A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 1.

The incidence of head and neck cancer is on the rise. Most head and neck cancers are treated with surgery, radiotherapy, chemotherapy or a combination of these modalities. Patients undergoing radiotherapy can experience several unwanted oral side effects, which have both short and long term implications. Dental general practitioners should be aware of these implications and should liaise closely with the restorative consultants and the oncology team to establish the best oral care pathway. This two-part series is a review of the oral changes that occur during and after radiotherapy and the oral management of head and neck oncology before, during and after radiotherapy. This article deals with both immediate sequelae such as cellulitis, mucositis, dysphagia, dysguesia and weight loss as well as long term sequelae such as rampant caries, trismus, xerostomia and osteoradionecrosis. It also encompasses the importance and need for pre-radiotherapy assessment.

A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 2.

The incidence of head and neck cancer is on the rise. Radiation therapy is one of the major treatment modalities for the management of oral malignancies. As with any treatment modality, radiation therapy is associated with various complications. The second part of this series is a review of the oral changes that occur during and after radiotherapy and the oral management of head and neck oncology patients before, during and after radiotherapy. Dental practitioners will encounter patients who have been affected by cancer or who are current cancer patents. General dental practitioners (GDPs) have a vital and proactive role in supporting such patients. The aim of this article is to review the oral management of these patients during and after radiotherapy, and gives practical advice for GDPs and their teams in the long-term care of these patients.

The effect of monosodium glutamate on parotid salivary flow in comparison to the response to representatives of the other four basic tastes.

Parotid salivary flow was recorded from eight fit and healthy subjects using modified Lashley cups connected to an instantaneous flow meter in response to gustatory stimuli. The gustatory stimuli were monosodium glutamate (MSG), sodium chloride, sucrose, magnesium sulphate and citric acid. Stimuli were applied for 30 s, and repeated after the flows had returned to baseline following the rinse. Subjects were a significant source of variation for salivary response to each different test stimuli (p<0.001). The normalised salivary flow showed a strong correlation to concentration for all test stimuli (p<0.0001). The parotid salivary flow to MSG (umami) showed a dose-dependant response in which both Na(+) and glutamate ions contributed. The overall order of relative salivary flow responses from highest to lowest flows was citric acid (sour)>MSG (umami)>NaCl (salt)>sucrose (sweet)>=magnesium sulphate (bitter). The relative responses of the peak salivary flows showed the same ordered relation. The peak salivary flow provided a greater contribution to the response to citric acid, NaCl and MSG compared to the response to sucrose and magnesium sulphate.

Is there a parotid-salivary reflex response to fat stimulation in humans?

The perception of fats in foods may involve gustatory, olfactory or textural cues. There is contradictory evidence as to whether the orosensory perception of fat is as a basic quality of taste or related to the physical characteristics of fat. A dose-response reflex parotid-salivary secretion has, however, been shown for the accepted basic taste qualities. The aim of this study was to establish whether varying fat concentration in two food types causes an associated dose-response reflex parotid secretion in humans. Parotid salivary flow was recorded using Lashley cups and cannulae connected to an instantaneous flow meter. Gustatory stimuli were achieved using 3 ml of skimmed (0.1% fat), semi-skimmed (1.7% fat) or full (3.6% fat) milk (Sainsbury) or 5 g of extra-light (5% fat), light (16% fat) or original (24% fat) cream cheese (Kraft). No significant differences in salivary flow rate were shown within the milk group (n=10, P=.93) or within the cream-cheese group (n=11, P=.82). Furthermore, no correlation was observed between increasing fat concentration and flow within either the milk (P=.98) or the cream-cheese group (P=.69; Pearson Product Moment Correlation). These results do not support the hypothesis that there is a fat-specific dose-response parotid reflex.