Periodontal Disease and Overall Health: A Clinician's Guide

284 Periodontal Disease and Overall Health: A Clinician's Guideis a condition defined by exposed bone inareas of radiation injury. A recent retrospectivestudy of 207 patients who receivedradiation therapy showed osteoradionecrosisin 5.5% of patients. 44 This com -plication of radiation therapy occurs as aresult of decreased wound healing. It canoccur spon taneously, but more frequentlyoccurs after tissue trauma resulting inexposed bone, especially dental extraction.Preradiation assessment for potential problemsand appropriate preradiation extractionscan help limit postradiation dentalextractions and the potential developmentof osteo radio necrosis.SurgerySurgical resection is an important treatmentmodality for head and neck cancers.Unfortunately, these surgeries are frequentlydisfiguring and debilitating. Furthermore,infection of the oral cavity can lead to significantsetbacks in recovery, as well as delayadjunctive chemotherapy or radiation.Thorough preoperative oral and dental evaluationcan help improve outcomes. Patientswho undergo significant resections often requireremovable prostheses to maintain functionand may also undergo skin grafting aspart of the surgical procedure. There are intra-oralprostheses that can aid in speech andnutrition, while extra-oral prostheses canhelp to reduce disfiguration. Regardless ofthe type of prosthesis, a preoperative meetingwith the patient and family can help themknow what to anticipate postoperatively.Close postoperative monitoring of the surgicalsite is essential. When applicable, theskin graft site should be monitored for viability.During the initial postoperative evaluation,the patient can be instructed in anoral care regimen, as well as oral openingexercises to aid in a recovery of function.There are several commercially availablemechanical devices that can aid in oral openingexercises. 45,46Periodontal Disease and Cancer RiskThis chapter section has focused on theeffect of cancer treatments on oral tissues. Amultidisciplinary approach, with involvementof medical and dental professionals, isnecessary to optimize oral care in cancer patients.However, it must be noted that poororal health may be a risk factor for the developmentof cancer. Multiple studies havedemonstrated the inflammatory effects ofperiodontal disease, and this inflammatorystate might have an effect on the developmentof cancer. There appears to be a relationshipbetween tooth loss and head andneck cancer that is independent of alcoholand tobacco use. Furthermore, tooth loss hasbeen shown to be a risk factor for the develop -ment of esophageal, gastric, and pancreaticcancers. Additionally, periodontal diseasehas been associated with a small, but significantincrease in overall cancer risk. 29,30Recommendations for Cancer andPeriodontal Disease ManagementPatients with cancer represent a uniquesegment of the dental population. Many cancertreatments are toxic to oral tissues. Onthe other hand, chronic oral infectious andinflammatory conditions such as periodontaldisease and endodontic lesions may contributeto cancer risk, and if they persist orexacerbate during cancer therapy, they couldbe a source of life-threatening infection. Pretreatmentdental evaluation of the cancerpatient is highly recommended and can helpidentify potential problems and facilitate themanagement of anticipated side effects oftherapy.Dentists and physicians need to worktogether to plan care for their patients; inparticular, there should be:A pretreatment oral evaluation for anyexisting periodontal, carious, or endodonticproblems that may be a future source ofchronic infection or may be exacerbatedby cancer treatment or if cancer therapy