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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) 20449756Catherine/2010Cancer patients undergoing chemotherapy and/or radiotherapySystematic Review of 46 observational studies (24 were cohort, 8 were case control and 14 were cross-sectional).
Key resultsDENTAL 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: 04/13/2012spacer
E-mail Carawan@livemail.uthscsa.edu
Author Stacey Carawan
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
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None available
Comments and Evidence-Based Updates on the CAT
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by Monica Gerges, Garrett Rist (San Antonio, Texas) on 11/28/2017
I completed a new search on this clinical question on November of 2017. I found new research published on the subject of this clinical question that supports the information presented in this CAT. The new data is also published in the form of a systematic review in 2012 by Michelet (PMID #23059916). The overall findings of both studies suggest that patients undergoing or who have undergone radiotherapy for cancer treatment have the highest DMFT.

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