Особливості надання стоматологічної допомоги пацієнтам зі злоякісними пухлинами (огляд літератури)

Abstract

Онкологічні захворювання є високо поширеними в багатьох країнах світу, сучасні протоколи їх лікування передбачають застосування цілого комплексу медикаментозних, фізичних і хірургічних методів впливу на пухлинні клітини. Таке лікування відрізняється підвищеним ризиком виникнення побічних ефектів від терапії та різноманітних ускладнень. Доведено, що протипухлинна хіміотерапія та променеве лікування негативно впливає на стоматологічний статус пацієнта і може призводити до розвитку ускладнень в щелепно-лицевій ділянці. Поряд із тим, наявність стоматологічної патології та джерела хронічної інфекції негативно впливають на сприйняття пацієнтом курсів комплексної протипухлинної терапії. До початку хіміотерапії доцільно розпочати і завершити санацію порожнини рота і усунути джерела хронічної інфекції. Проведення стоматологічних маніпуляцій у пацієнта, який отримує хіміотерапію має вищі ризики виникнення кровотеч, порушення регенерації тканин, негативного перебігу запальних процесів. Окремі протипухлинні лікувальні комплекси можуть призводити до асептичних аваскулярних некрозів кісткової тканини щелеп.

Онкологические заболевания является широко распространенными во многих странах мира, современные протоколы их лечения предусматривают применение целого комплекса медикаментозных, физических и хирургических методов воздействия на опухолевые клетки. Подобное лечение отличается повышенным риском возникновения побочных эффектов от терапии и различных осложнений. Доказано, что противоопухолевая химиотерапия и лучевое лечение негативно влияет на стоматологический статус пациента и может приводить к развитию осложнений в челюстно-лицевой области. Наряду с этим, наличие стоматологической патологии и источники хронической инфекции в полости рта отрицательно влияют на восприятие пациентом курсов комплексной противоопухолевой терапии. До начала химиотерапии целесообразно завершить санацию полости рта и устранить источники хронической инфекции. Проведение стоматологических манипуляций у пациента, получающего химиотерапию имеет повышенные риски возникновения кровотечений, нарушение регенерации тканей, неблагоприятного течения воспалительных процессов. Некоторые противоопухолевые лечебные комплексы могут приводить к возникновению асептических аваскулярных некрозов костной ткани челюстей.

Cancer diseases are widespread in many countries over the world. The modern protocols of treatment include using of a whole range of pharmacological, physical and surgical methods to affect tumor cells. Such treatment is characterized by increased risk of side effects from therapy and various complications. It is proved that the anti-tumor chemotherapy and radiation therapy have a negative effect on the dental status of the patient and may lead to complications appearing in the maxillofacial region. By the way, the presence of dental diseases and chronic infection in oral cavity negatively affects the patient's perception of complex antitumor therapy courses. Prior to chemotherapy it is expedient to finish the sanation of the oral cavity to eliminate chronic infections' sources. Carrying out dental procedures for patient receiving chemotherapy causes increased risk of bleeding, tissues' regeneration disorders and negative inflammatory processes lasting. Some of anticancer therapeutic complexes may cause the aseptic avascular necrosis of the jaw bone tissue. The quality and technologies of cancer treatment are different in many countries. That depends on accepted national treatment standards and is associated with high cost of therapy and processability of the most therapeutic and diagnostic procedures. Along the same, modern protocols of cancer patients care are include not only abnormal cells' physical destruction, they eliminate the complications of underlying disease and side effects of applied medical diagnostic technologies but also protocols lead to possible rehabilitation of the patient and to return him to active life. In such cases, the antioncologic care is provided by a team of doctors and paramedical staff. Dental care to cancer patients is a necessary and often it is a kind of component of a complete patient's rehabilitation. However, the technology of dental care providing to abovementioned patients is some extent different from care to somatically healthy patients with other comorbidities. Professional and specialized literature often contains information on providing dental care to patients with malignant tumors of the head and neck but patients with existing tumors in other organs and anatomical areas also require a special approach by the dentist. The purpose of the dental examination before prescribing chemotherapy — is to identify existing and potential source of infection in the oral and maxillofacial area. Therefore appropriate infection control oral is administered before the anticancer chemotherapy. Another controversial issues in oncology and dentistry can be attributed to the specific complications is the use of inhibitors of osteoclasts which can cause necrosis of the jaw bone; regular use of chlorhexidine bigluconate leads to dysbiosis of mucous membranes; prevention of bacterial endocarditis is necessary for patients receiving cardiotoxic agents or radiotherapy in the area of ​​the chest having a source of chronic dental infection. According to experience of many anti-cancer clinics clinicists argued that most of anticancer remedies have oral toxicity, that contribute to the occurrence of severe clinical side effects in the mouth. These side effects include xerostomia, dysgeusia (taste disorder), hypersensitivity of teeth (up to phantom "toothache"), bleeding gums, sores on the mucosa, hemorrhagic mucositis and herpes, bacterial and fungal infections. Some sources introduce the concept of secondary oral toxicity of chemotherapy referring to the phenomenon expressed violations in the mouth. Additionally, severe pain and discomfort in the mouth can disrupt the function of nutrition, violate the general condition of the patient.. In some clinical situations intensive inflammation in the mouth and throat causes unability of feeding to patients in general. These serious complications may occur during chemotherapy and radiotherapy using for example in the treatment of nasal adenocarcinoma. In some complex cases and these patients require food probe. Patients having anti-tumor chemotherapy should be informed about importance for their adherence to oral hygiene, such patients should be provided with detailed instructions on individual oral hygiene, more effectively for them is hygienic education: 1) patients with complete and partial removable dentures should at least once a day to remove, clean with a toothbrush and baking soda and leave them for 30 minutes in antiseptic solution; 2) do not keep dentures in the mouth during sleep or if irritation or inflammatory changes in the oral mucosa; 3) careful use dental flosses without further injury marginal periodontal and interdental papillae; 4) use for cleaning teeth soft and ultra soft toothbrushes with dental pastes without potent active substances; 5) in such patients is advisable to apply fluoride mouthwashes, preferably in the evening; 6) do not use chlorhexidine-based mouthwash; 7) do not use alcohol-based mouthwash and other oral hygiene products; 8) do not use toothpicks; 9) avoid the use of abrasive or overly spicy food. During anticancer chemotherapy the patient may have selective effects and overall immune because dental disease or treatment may have serious consequences. Before any dental surgical intervention it is necessary to consult with the oncologist. Typically, patients with a satisfactory status of oral hygiene and those that are on the supervision of a dentist during chemotherapy have fewer complications and side effects by combined treatment. Carrying dental manipulations and interventions which not to be avoided must follow the next requirements. Activities of treatment periodontopathia should ideally be carried out before the appointment of chemotherapy or after comprehensive cancer treatment. For patients with leukemia periodontal therapy should be deferred until the underlying disease remission because of the high risk of bleeding. Consequently, the dental care provision to patients with cancer is special issue of dentistry. The vast majority of experts have more information to provide dental care to patients with head and neck tumors but the dental management of patients with other localized tumor is not described in the profile literature. Performing of active anticancer therapy affects the functions of all organs and systems, and to avoid possible complications dental rehabilitation must be completed before the start of chemotherapy. Daily dental manipulations among patients on anticancer chemotherapy have relatively risk of severe complications and require close cooperation of dentists and oncologists. That may be described as a multidisciplinary approach.