BRIDGET M. WRIGHT, MACPR, BSDH, EFDA, is an assistant clinical professor at The Ohio State University (OSU), Division of Dental Hygiene in Columbus, where she teaches dental hygiene and expanded functions dental auxiliary (EFDA) students. She is the course director for dental anatomy and EFDA courses. Prior to joining the faculty, Wright practiced as a dental hygienist and EFDA. Currently, she treats patients in the Dental Oncology Clinic at OSU one day per week. Wright can be reached at: [email protected]. MATTHEW J. MESSINA, DDS, is an assistant clinical professor in the Division of Restorative and Prosthetic Dentistry at OSU College of Dentistry. He is the interim director of dental oncology for OSU and has more than 35 years of private practice experience. While lecturing nationally on dental oncology for the dental team, Messina provides information and support for dentists, dental hygienists, and dental assistants in the care and treatment of their patients. He is also the director of the predoctoral practice management curriculum at OSU. The authors have no commercial conflicts of interest to disclose. dimensionsofdentalhygiene.com July/August 2023 • Dimensions OF DENTAL HYGIENE 33 Severe mucositis may result in malnutrition, treatment delays, and overall reduction in suc- cess of cancer treatment.8 Depending on radiation dosing, symptoms can occur at varying intervals, but often peak toward the completion of treatment and generally begin to improve over several weeks post-RT.9 Treatment options include Magic Mouthwash or Magic Mouthwash with nystatin for patients with concomitant oral candida infection (Table 1, page 34).9 Trismus refers to muscle spasms or restriction of the muscles of mastication that hinders patients’ ability to open their mouths. A normal opening should allow the patient to place two or three fingers vertically between their incisors. Patients may experience trismus during and after treatment, making it difficult for them to eat and perform thorough oral hygiene care.9 This could lead to additional oral and nutri- tional complications and a significant reduction in quality of life. Treatment options include exercising three times a day by opening and closing the mouth as far as possible without pain, repeating 20 times or referral to a physical or occupa- tional therapist for additional support. Xerostomia is very common during and after RT, due to damage to salivary glands from the radiation. RT results in hyposalivation and the feeling of xerostomia. Patients may see improvements during the first year following treatment, but hyposalivation and xerostomia often persist.9 As a result, patients are at increased risk for both periodontal diseases and dental caries and may require additional support for self-care.9 Treatment options include saliva stimulants (containing xylitol), dry mouthrinses, and discontinuing tobacco use (if applicable). RT causes hyposalivation and xerostomia, which dramatically increase the risk for dental caries. Approximately 29% of patients receiving H/ N RT develop radiation-related caries within 3 months of treatment conclusion.10 Radiation caries is highly destructive and rap- idly progresses.11 Every effort should be focused on prevention, as the management of severe radiation caries can be difficult. Additionally, effects of RT alter enamel and dentin, which may compromise the bonding of adhesive dental materials, posing more challenges. Preventive treatment options include nutritional counseling and prescription fluoride products. Osteoradionecrosis of the jaw (ORN) is one of the most concerning complications of H/ N RT. Clinically characterized by exposed necrotic bone within the field of H/ N RT, ORN more commonly affects the mandible than the maxilla.12–14 While the risk of ORN is present after any level of radiation exposure, it increases signifi- cantly when the patient receives more than 6,000 centigrays (cGy) of radiation and if a trig- gering event occurs in the radiation field post-RT.15–17 Triggering events include dental extractions, especially mandibular posterior teeth with roots that lie below the mylohyoid line; osseous periodontal surgery; and severe denture sores.14,18 Despite the evolution of RT modalities, ORN continues to pose a therapeutic challenge and its cause remains unclear. ORN lesions can occur years after the RT is concluded so vigi- lant history and oral examination remain important. ORN is diagnosed as a clinical presentation of irradiated bone that is nonvital/ necrotic and exposed through the overlaying mucosa without healing for a period of 3 months or longer.19 The presentation of early ORN may be asymptomatic, although pain is common if the lesion progresses. Other associated symptoms may include oral malodor, dysgeusia, and food impaction in the area of exposed bone. In severe cases, ORN can result in fistulae, com- plete devitalization of regions of bone, and pathologic fractures of the jaw.20 ORN lesions typically occur between 4 months and 2 years post-RT and the risk decreases over time, but remains for life.9,18,20
