable to dentists in multiple fields that will encounter cancer-therapy patients at increased risk for dental disease. Chemotherapy patients will specifically be at an increased risk of caries, which warrants very close dental observation. With concern to treatment, cancer-therapy patients are also at a greater risk for infection due to their immune suppressed state, so treatment should be done cautiously.

Specialty/Discipline

(Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Restorative Dentistry) (Dental Hygiene)

Keywords

Head and neck cancer, chemotherapy, radiotherapy, dental disease

ID#

2223

Date of submission:

04/13/2012

E-mail

Carawan@livemail.uthscsa.edu

Author

Stacey Carawan

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

Thomas Oates, DMD, PhD

Faculty mentor/Co-author e-mail

Oates@uthscsa.edu

Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)	post a rationale
None available

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