Neurotoxicity
Selected classes of chemotherapy, including the vinca alkaloids, vincristine,
and vinblastine, can cause direct neurotoxicity. Deep-seated, throbbing
mandibular pain can occur. Since this symptom is also consistent with acute
dental pulpal disease, it is important that a thorough history and oral
physical examination be performed when oral pain is present; radiographs and
vitality testing of the dental pulp are typically necessary. After neurotoxicity is
appropriately diagnosed, management includes pain support and
patient counseling. The symptom generally resolves within a week
following cessation of the causative chemotherapy.
Dental hypersensitivity may occasionally arise in patients weeks or months
after discontinuation of chemotherapy. Additionally, it has been observed that patients being treated with cyclosporine for treatment of graft-versus-host disease will report increased thermal sensitivity. The mechanisms of this response are not known. Fortunately, thermal stimuli are self-resolving after discontinuation or withdrawal of therapy, though they can persist for several months. Topical
application of fluorides and/or desensitizing toothpaste may ameliorate the
discomfort.
Patients may experience temporomandibular dysfunction pain involving muscles of mastication, temporomandibular joints, or teeth. This condition is not unique to cancer patients, and
it correlates with stress and dysfunctional habits including bruxism and clenching
of the jaws. Stress and sleep dysfunction appear to be the most frequent etiologic factors. Judicious use of muscle relaxants or anxiety-reducing agents plus
physical therapy (moist heat applications, massage, and gentle stretching) are
standard approaches for management. For patients who have propensity for
clenching or bruxism during sleep, customized occlusal splints for use while
sleeping may be of value.
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