Preservation of dentition and its supporting structures is imperative to optimize masticatory function and quality of life in head and neck cancer survivors. Curative radiation to the oral cavity creates lifelong challenges. Dental integrity is impacted by xerostomia, trismus, and risk for chronic infections. Poor adherence to preventive care can lead to rampant caries and debilitating problems with chronic pain, nutrition, and a return to a healthy lifestyle. Head and neck cancer survivors are challenging patients. Knowledge about the patient’s disease, treatment, and consequences of treatment will prepare the dental hygienist to create a long-term plan of care for the patient and family.

The dental profession has long regarded fluoride as a primary element in the prevention of dental caries. Topical and systemic fluorides are regularly incorporated within the community, dental office, and home avenues. Despite the fact there are other preventive modalities, fluoride remains a well-established, evidencebased therapeutic intervention. This article will review the early history; mechanism of action; delivery methods for fluoride in private practice, home, and community; and the clinician’s role in optimizing best practices and safe use of fluoride.

Dental erosion is a prevalent condition that occurs worldwide. It is the result of exposure of the enamel and dentin to nonbacterial acids of extrinsic and intrinsic origin, whereby mineral loss occurs from the surface of the tooth. The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first molars in adolescents. Characteristic early signs of dental erosion include smooth and flat facets on facial or palatal surfaces, and shallow and localized dimpling on occlusal surfaces. Early intervention is key to effectively preventing erosive tooth wear. Effective prevention of dental erosion includes measures that can avoid or reduce direct contact with acids, increase acid resistance of dental hard tissues and minimize toothbrushing abrasion.

Water fluoridation heralded the use of fluoride as an anti-caries agent. Since that time, both systemic and topical fluoride have become available and the use of fluorides has contributed greatly to reducing the level of caries seen in the population. Systemic fluoride supplements are available as tablets and drops, for use in accordance with the recommendations on fluoride supplement dosing.Vehicles for topical fluorides include in-office fluoride varnishes, gels, and foams, and home-use fluoride dentifrices, rinses and prescription products. The primary mechanisms of action involved with the use of topical fluorides are the prevention of demineralization and promotion of remineralization, by ensuring the ready availability of intra-oral fluoride.

Considerations in selecting an appropriate in-office and home-use topical fluoride protocol for individual patients include the patient's age, caries risk level, exposure to fluoride from all sources, and the current recommendations on professionally-applied topical fluorides. Other important considerations include product efficacy and safety, the patient's dental status as well as compliance with brushing and age-appropriate use of fluoride toothpaste, and clinician and patient preferences.

Methamphetamines were originally derived from amphetamine. Meth can be illegally and easily synthesized, and is known by many names, including speed, crystal meth and ice. In the United States, more than 10 million people report having tried meth. Its use results in immediate effects that can be pleasurable but medically dangerous. Longer-term use results in serious and devastating medical, psychological and oral conditions, and in extreme cases can result in death. Dental professionals are in a position to help with the early identification of meth abuse and to refer patients to medical professionals for counseling and treatment. Palliative and preventive oral care and treatment, as well as counseling, should be provided, along with monitoring of the patient, and definitive care should be provided when appropriate for the individual patient.

In the United States in 2007, over 34,000 new cases of oral cavity and oropharyngeal cancer will be diagnosed. The single greatest risk factor for oral cancer in the United States is the use of tobacco. A strong association has been found between oral and oropharyngeal cancer and the presence of HPV in oral tissues. The five-year relative survival rate is estimated at 59.1% overall for oral and pharyngeal cancers diagnosed during 1996–2003. An estimated 85% of oral premalignant and malignant lesions present clinically as leukoplakias. Early detection of oral cancer is complicated by the fact that many lesions in their earlier stages may be completely asymptomatic, and the detection of suspicious lesions is increased through regular screening of patients. Historically, unaided visual examination, palpation, and radiographs were available for oral cancer screening. In recent years, screening technologies have become available that supplement the visual examination. If suspicious lesions are found during the screening procedure, the lesion must be biopsied or the patient referred to a specialist for further evaluation. The ability to identify lesions and to predict which lesions will undergo malignant transformation would facilitate early diagnosis and subsequent disease management tailored to the individual patient. The ultimate goals are to reduce both mortality and morbidity, and to improve patients’ quality of life.
 

Oral side effects are commonplace with cancer chemo and adjunctive therapies. Intravenous bisphosphonate therapy can lead to osteonecrosis, especially after a tooth extraction or oral surgery. Scheduled cleanings should be performed every six months or quarterly, as well as compliance with meticulous home oral hygiene, depending on risk factors and the patient’s health. Chemotherapy can cause a host of oral side effects including hypersensitivity due to discomfort and pain, ulcerated gingival tissues, impaired taste buds, erosion of tooth enamel due to vomiting, and mucositis. The primary method of treating mucositis is palliative therapy. Therapy includes home oral hygiene, pain control, oral mouth rinses, and palliation of dry mouth. It is important for dental hygienists to be aware of these side effects and how to counsel their patients appropriately.

Recurrent aphthous ulcers (RAU) and recurrent herpes labialis (RHL) are two of the common oral/peri-oral lesions experienced in the general population. Treatment options include over-the counter and prescription products.

Endodontic treatment is a predictable procedure with high success rates. Success depends on a number of factors, including appropriate instrumentation, successful irrigation and decontamination of the root canal space to the apices and in areas such as isthmuses. These steps must be followed by complete obturation of the root canals, and placement of a coronal seal, prior to restorative treatment. Several irrigants and irrigation systems are available, all of which behave differently and have relative advantages and disadvantages. Common root canal irrigants include sodium hypochlorite, chlorhexidine gluconate, alcohol, hydrogen peroxide and ethylenediaminetetraacetic acid (EDTA). In selecting an irrigant and technique, consideration must be given to their efficacy and safety.

Twenty-six million people in the United States are living with chronic kidney disease (CKD). As the baby boomer generation continues to mature, medical procedures extending life improve, and with pharmacology advances, this number will increase. With an increased number of patients living with CKD seeking dental treatment, will the dental healthcare provider be prepared to provide treatment to patients living with renal disease-induced anemia, and with secondary hyperparathyroidism and its effects on bone metabolism and the cardiovascular system? Many providers are familiar with providing palliative treatment for xerostomia, but how do you recommend palliative treatment for someone who is on strict fluid and dietary restrictions, such as patients living with end stage renal disease? Diabetes and hypertension are the two greatest causes of kidney disease. Dental providers should be knowledgeable about the different stages of renal disease and different treatments associated with this condition, and be prepared to address oral complications of renal disease. The dental healthcare provider must become more familiar with the impact of periodontal disease on renal disease, specific medical challenges and become proficient in collaborating with medical healthcare providers to provide dental treatment to these patients.

Bisphosphonate drugs are a commonly utilized therapy in prevention and treatment of osteoporosis and treatment of bone lesions in certain cancers. Bisphosphonates are used in these conditions because of their ability to increase skeletal bone mass. However, these drugs also affect healing of bone, particularly in the dentoalveolar region. The most commonly accepted theories explaining this effect are osteoclast inhibition and anti-angiogenic properties of bisphosphonates. Bisphosphonate osteonecrosis of the jaws may occur in patients exposed to bisphosphonate drugs who have dental disease, experience soft tissue trauma, or require dental surgery. This side effect involves exposure of bone and a lack of normal healing which may result in pain, purulence, formation of sequestra, and in severe cases pathologic fracture. Fortunately these complications can often be avoided by following clinically accepted protocols focused on optimizing oral health prior to drug initiation, weighing risk factors prior to invasive procedures, and using conservative, atraumatic techniques when surgery is needed. All dental professionals should be aware of this condition when reviewing medical histories and making treatment decisions, and must remain updated in the constantly evolving science related to treatment protocols and to other non-bisphosphonate drugs which exhibit similar side effects.