Table 2. Oral Complications of Cancer Chemotherapy continued...
Resolution of oral toxicity, including mucositis and infection, generally coincides with granulocyte recovery. This relationship may be temporally but not causally related. For example, oral mucosal healing in hematopoietic stem cell transplantation patients is only partially dependent on rate of engraftment, especially neutrophils.
Head/Neck Radiation–induced Complications
Head and neck radiation can cause a wide spectrum of oral complications (refer to the list of Oral Complications of Radiation Therapy). Ulcerative oral mucositis is a virtually universal toxicity resulting from this treatment; there are clinically significant similarities as well as differences compared with oral mucositis caused by chemotherapy. In addition, oral mucosal toxicity can be increased by use of head and neck radiation together with concurrent chemotherapy.
Head and neck radiation can also induce damage that results in permanent dysfunction of vasculature, connective tissue, salivary glands, muscle, and bone. Loss of bone vitality occurs:
- Secondary to injury to osteocytes, osteoblasts, and osteoclasts.
- From a relative hypoxia due to reduction in vascular supply.
These changes can lead to soft tissue necrosis and osteonecrosis that result in bone exposure, secondary infection, and severe pain.
Oral Complications of Radiation Therapy
- Acute complications:
- Oral mucositis.
- Salivary gland dysfunction:
- Taste dysfunction.
- Chronic complications:
- Mucosal fibrosis and atrophy.
- Dental caries.
- Soft tissue necrosis.
- Taste dysfunction:
- Muscular/cutaneous fibrosis.
Unlike chemotherapy, however, radiation damage is anatomically site-specific; toxicity is localized to irradiated tissue volumes. Degree of damage depends on treatment regimen-related factors, including type of radiation utilized, total dose administered, and field size/fractionation. Radiation-induced damage also differs from chemotherapy-induced changes in that irradiated tissue tends to manifest permanent damage that places the patient at continual risk for oral sequelae. The oral tissues are thus more easily damaged by subsequent toxic drug or radiation exposure, and normal physiologic repair mechanisms are compromised as a result of permanent cellular damage.
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