Hong Catherine H L, Hu Shijia, Haverman Thijs, Stokman Monique, Napeñas Joel J, Braber Jacolien Bos-den, Gerber Erich, Geuke Margot, Vardas Emmanouil, Waltimo Tuomas, Jensen Siri Beier, Saunders Deborah P
Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
Support Care Cancer. 2018 Jan;26(1):155-174. doi: 10.1007/s00520-017-3829-y. Epub 2017 Jul 22.
This systematic review aims to update on the prevalence of odontogenic-related infections and the efficacy of dental strategies in preventing dental-related complications in cancer patients since the 2010 systematic review.
A literature search was conducted in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 2009 and 30 June 2016. Each study was assessed by 2 reviewers and the body of evidence for each intervention was assigned an evidence level.
After examination of the abstracts and full-text articles, 59 articles satisfied the inclusion criteria. The weighted prevalence of dental infections and pericoronitis during cancer therapy was 5.4 and 5.3%, respectively. The frequency of dental-related infections during intensive chemotherapy after complete, partial, and minimal pre-cancer dental evaluation/treatment protocols ranged from 0 to 4%. Protocols involving third molars extractions had the highest complications (40%).
In view of the low prevalence of infections and the potential for complications after third molar extractions, it is suggested that partial dental evaluation/treatment protocols prior to intensive chemotherapy; whereby minor caries (within dentin), asymptomatic third molars or asymptomatic teeth without excessive probing depth (<8 mm), mobility (mobility I or II) or with periapical lesions of <5 mm were observed; is a viable option when there is insufficient time for complete dental evaluation/treatment protocols. The use of chlorhexidine, fluoride mouth rinses as well as composite resin, resin-modified glass ionomer cement (GIC), and amalgam restorations over conventional GIC in post head and neck radiation patients who are compliant fluoride users is recommended.
本系统评价旨在更新自2010年系统评价以来，牙源性相关感染的患病率以及牙科策略在预防癌症患者牙科相关并发症方面的疗效。
在MEDLINE/PubMed和EMBASE数据库中检索2009年1月1日至2016年6月30日发表的文章。每项研究由2名评审员评估，每种干预措施的证据体被赋予一个证据水平。
在审查摘要和全文文章后，59篇文章符合纳入标准。癌症治疗期间牙科感染和冠周炎的加权患病率分别为5.4%和5.3%。在完成、部分和最低限度的癌症前牙科评估/治疗方案后进行强化化疗期间，牙科相关感染的发生率为0%至4%。涉及拔除第三磨牙的方案并发症最高（40%）。
鉴于感染患病率较低以及拔除第三磨牙后有发生并发症的可能性，建议在强化化疗前采用部分牙科评估/治疗方案；即观察到轻度龋齿（牙本质内）、无症状的第三磨牙或无过度探诊深度（<8mm）、松动度（I度或II度松动）或根尖周病变<5mm的无症状牙齿；当没有足够时间进行完整的牙科评估/治疗方案时，这是一个可行的选择。对于依从使用氟化物的头颈部放疗后患者，建议使用氯己定、含氟漱口水以及复合树脂、树脂改性玻璃离子水门汀（GIC）和汞合金修复体，而不是传统的GIC。
