Osteoradionecrosis (ORN) of the jaws is a serious problem that can happen after people have radiotherapy as part of their treatment for head and neck cancer. ORN refers to the death and exposure of bone that result from damage to the tissues due to being exposed to radiation. ORN is very difficult to treat and it is important that steps are taken to prevent it. In this review, we looked at any treatments that have been used to prevent ORN. Continue reading
Sore mouth and ulcers (oral mucositis) is a side effect of treatment for cancer including chemotherapy, head and neck radiotherapy, and targeted therapy, affecting over 75% of high-risk patients. Ulcers can lead to severe pain and difficulty with eating and drinking. Sufferers may need strong painkillers, possibly have to go into hospital and even be fed through a tube into their stomach or their veins. These complications may disrupt their cancer therapy, meaning they are not receiving the best treatment, which may reduce survival. Cancer patients have weakened immune systems due to their treatment and are less able to fight infections. An ulcer is an open wound and there is a risk that bacteria can enter the body leading to infection or sepsis (a dangerous inflammatory reaction of the body to infection).
Mouth soreness and ulcers can be costly to healthcare systems, yet there are few preventive interventions or treatments proven to be beneficial. Cytokines and growth factors may help the regeneration of cells lining the mouth, thus preventing or reducing oral mucositis and its negative effects.
Problems with saliva production and salivary glands are a significant and mostly permanent side effect for people after radiotherapy treatment to the head and neck. When this occurs the condition is known as dry mouth or xerostomia. Dry mouth is not measurable and is a subjective or personal expression of how the mouth feels. It can have other causes and is a consequence of the production of less saliva or by the consistency of saliva. The rate of flow of saliva in an individual’s mouth however can be measured. People who have dry mouth have a reduced quality of life. They can experience issues with taste and general discomfort, difficulties chewing, swallowing and speaking as well as tooth decay, thrush and other infections of the mouth. A wide range of drugs that work in different ways have been used to try and prevent problems with salivary glands caused by radiotherapy. Unfortunately there is currently not enough evidence to show which drugs or which type of drugs are most effective. Continue reading
Oral cancers (cancer of the mouth and cancer of the throat) are the sixth most common cancer worldwide, accounting for an estimated 4% of all cancers. There is a higher frequency of these cancers in men. Smoking, alcohol consumption and betel quid chewing are the main risk factors. Cancer of the throat is associated with infection from the human papilloma virus (HPV), which can be transmitted through sexual contact. Low socioeconomic status (a measure of a person’s income, education and occupation in relation to other people’s) is associated with a higher frequency of oral cancers and poorer survival rates. Survival following a diagnosis of mouth or throat cancer remains poor, with around 50% of people still alive at five years (five-year survival rate).
New therapies targeted at the cells that give rise to oral cancers are being developed. The advantage these may have over conventional chemotherapy is that rather than affecting both healthy and cancerous cells they just target cancer cells. Immunotherapy (also known as biological therapy, biotherapy or biological response modifier therapy) may improve the functioning of the immune system so it is more effective at destroying cancer cells. Local immunotherapy delivers treatment directly into the tumour and systemic immunotherapy targets the whole body, and may be useful for stopping the cancer spreading or the return of primary tumours in more advanced cancer. Continue reading
November is Mouth Cancer Action Month, and the Cochrane Oral Health Group has a range of systematic reviews dedicated to the topic. Mouth cancer can affect anybody; in the UK more than 6,700 people were diagnosed with the condition last year, and more than 2,000 people died from the disease, more than testicular and cervical cancer combined. Here’s what the evidence says… Continue reading
The Cochrane Oral Health Group‘s editorial team met last week to consider which new titles to register. OHG have had a number of submissions over the last six months, and three titles have been registered by the Group. The editors identified them as priority topics, and agreed that they did not significantly overlap with any existing reviews:
Interventions for the prevention of osteoradionecrosis of the jaws in patients receiving head and neck radiotherapy
This review will be led by Dr. Amri Azarpazhooh from the University of Toronto in Canada. He will be joined on the team by Dr. Michael Duchnay, Dr. Grace Bradley, Dr. Howard Tenenbaum, Dr. Prakeshkumar S. Shah and Dr. Hamid Reza Raziee, who are all also based at the University of Toronto.
Prevention of gag reflex for patients undergoing dental treatment
Dr. Eachempati Prashanti from Melaka-Manipal Medical College in Malaysia will lead this new review. Dr. P. Renjith George, Professor Nagraj Sumanth Kumargere, Dr. Laxminarayan Karanth and Dr. Htoo Htoo Kyaw Soe will also be on the on the author team.
Autologous platelet concentrates for regeneration of periodontal defects
This review will be a collaboration between authors based in Italy and India. Dr. Massimo Del Fabbro from Università degli Studi di Milano leads the team, his colleagues Dr. Valentina Ceresoli and Dr. Caterina Ceci will join him as authors. Dr. Silvio Taschieri from University of Milan IRCCS Galazzi Orthopaedic Institute is also an author. The author team is completed by Dr. Saurav Panda, Professor Sheeja Varghese, Professor Malaiappa Sankari, Professor N. D. Jayakumar and Dr. Surenda Ramamoorthi from Saveetha University, India.
We look forward to publishing the protocols in the near future, watch this space!
We now have a total of 200 published systematic reviews and protocols on the Library, congratulations to all of our authors, editors and referees on this fantastic achievement!
Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications
by Shiyana Eliyas, Ahmed Al-Khayatt, Richard WJ Porter, Peter Briggs
This new review aimed to assess the effects of maintaining the patient’s natural dentition during radiotherapy in comparison to extracting teeth before radiotherapy in areas that are difficult to access by the patient and the dentist, should reduction in mouth opening occur after radiotherapy to the jaws. No clinical trials were identified, and there is no high quality evidence on this clinically important topic.
Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy
by Kelvin KW Chan, Anne-Marie Glenny, Susan Furness, Helen V Worthington
This review is the fourth in a series of Cochrane reviews looking at different treatment modalities for oral cavity and oropharyngeal cancers: surgical treatment, chemotherapy and radiotherapy. There is a great deal of current research into new therapies for cancer and many of these make the headlines in the news. However, there is a significant time lag between laboratory discoveries and the introduction of new treatments into clinical care. This review will evaluate the randomised controlled trials of targeted and immunological therapies for patients with oral cavity or oropharyngeal cancer.
Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients
by Dimitrios Kloukos, Piotr Fudalej, Patrick Sequeira-Byron, Christos Katsaros
The conventional orthognathic surgery for correction of maxillary retrusion/hypoplasia is a Le Fort I osteotomy. Distraction osteogenesis is the surgical process of correction of skeletal deformity utilizing bone lengthening by gradual mechanical distraction. This review will compare the effectiveness of the two methods in patients with orofacial clefts.
Professionally-applied chemically-induced whitening of teeth in adults
by Alonso Carrasco-Labra, Romina Brignardello-Petersen, Nicolás Yanine, Ignacio Araya, Gabriel Rada, R Graham Chadwick
Professionally-applied bleaching treatments have been used for a long time. Despite all of the information available, it is difficult for clinicians to determine which is the most effective treatment for tooth discolouration and the level of potential harms of these treatments. This review aims to assess the evidence about the beneficial and adverse effects of in-office, professionally-applied chemically-induced whitening of teeth in adult patients. It will complement another Cochrane systematic review of the evidence for the use of home-based treatment methods.