Dental care for cancer patients undergoing radiotherapy of the head and neck region
More details
Hide details
Department of Integrated Dentistry, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland
Department of Mycology, Chair of Microbiology, Jagiellonian University Medical College, Kraków, Poland
Corresponding author
Jolanta Pytko-Polończyk   

ul. Montelupich 4, 31-155 Kraków, Poland
J Pre Clin Clin Res. 2012;6(2):111-117
Despite the considerable progress that has been made in radiotherapy in recent years, the side effects of ionising radiation treatment still constitute a major therapeutic problem on account of the multi-sidedness of the complications involved. The objective of the study was to determine the clinical condition of patients and the presence of fungi in the patients before, during and after radiotherapy, and on this basis prepare guidelines for local dental treatment as a recommended procedure for supporting cancer treatment. A total of 82 patients were treated for cancers of the head and neck organs with radiotherapy. The clinical condition of the oral cavity was assessed as was the appearance of fungi (a qualitative and quantitative assessment) in patients prior to the beginning of treatment, during treatment (weeks 2 and 4 of treatment), as well as after its conclusion. The sensitivity of selected strains of fungi to anti-fungal drugs was also assessed using the ATB Fungus method. During the course of the radiotherapy the condition of patients deteriorated significantly, especially in week 4 of the treatment, which was confirmed by mycological tests and the appearance of symptoms of oral mucositis. Assessments of fungal abundance (intensiveness) of fungi at particular stages of the study illustrates the dynamic of the fungal process.

1) the use of radiotherapy has side effects which have a negative impact on the oral capacity of patients, i.e. inflammation of the mucous membrane (oral mucositis) and the appearance of erosion and ulceration; 2) simultaneously, the level of yeast-like fungi increases and candidiasis develops; 3) bacterial and fungal infections, as well as increasing acute post-radiation reaction in the mucous membranes of head and neck organs, requires prophylaxis and dental treatment.

Ann Oncology (Official Journal of the European Society for Medical Oncology) 2003; 14, Supl 5.
Milecki P. Selected aspects of side effects in the radiotherapy of head and neck cancer. Post Chir Głowy Szyi. 2004; 1: 15-32 (in Polish).
Scully C, Epstein J, Sonis S. Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy. Part 2: diagnosis and management of mucositis. Head Neck 2004; 26(1): 77-84.
Peterson DE. Research advances in oral mucositis. Curr Opin Oncol. 1999; 11: 261-266.
Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004; 4: 277-284.
Fotos P, Vincent SD, Hellstein JW. Oral candidosis. Clinical, historical, and therapeutic features of 100 cases. Oral Surg Oral Med Oral Pathol. 1992; 74(1): 41-49.
Petkowicz B, Skiba-Tatarska M, Wysokińska-Miszczuk J. Oral candidiasis. Gerontologia Pol. 2006; 14(4): 160-164 (in Polish).
Ramirez-Amador V, Silverman S, Mayer P, Tyler M, Quivey J. Candida colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84(2): 149-153.
Hashimoto Y, Tanioka H. Vertebral osteomyelitis associated with disseminated Candidiasis in an oral cancer patient. J Oral Maxillofac Surg. 1991; 49(8): 901-903.
Nagy KN, Szoke I, Sonkodi I, Nagy E, Mari A, Szolnoky G, Newman HN. Inhibition of microflora associated with oral malignacy. Oral Oncology. 2000; 36(1): 32-36.
Grushka M, Epstein JB, Gorsky M. Burning mouth syndrome. AM Fam Physician. 2002; 65(4): 615-620.
Haveman CW. Xerostomia management in the head and neck radiation patient. Tex Dent J. 2004; 121(6): 483-497.
Kraseman C. Pobieranie i transportowanie materiałow do badań mikrobiologicznych. Bayer AG – PTZS – Med Prakt. 1995.
Torres-Rodriguez JM, Alvarado-Ramirez E. In vitro susceptibilities to yeasts using the ATBR FUNGUS 2 method, compared with Sensititre Yeast OneR and standard CLSI (NCCLS) M27-A2 methods. J Antimicrob Chemother. 2007; 60(3): 658-661.
R Development Core Team R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing Vienna, Austria 2008; url =
Kostler VJ, Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: Options for prevention and treatment. CA Cancer J Clin. 2001; 51: 290-315.
Heimdahl A. Prevention and management of oral infections in cancer patients. Support Care Cancer. 1999; 7: 224-228.
Markitziu A, Zafiropoulos G, Tsalikis L, Cohen L. Gingival health and salivary function in head and neck- irradiated patients. Oral Surg Oral Med Oral Pathol. 1992; 73(4): 427-433.
Carl W, Emrich LS. Management of oral mucositis during local radiationand systemic chemiotherapy: A study of 98 patients. J Prosthet Dent. 1991; 66: 361-369.
Grotz KA, Genitsariotis S, Vehling D, Al-Nawas B. Long-term oral Candida colonization, mucositis and salivary function after head and neck radiotherapy. Support Care Cancer. 2003; 11: 717-721.
Almstahl A, Wikstrom M, Fagerberg-Mohlin B. Microflora in oral ecosystems in subjects with radiation-induced hyposalivation. Oral Diseases. 2008; 14(6): 541-549.
Thaweboon S, Thaweboon B, Srithavaj T, Choonharuangdej S. Oral colonization of Candida species in patients receiving radiotherapy in the head and neck area. Quintessence Int. 2008; 39(2): e52-e57.
Bensadoun RJ, Patton LL, Lalla RV, Epstein JB. Oropharyngeal candidiasis in head and neck cancer patients treated with radiation: update 2011. Support Care Cancer. 2011; 19(6): 737-744.
Schelenz S, Abdallah S, Gray G, Stubbings H, Gow I, Baker P, Hunter PR. Epidemiology of oral yeast colonization and infection in patients with hematological malignancies, head neck and solid tumors. J Oral Pathol Med. 2011; 40: 83-89.
Karbach J, Walter C, Al-Nawas B. Evaluation of saliva flow rates, Candida colonization and susceptibility of Candida strains after head and neck radiation. Clin Oral Invest. doi:10.1007/s00784-011-0612-1 (2011).
Łukaszuk C, Krajewska-Kułak E, Niczyporuk W, Theodosopoulou E, Hatzopulu A, Krawczuk-Rybak M, Wojtukiewicz M. Variations of enzymatic activity and biotypes of the yeast like fungi strains isolated from cancer patients. Annales Academiae Medicae Bialostocensis. 2005; 50, suppl. 1: 16-19.
Akpan A, Morgan R. Oral candidiasis. Postgrad Med J. 2002; 78: 455- 459.
Lockhart SR. Natural defenses against Candida colonization breakdown in the oral cavities of the elderly. J Dent Res. 1999; 78: 857-868.
Martinez-Suarez JV, Rodriguez-Tudela JL. Patterns of in vitro activity of itraconazole and imidazole antifungal agents against Candida albicans with decreased susceptibility to fluconazole from Spain. Antimicrobial Agents and Chemotherapy. 1995; 39(7): 1512-1516.
Burn AK, Fothergill AW, Kirkpatrick WR, Coco BJ, Patterson TF, McCarthy DI, Rinaldi MG, Redding SW. Comparison of antifungal susceptibilities to fluconazole and voriconazole of oral Candida glabrata isolates from head and neck radiation patients. J Clin Microbiol. 2004; 42(12): 5846-5848.
Journals System - logo
Scroll to top