Pecularities of hard tissues pathology of the teeth in cancer patients during of chemotherapy

Abstract

Introduction. The leading place in the structure of dental diseases is occupied by the pathology of the hard tissues of the teeth. In combination with periodontal pathology, it leads to premature loss of teeth, which significantly reduces the quality of life of the patients. A particularly aggressive course of the pathology of the hard tissues of the teeth occurs with severe somatic diseases – oncology and hematology pathology. a particularly unfavorable course, according to clinical observations, occurs during and after special anticancer treatment, especially cytotoxic chemotherapy. Based on the totality of the course of the main disease and the consequences of special treatment, this leads to complete adentia. Clear clinical and organizational principles for providing assistance to this contingent of patients have not been developed. Purpose: To study the problems of the pathology of the hard tissues of the teeth during and as a result of antitumor chemotherapy of tumors of extra-oral localization, the peculiarities of the carious process and the possibilities of prevention and correction of such complications. Materials and methods. A clinical and laboratory study of the state of the teeth of 210 cancer patients with extraoral localization of tumors and 23 persons of the control group was carried out. The KPV index was evaluated according to generally accepted methods. The hygienic condition of the oral cavity is characterized by the Fedorov-Volodkina index. The state of local immunity of the oral cavity and general immune reactions were studied. The bacterial biocenosis of the oral cavity of cancer patients was studied too. All obtained results were processed according to generally accepted methods of variational statistics using Student-Fisher criteria. The level of significance of the results is P < 0.05. Results and discussion. Pathology of the hard tissues of the teeth of carious and non-carious origin was observed in significant number of cases. From the anamnesis, it becomes known that during the period of stay in the oncological registry and antitumor treatment, the condition of the teeth deteriorated sharply. In 1–2 years the crowns of the teeth were destroyed up to the gingival margin. The specific localization of the carious spots and carious cavities was the cervical areas of the teeth. The vast majority of patients (78%) consulted a dentist before surgery for the underlying disease and were defamed. In the main group, a high KPV index is noted, which ranges from 5.50 to 18.37 in different age categories, and the number of caries complications is quite low and ranges from 0 to 0.5 per patient depending on age. Bacterial biocenosis is represented by polymorphic coccal flora, gram-positive and gram-negative, hemolytic strains predominated. During cytostatic therapy, the local immune system and factors of non-specific reactivity of the tissues of the oral cavity are affected. The number of T-lymphocytes in the capillary blood of the gingival papilla decreases, the concentration of immunoglobulin G increases. The concentration of secretory immunoglobulin A in saliva decreases and the protein content, which are proven cariogenic factors, increases significantly. Conclusions. Complications from the oral cavity take second place after hematological toxicity as a result of antitumor therapy, They have a different nature: caries and non-carious lesions of the hard tissues of the tooth, infectious mucositis, periodontal diseases, infections of the dental pulp; non-infectious: xerostomia, neurotoxicity (hyperesthesia and paresthesia of the mucous membrane and teeth). Moreover, the consequences of aggressive immunosuppressive therapy for the condition of the oral cavity can be traced in individuals in remission after receiving antitumor therapy in childhood. Thus, this contingent needs the attention of the dental community to ensure an acceptable quality of life. The successes of modern oncology, encouraging results of targeted and immunotherapy increase the chances of cancer patients for longterm recurrence-free survival, which requires the creation of an effective system of dental dispensation.