| 1. |
- Almståhl, Annica, 1973, et al.
(författare)
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Explorative study on mucosal and major salivary secretion rates, caries and plaque microflora in head and neck cancer patients
- 2018
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Ingår i: International Journal of Dental Hygiene. - : Wiley. - 1601-5029. ; 16:4, s. 450-458
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse mucosal and major salivary secretion rates, caries and plaque microflora in connection with treatment for cancer in the head and neck region. Methods: Thirty-three patients were included and the number of teeth, filled surfaces and caries lesions registered. The labial and buccal gland secretion and stimulated whole salivary secretion rates were determined. Supragingival plaque microflora was analysed using cultivation technique. Data were collected pretreatment, during treatment and 6 months, 1 year and 2 years post-treatment. Results: Two years post-treatment, 36% had new caries lesions, which had been restored. The labial secretion was comparable with pretreatment, while the buccal secretion was lower (P < .001). The stimulated secretion rate was lower compared with pretreatment (P < .001) and was 0.7 mL/minute for 50%. Growth of lactobacilli increased during treatment (P < .001) and remained increased (P < .001), while growth of mutans streptococci was decreased (P < .01) 2 years post-treatment. Growth of Candida increased over time and was higher 2years post-treatment compared with pretreatment (P < .001) while growth of Prevotella was lower (P < .01). Conclusions: Two years post-treatment, the stimulated salivary secretion rate was substantially decreased, acid-tolerant lactobacilli and Candida increased, acid-sensitive microorganisms decreased, and the caries prevalence was low.
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| 2. |
- Almståhl, Annica, 1973, et al.
(författare)
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Explorative study on quality of life in relation to salivary secretion rate in head and neck cancer patients treated with radiotherapy.
- 2016
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Ingår i: Head & neck. - : Wiley. - 1097-0347 .- 1043-3074. ; 38:5, s. 782-791
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radiation therapy (RT) to the head and neck (H&N) region often results in oral complications. In this explorative study, the pretreatment and posttreatment (6 months and 12 months) quality of life (QoL) was analysed for patients with H&N cancer. The associations between QoL and salivary secretion rates were analysed. Methods: In 29 patients (19 men and 10 women, mean age 59±8 years), the stimulated whole salivary secretion and buccal minor gland secretion were measured. The patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS). Results: One year after the completion of radiotherapy, subjects with hyposalivation (≤ 0.7 ml/min) reported clinically meaningful, but not statistically significant differences, in cognitive functioning, insomnia, swallowing, social eating, dry mouth, sticky saliva and use of painkillers. Statistically significant differences were found for emotional functioning, sticky saliva and dyspnea (p<0.05). Thirtythree percent of them had a HADS score suggesting anxiety problems compared to 8% for those with whole stimulated salivary secretion rates > 0.7 ml/min. Conclusion: Radiotherapy in the H&N region, also using intensity-modulated radiotherapy, is associated with many aspects of life such as cognitive functioning, insomnia, dry mouth and sticky saliva, especially for those with hyposalivation. This article is protected by copyright. All rights reserved.
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| 3. |
- Almståhl, Annica, 1973, et al.
(författare)
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Explorative study on quality of life in relation to salivary secretion rate in head and neck cancer patients treated with radiotherapy up to 2 years post treatment.
- 2019
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Ingår i: International journal of dental hygiene. - : Wiley. - 1601-5037 .- 1601-5029. ; 17:1, s. 46-54
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyse quality of life (QoL) pretreatment and up to 24months post radiation therapy (RT) in patients with head and neck (H&N) cancer.Twenty-nine patients (19 men and 10 women) with a mean age of 59±8years were included. The stimulated salivary secretion was measured and the patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS) pretreatment and at 6, 12 and 24months post RT.At all time-points after RT (6, 12, and 24months), patients with hyposalivation (stimulated secretion rate ≤0.7mL/min) reported clinically significant differences (> 10 points) regarding insomnia, swallowing, social eating, dry mouth, and sticky saliva. Statistically significant differences were found for emotional functioning and insomnia at 12months (P<0.05 for both) and for sticky saliva at both 12 and 24months (P<0.05 and P<0.01). The number of clinically significant differences increased from 10 at both 6 and 12months post-RT to 14 functioning/symptom scales and single items at the 24months follow-up. At 24months post RT, 21% of patients with hyposalivation had HADS scores suggesting anxiety problems compared to 7% for those with stimulated salivary secretion rates >0.7mL/min.Patients with hyposalivation showed deterioration in health related quality of life (QoL) at 24months compared with 12months post RT. Most pronounced were problems with insomnia, swallowing, social eating, dry mouth, and sticky saliva.
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| 4. |
- Almståhl, Annica, 1973, et al.
(författare)
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Microflora in oral ecosystems and salivary secretion rates - A 3-year follow-up after radiation therapy to the head and neck region
- 2015
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Ingår i: Archives of Oral Biology. - : Elsevier BV. - 0003-9969 .- 1879-1506. ; 60:9, s. 1187-1195
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Results indicate that late improvements of radiation therapy (RT) in the head and neck region may diminish the long-term effects on salivary glands and oral microflora. The aim was therefore to analyze salivary secretion rates and oral microflora over time in RT subjects. Design: Twelve dentate subjects (28 +/- 2 teeth) and 12 controls were included. A clinical examination was performed and the salivary secretion rates were determined. Microbial samples, analyzed using cultivation technique, were collected from the soft tissues, supragingival plaque and gingival crevice region. Results: Compared with the controls, the RT group (n = 11) had 3 years post RT higher numbers and proportions of lactobacilli (p < 0.001 and p < 0.01) and Candida albicans (p < 0.01 and p < 0.05) in the supragingival plaque, higher numbers of enterococci in the vestibulum in the molar region and on the tongue (p < 0.05 for both), a lower total count (p < 0.001) and lower numbers of streptococci, Streptococcus salivarius and Fusobacterium nucleatum (p < 0.01) on the tongue. Although both stimulated and unstimulated salivary secretion rates were increased over time, the proportion of microorganisms associated with oral health decreased, and microorganisms associated with oral disorders increased. Despite a comparable oral hygiene, it was only the 27% who had a stimulated salivary secretion rate >= 1.0 ml/min and a buffering capacity >= 6.0, where a recovery of the flora could be seen. Conclusion: The results indicate that regaining a normal, stimulated salivary secretion rate and buffering capacity are prerequisites to regaining an oral flora associated with good oral health. (C) 2015 Elsevier Ltd. All rights reserved.
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| 5. |
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| 6. |
- Almståhl, Annica, 1973, et al.
(författare)
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Mucosal microflora in head and neck cancer patients
- 2018
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Ingår i: International Journal of Dental Hygiene. - : Wiley. - 1601-5029. ; 16:4, s. 459-466
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse the tongue and buccal microflora prospectively in head and neck cancer patients treated with radiation therapy (RT). Methods: In 33 dentate patients, microbial samples from the tongue and buccal mucosa were collected pretreatment, during treatment, and 6 months, 1 year and 2 years post-treatment. Microorganisms associated with oral health and oral disorders were analysed using cultivation technique. Oral mucositis was scored at the appointment during treatment. Results: Compared with pretreatment, lactobacilli and Candida increased on the tongue, while streptococci and Neisseria decreased during treatment. Two years post-treatment, Neisseria and Prevotella were decreased and Candida increased. On the buccal mucosa, an increased growth of lactobacilli and increased detection frequencies of the opportunistic bacteria Staphylococcus aureus, Gram-negative enteric rods and enterococci were seen during treatment compared with pretreatment. Seventy per cent showed severe mucositis during treatment. Two years post-treatment the total count as well as streptococci, Neisseria and Fusobacterium nucleatum were decreased and lactobacilli increased compared with pretreatment. Conclusion: Despite improvements in treatment for cancer in the head and neck region, microorganisms associated with oral health decrease during treatment and mucosal pathogens increase. Two years post-treatment, levels of acid-tolerant (lactobacilli and Candida) were increased, while acid-sensitive microorganisms (Neisseria and F.nucleatum) were decreased, plausibly due to persisting decreased salivary secretion rate.
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| 7. |
- Johnson, Joakim, et al.
(författare)
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Development and validation of the Gothenburg Trismus Questionnaire (GTQ).
- 2012
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Ingår i: Oral oncology. - : Elsevier BV. - 1368-8375. ; 48:8, s. 730-736
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To develop and validate a comprehensive, self-administered questionnaire for patients with limited ability to open the mouth, trismus. MATERIALS AND METHODS: We derived the Gothenburg Trismus Questionnaire (GTQ) from empirical evidence in the medical literature and interviews with medical experts as well as patients. The draft version was tested in a pilot study (n=18). Patients with a maximal incisal opening (MIO) of ⩽35mm were included. The study comprised patients with benign jaw-related conditions (n=51), patients treated for head and neck (H&N) cancer (n=78) and an age- and gender-matched control group without trismus (n=129). RESULTS: The GTQ instrument was well accepted by the patients, with satisfactory compliance and low rates of missing items. After item reduction, due to items not being conceptually relevant and/or low factor loadings, the GTQ demonstrated high internal consistency (Cronbach's alpha 0.72-0.90), good construct validity and known-group validity. CONCLUSION: We developed a trismus-specific self-administered questionnaire, the GTQ, that showed good psychometric properties. We suggest this questionnaire, that has clear clinical relevance, to be adopted and used in clinical practice and in research, acting as a screening tool as well as an endpoint in intervention and jaw physiotherapy/rehabilitation studies.
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| 8. |
- Johnson, Joakim, et al.
(författare)
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Trismus in head and neck cancer patients in Sweden: incidence and risk factors.
- 2010
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Ingår i: Medical science monitor. - 1234-1010. ; 16:6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim was to retrospectively investigate trismus (reduced mandible mobility) development in specified head and neck (H&N) cancer diagnosis according to different radiotherapy dosage regimens. MATERIAL/METHODS: Sixty-nine out of 246 patients with different H&N cancer diagnoses and available maximum interincisal opening (MIO) measurements before and after treatment were analyzed according to age, gender, radiation dose, tumor site and stage, and Karnofsky Performance Status Scale index. MIO was measured over time (range: 3-48 months), with a cutoff criterion for trismus of 35 mm. RESULTS: Overall, 42% of the patients had post-treatment MIO <35 mm, and trismus incidence was highest in patients treated for parotid gland tumors followed by those treated for nasopharyngeal cancers. The mean MIO values at baseline were significantly different (p=0.0078) between patients who developed trismus (i.e. MIO <35 mm; mean: 43 mm) and those who did not (mean: 51 mm). The trismus patients also had significantly larger tumors (p=0.0437), poorer physical function before start of treatment (p=0.0344), and had more often received a higher total tumor radiation dose (p=0.0418). CONCLUSIONS: This study reports a high incidence of trismus in H&N cancer patients after treatment. Furthermore, it was found that poor physical function before the start of treatment and high external beam radiation therapy (EBRT) dosages (>50 Gy) were related to significantly more trismus. Future prospective studies are needed to provide a better understanding of different risk factors associated with trismus development, the impact on health-related quality of life, and the effects of early treatment.
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| 9. |
- Montalvo, Charlotte, et al.
(författare)
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Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study.
- 2020
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Ingår i: Ear, nose, & throat journal. - : SAGE Publications. - 1942-7522 .- 0145-5613.
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Tidskriftsartikel (refereegranskat)abstract
- Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.
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| 10. |
- Pauli, Nina, et al.
(författare)
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Exercise intervention for the treatment of trismus in head and neck cancer.
- 2014
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Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 53:4, s. 502-509
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Tidskriftsartikel (refereegranskat)abstract
- Background. The aim of this study was to investigate the impact of structured exercise with jaw mobilizing devices on trismus and its effect on trismus symptomatology and health-related quality of life (HRQL) in head and neck (H&N) cancer patients. Material and methods. Fifty patients with H&N cancer and trismus, i.e. maximum interincisal opening (MIO) ≤ 35 mm participated in a structured intervention program with jaw exercise. The patients in the intervention group underwent a 10-week exercise program with regular follow-up. A control group comprising of 50 patients with trismus and H&N cancer were matched to the intervention group according to gender, tumor location, tumor stage, comorbidity and age. HRQL and trismus-related symptoms were assessed. Results. The mean MIO improvement was 6.4 mm (4.8-8.0) and 0.7 (-0.3-1.7) mm in the intervention group and control group respectively, three months post-intervention commencement (p < 0.001). The intervention group demonstrated a statistically significant improvement in Role functioning, Social functioning and Global quality of life (EORTC QLQ C30) and in all Gothenburg Trismus Questionnaire (GTQ) domains, i.e. jaw-related problems (p < 0.001), eating limitation (p < 0.05) and muscular tension (p < 0.001). Conclusion. We found that a structured jaw exercise program was effective and improved the mouth opening capacity significantly. The objective effect on trismus (MIO) was also reflected in the patient-reported outcome questionnaires where the patients who underwent the structured exercise program after cancer treatment reported improvements in HRQL and less trismus-related symptoms compared to the control group.
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