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Dr. Jyoti Ghoshal's Profile
Oral Mucositis
Oral Mucositis
Refers to erythematous &ulcerative lesions of oral mucosa observed in the patients with cancer being treated with Chemotherapy and radiotherapy
Lesions are often very painful &compromise nutrition &oral hygiene &as well as increase risk for local&systemic infections
It also involve other areas of the alimentary tract for eg—GIT mucositis can manifest as diarrhea
Oral mucositis initially presents as a erythema of the oral mucosa which then often progresses to erosion and ulceration. The ulcerations are typically covered by a white fibrinous pseudomembrane. The lesions heal within approximately 4-6 weeks after the last dose of somatotoxic chemotherapy or radiation therapy
Several factors affect the clinical course of mucositis Lesions are usually limits to non-keratinized surfaces ie lateral and ventral tongue,, buccal mucosa &soft palate .Ulcers arise within 2 wks after initiation of therapy The cinical severity is directly proportional to the dose of radiation administered .Most patients who have received more than 5000cGy to the oral mucosa will devlop severe ulcerative oral mucositis
Clinical course of oral mucositis may sometimes be complicated by local infections such as Herpes - simplex and fungal infections such as candidiasis
Management of oral mucositis has been largly palliative
Primary symptom pain affects nutritional intake ,,mouth care &quality of life.. Thus pain management is of upmost imp in this case .. saline gargles ,,ice chips,,&topical mouth rinse contaning lidocaine an anesthetic agent can be used
Nutritional intake can be severly compromised by pain& in addition taste change also occur after chemo,, radiotherapy,, It is essential to monitor nutritional intake &weight .A soft diet ,, liquid diet when oral mucositis present
TREATMENT OF DRY MOUTH---Patients undergoing cancer therapy suffer from xerostomia (Dry mouth) or hyposalivation can further aggrevate inflamed tissues &increase local infection &make mastication difficult &aggrevate the oral mucositis . hence treatment for such conditions should also be considered
A--- chewing of sugarless gum to stimulate flow
B ---use of cholinergic agents as necessary
C ----adv to sip water frequently allieviate dry—
TREATMENT OF BLEEDING---In the patients who are thrombocytopenic as a result of high dose chemotherapy ,, bleeding may occur from ulcerative oral mucositis This can usually be controlled by local hemostatic agents such as fibrin,,glue or gelatin spongue
Oral mucositis is a clinically imp &sometimes dose limiting complication of cancer therapy
Clinical management is largly focused on palliative measure such as pain management ,, nutritional support& maintanaince of good oral hygiene

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Radiation and its effects on oral cavity
Radiation and its effects on oral cavity
Oral mucous membrane –during radiation
A- Mucositis—oral mucous membrane show areas of redness and inflammation
B- Desquamated Epithelial Layer—mucous membrane begins to breakdown with the formation of a white to yallow pseudomembrane
C- Infection—it devlopes due to bad oral hygiene Secondary infections by candida albicans
After radiation
Mucosa begins to heal rapidly in about 2 months.Later it becomes atrophic thin,,&avascular.atrophy developes due to obliteration of the fine vasculature&fibrosis of the connective tissue.
Ulcers results from a denture sore,, radiation necrosis or tumour recurrence
Taste Buds---are sensitive to radiation&results in-desquamation of taste buds..
Loss of taste sensation----bitter and acid flavour are more severly affected when posterior2/3of tongue is irradiated .. Ant 1/3 of tongue irradiated ,, causes loss of salt &sweet sensation . Recovery of taste buds requires at least 60-120 days after irradiation
Salivary Glands
Parotid glands are more sensitive than submandibular &sublingual glands
a) progressive loss of salivary secretion
b) xerostomia ---dryness of mouth
c) swallowing is difficult &painful because the residual saliva loses its normal lubricating properties
d) PH &Buffering capacity of saliva falls down
e) Histologically,acute inflammatory response may occur soon after the initiation of therapy. Progressive fibrosis adiposis ,, loss of fine vasculature °enerative parenchyma results in xerostomia
f) Salivary changes influence on the oral microflora leading to radiation caries by increase in strepto-mutans,lactobacillus, candida micro-organisms & thick,, acidic ,, viscous,, small volume of saliva causes radiation caries

Teeth
During tooth developmental period- retards the growth of teeth
Before tooth calcification –destroy the tooth bud
After tooth calcification it inhibit celluar differntiation causing malformation & arresting tooth growth
Children receiving radiation therapy to the jaw shows defects in permanent dentition such as retarded root development,, dwarfing teeth &anodontia
In some instances irradiation of developing teeth after complete calcification causes premature eruption
Irradiation of teeth may retard root formation but no changes in the eruptive mechanism of teeth
Adult teeth are very sensitive to irradiation .. Pulpal tissue shows fibro-atrophy after radiation
Radiation causes no effect on enamel, dentin &cementum

RADIATION CARIES
It is a rampant form of caries that may occur in, individuals who receive radiotherapy .carious lesions results from changes in the salivary glands &saliva.. decrease flow,,decrease PH,,decrease buffering capacity&increase viscocity becauses of reduced or absent cleaning action of normal saliva results in accumulation of debris quickly…Radiation caries has the rapid course &widespread attack which distinguish other caries
BONE
Irradiation of the bone causes damage to the vasculation of periosteum &cortical bone..
Radiation also destroys osteoclasts&to a lesser extent osteoblasts .Bone marrow is replaced with fatty marrow &fibrous connective tissue .. Marrow tissue becomes hypovascular ,, hypoxic,, &hypocellular
Osteoradionecrosis is the critical complication that occur in bone ,, after irradiation The decrease vascularity of the mandible renders it easily infected by micro-organisms from the oral cavity.. This bone infection may result from radiation induced breakdown of mucous membrane from denture sore or tooth extraction ..It is more common in mandible because of less vascular supply &it is more frequently exposed to radiation

Treatment of Osteoradiaonecrosis
A)----prevent radiation caries by restoring all caries lesions before irradiation starts
B)--- maintain good oral hygiene
C)---Removing all poorly supported &badly carious teeth &allow sufficient time to heal up the extraction wounds
D)Daily topical fluride application
E) Adjusting dentures to minimize risk of denture sores
F) hyperbaric oxygen
G) Resction of sequestra or mandibulectomy
H) Nutrition supplements
I) Antibiotics& analgesics can be given
..

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Alcoholism + Dental Health
chronic alcoholics neglect themselves as they are under influence of alcohol &preoccupied with their addictiob &often due to negligencethey lead into poor oral hygiene
alcoholics have a high incidence of decayed ,, missing teeth compared to non -alcoholics
They have increased rate of chronic advanced generalised periodontitis with inflamed gingivae,, loss of stippling,,, blunting of interdental papillae,, deep pocket with bone loss
increased level of tooth wear due to attrision,, is present in pyschiatric alcoholics ,, this is due to stimulation of the brainstem reticulo activatory system
leading to masseteric muscle activity causing bruxism during rapid eye moment sleep
Advanced dental erosion affecting the palatal surface of upper incisors .This erosion of teeth may be dur to chronic vomiting
Xerostomia secondary to chronic alcoholism may lead to tooth wear ,, decaying of teethdue to reduced buffering from a reduction of salivary flow
The risk for developing oral sq cell carcinoma is 10-15 times more in alcoholics it could be coz of oral mucosa rendered more susceptible to carcinogens
These patients are difficult to manage when they attend clinic
They have poor oral hygiene,, deposits &may be coated tongue ,, angular cheilosis as well

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dry mouth
Everyone has a dry mouth once a while when ther are upset,, nervos under pressure or scared.But if someone have it all the time or most of the time it is termed a dry mouth.
It is a condition of not having saliva or so called spit which keeps the mouth wet in enough amount.
Saliva is most imp as it helps in digestion,, buffers oral cavity so prevents infections by controlling growth of harmful microorganisms
If not in sufficient amount causes tooth decay &gum diseases &one might not get proper nutrient due to difficulty in chewing & swollowing foods &may lead to bad health
There are diff causes of dry mouth such as parkinsons disease ,,diabetes ..hiv after radio&chemotherapy for cancer or may be due to nerve damage of saliva producing glands or glands itself due to trauma in head &neck region

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HAZARDS OF TONGUE PIERCING
LIKE BODY PIERCING ie NOSE EAR LOBE, EYEBROWS BELLY ETC TONGUE PIERCING BCOMING POPULAR .
IT INVOLVES PLACING STUD THROUGH TONGUE.THIS STUD CAUSES CHIPPING OF TEETH,, RECESSION OF GUMS AND MAY B NERVE DAMAGE.
PEOPLE GOING FOR SUCH THINGS DONT REALIZE RISK FOR DEVLOPING FATAL INFECTIONS.
UNCLEAN PIERCING EQUIPMENT CAN GIVE RISE INFECTIONS LIKE BLOOD BORNE HEPATITIS ,,TOOTH FRACTURES , AND INSTRUMENT USED MAY PIERCE BLOOD VESSEL '

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