Instructor: Dr. Heddie Sedano, D.D.S. Dr.Odont.
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ORAL COMPLICATIONS DURING CANCER TREATMENT: LECTURE (p. 3)
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OTHER LESIONS. Additionally to OM, which is the most frequently
observed complication of cancer treatment, other oral alterations
are also observed, especially with radiation therapy, such as: loss of
taste, mucosal pallor, bleeding gingiva, xerostomia with consequent
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Figure 2. This 60 year-old woman had undergone radiation for an
adenocarcinoma of the parotid gland. Note the rampant caries and the
dryness of the gingiva as a consequence to xerostomia.
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caries formation, due to salivary gland destruction, and
osteonecrosis which in many instances is initiated by severe
periodontal involvement (18). Periodontal disease can also be the
result of increased oral microbial based destruction and salivary
gland dysfunction.
Moderate to severe pain is generally associated with any of these
findings. Children undergoing radiation of the head and neck areas, in
addition to oral mucositis (10), may also develop failure or delay in
tooth development and or eruption, enamel hypoplasia, microdontia
and abnormal root formation (21). Salivary glands and teeth germs
are highly susceptible to the effects of radiation.
OSTEORADIONECROSIS (ORN) is an indefinite risk which may even
occur several years after cessation of radiotherapy and generally
depends on the radiation dose. ORN occurs with greater frequency in
the mandible than in the maxilla (24:1 ratio) due to its more
compact bone composition and less adoptive vascular circulation.
Significant causes for the development of ORN are periodontal and
dental pathology as well as tooth extractions shortly before, during,
or shortly after radiation. Edentulous patients have a lesser risk to
develop ORN than dentate patients. ORN is generally accompanied by
intense pain, additional findings are sequestration and even
pathologic fracture of the affected bone. ORN is actually not a
primary infection of bone but a consequence to diminished vascular
supply induced by radiation. One of the main alterations seems to be
obliteration of the inferior dental artery (inferior alveolar artery)
which brings about hypovascularity and hypoxia to the affected
areas with resultant ischemic necrosis of bone initiating ORN.
Several opportunistic infections can further complicate the clinical
findings in ORN. Soft tissue necrosis in the area of irradiation is
rare but when present it manifests as an area of ulceration which
sometimes is difficult to differentiate from residual carcinoma.
Oral candidal infection has been frequently reported in patients
under chemotherapy treatment and in some cases it even extends to
the respiratory system including the lungs (5). Long term changes in
the area of irradiation on the oral mucosas are fibrosis and
telangiectasia, findings which are not present in every patient (22).
Systemic complications are lack of proper nutrition, depression and
isolation (15).
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