Antibiotic Prophylaxis in Dentistry: Key Differences Between Pediatric and Adult Patients

Antibiotic prophylaxis in dentistry is a preventive strategy aimed at reducing the risk of bacteremia-related systemic infections associated with invasive dental procedures.

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Dental Article 🔽 Antibiotics in Pediatric Dentistry: When They Are Needed and When They Are Not ... This guide reviews indications, contraindications, dosing considerations, and clinical decision-making for antibiotics in pediatric patients, with updated evidence-based recommendations.

Although general principles are shared, significant differences exist between pediatric and adult patients, particularly regarding pharmacokinetics, pharmacodynamics, indications, and risk assessment. Understanding these distinctions is essential to ensure safe, effective, and evidence-based dental care.

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✅ Indications for Antibiotic Prophylaxis in Dentistry
Current international guidelines emphasize that antibiotic prophylaxis should be limited to high-risk patients rather than applied routinely. The main indications include:

▪️ Patients with specific cardiac conditions at high risk of infective endocarditis
▪️ Immunocompromised individuals
▪️ Selected cases involving prosthetic joint complications, based on medical consultation
In pediatric dentistry, indications are even more restrictive due to immature organ systems and increased susceptibility to adverse drug reactions.

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✅ Pharmacological Differences Between Pediatric and Adult Patients

Pharmacokinetics
Children differ from adults in drug absorption, distribution, metabolism, and elimination. Factors such as higher total body water, lower plasma protein binding, and immature hepatic and renal function directly influence antibiotic dosing and frequency.

Pharmacodynamics
Pediatric patients may demonstrate altered therapeutic and toxic responses to antibiotics. Consequently, weight-based dosing and strict adherence to maximum recommended doses are mandatory to avoid toxicity or subtherapeutic exposure.

📊 Comparative Table: Pharmacokinetic and Pharmacodynamic Differences in Antibiotic Prophylaxis

Pharmacological Parameter	Pediatric Patients	Adult Patients
Drug Absorption	Variable gastrointestinal absorption due to immature digestive function	Predictable and stable absorption patterns
Drug Distribution	Higher total body water and lower plasma protein binding	More consistent volume of distribution
Metabolism	Immature hepatic enzyme systems	Fully developed hepatic metabolism
Renal Elimination	Reduced glomerular filtration rate in younger children	Stable renal clearance in healthy adults
Dose Calculation	Strict weight-based dosing required	Standard fixed dosing

💬 Discussion
The overuse of antibiotic prophylaxis in dentistry has been identified as a contributing factor to antimicrobial resistance, adverse drug reactions, and unnecessary healthcare costs. Pediatric patients are particularly vulnerable due to developing physiological systems and a higher risk of dosing errors.
In adults, systemic comorbidities often influence prophylactic decisions, whereas in children, cardiac status and immune maturity play a central role. Evidence-based guidelines consistently emphasize risk stratification over routine prescription, regardless of age group.

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✍️ Conclusion
Antibiotic prophylaxis in dentistry should be individualized, taking into account age-related pharmacological differences, systemic risk factors, and current clinical guidelines. Pediatric patients require greater caution, precise dosing, and stricter indications compared to adults. Adherence to evidence-based protocols is fundamental to optimize patient safety and reduce unnecessary antibiotic exposure.

🎯 Clinical Recommendations
Avoid routine antibiotic prophylaxis in low-risk dental procedures
Apply weight-based dosing and respect maximum dosage limits in children
Consult medical specialists when managing high-risk cardiac or immunocompromised patients
Follow updated international guidelines to prevent antimicrobial resistance

📚 References

✔ American Dental Association. (2021). Antibiotic prophylaxis prior to dental procedures. Journal of the American Dental Association, 152(6), 448–449. https://doi.org/10.1016/j.adaj.2021.03.004
✔ American Heart Association. (2021). Prevention of viridans group streptococcal infective endocarditis. Circulation, 143(20), e963–e978. https://doi.org/10.1161/CIR.0000000000000969
✔ American Academy of Pediatric Dentistry. (2023). Guideline on antibiotic prophylaxis for dental patients at risk. The Reference Manual of Pediatric Dentistry.
✔ Wilson, W., Taubert, K. A., Gewitz, M., et al. (2007). Prevention of infective endocarditis. Circulation, 116(15), 1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095

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Principles for the Management of Odontogenic Infections: An Evidence-Based Clinical Approach

Odontogenic infections remain a significant clinical challenge in dental practice due to their potential for rapid progression and life-threatening complications. These infections originate from dental or periodontal tissues and may spread to adjacent fascial spaces if not managed appropriately.

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The cornerstone of effective management lies in the early recognition, accurate diagnosis, and adherence to well-established treatment principles.

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The management framework proposed by Peterson et al. continues to be widely accepted and serves as a systematic, evidence-based protocol for controlling odontogenic infections while minimizing morbidity and mortality.

✅ Conceptual Framework for the Management of Odontogenic Infections
Although Peterson et al. originally proposed an eight-step protocol for the management of odontogenic infections, Velasco and Soto later introduced a simplified and clinically oriented adaptation. In their article Principles for the Management of Odontogenic Infections with Different Levels of Complexity, the authors condensed the original framework into seven core principles, maintaining diagnostic rigor and therapeutic effectiveness while improving clinical applicability.
This simplified model emphasizes sound clinical decision-making, prioritization of surgical intervention, and patient-centered care, making it particularly valuable in routine dental practice and academic training. Accordingly, the present article adopts the seven-step protocol proposed by Velasco and Soto, which remains firmly grounded in Peterson’s original principles while offering a more streamlined and practical approach for managing odontogenic infections across varying levels of severity.

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I. Determining the Etiology and Severity of the Infection
The first and most critical step is identifying the source and extent of the infection. Odontogenic infections typically arise from:

▪️ Pulpal necrosis
▪️ Periapical pathology
▪️ Periodontal infections
▪️ Pericoronal infections
Severity assessment must include evaluation of pain, swelling, fever, trismus, dysphagia, airway compromise, and fascial space involvement. Severe or rapidly spreading infections require urgent intervention due to the risk of systemic involvement.

II. Evaluation of Medical History and Immune Status
A comprehensive medical history is essential to identify conditions that may alter disease progression or treatment response. Patients with diabetes mellitus, immunosuppression, malignancies, or chronic systemic diseases are at higher risk for complications.
Understanding the patient’s immune status allows clinicians to anticipate aggressive disease behavior and tailor treatment accordingly.

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III. Decision on the Appropriate Setting of Care
The decision to manage the infection on an outpatient or inpatient basis depends on:

▪️ Severity and anatomical spread
▪️ Presence of systemic signs
▪️ Airway involvement
▪️ Patient’s general health status
Hospitalization is mandatory when there is airway compromise, systemic toxicity, dehydration, or involvement of deep cervical or fascial spaces.

IV. Surgical Management
Surgical intervention is the primary treatment modality for odontogenic infections. This includes:
▪️ Elimination of the infection source (tooth extraction or endodontic treatment)
▪️ Incision and drainage of abscesses
▪️ Adequate debridement of necrotic tissue
Antibiotics alone are insufficient without proper surgical management, especially in established abscesses.

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V. Medical and Nutritional Support
Supportive care plays a crucial role in recovery. Patients with severe infections often require:

▪️ Hydration therapy
▪️ Pain control
▪️ Nutritional support to maintain immune function
Adequate caloric intake and fluid balance are essential, particularly in patients with fever, dysphagia, or prolonged infection.

VI. Appropriate Selection and Prescription of Antibiotics
Antibiotic therapy should be adjunctive, not a substitute for surgical treatment. Selection must be based on:

▪️ Likely causative microorganisms
▪️ Local antimicrobial resistance patterns
▪️ Patient allergies and systemic condition
Empirical therapy often targets aerobic and anaerobic oral flora, with adjustments made based on clinical response. Rational antibiotic use is critical to prevent antimicrobial resistance.

VII. Periodic Patient Evaluation
Continuous monitoring is essential to assess treatment effectiveness. Follow-up should include evaluation of:

▪️ Reduction in swelling and pain
▪️ Improvement in systemic symptoms
▪️ Restoration of function
Failure to improve within 48–72 hours necessitates reassessment of diagnosis, surgical adequacy, and antimicrobial therapy.

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💬 Discussion
The principles proposed by Peterson et al. provide a structured and reproducible approach to managing odontogenic infections. Their strength lies in emphasizing early surgical intervention, patient-centered care, and judicious antibiotic use. In the context of rising antimicrobial resistance, adherence to these principles is more relevant than ever in contemporary dental practice.

✍️ Conclusion
The successful management of odontogenic infections depends on strict adherence to evidence-based principles, including accurate diagnosis, timely surgical intervention, appropriate antibiotic selection, and close patient monitoring. Applying the Peterson protocol systematically reduces complications and improves clinical outcomes.

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🎯 Clinical Recommendations
▪️ Always identify and eliminate the primary source of infection
▪️ Assess systemic and immune status before treatment planning
▪️ Do not rely solely on antibiotics without surgical intervention
▪️ Re-evaluate patients regularly to ensure clinical resolution
▪️ Refer or hospitalize promptly when airway or systemic involvement is suspected

📚 References

✔ Peterson, L. J., Ellis, E., Hupp, J. R., & Tucker, M. R. (2012). Contemporary Oral and Maxillofacial Surgery (6th ed.). St. Louis, MO: Mosby Elsevier.
✔ Flynn, T. R. (2011). Principles and surgical management of head and neck infections. Oral and Maxillofacial Surgery Clinics of North America, 23(3), 355–365.
✔ Hupp, J. R., Tucker, M. R., & Ellis, E. (2019). Contemporary Oral and Maxillofacial Surgery (7th ed.). Elsevier.
✔ Brook, I. (2017). Microbiology and management of odontogenic infections. Oral and Maxillofacial Surgery Clinics of North America, 29(4), 435–444.
✔ Velasco M., I., & Soto N., R. (2012). Principios para el tratamiento de infecciones odontogénicas con distintos niveles de complejidad. Revista Chilena de Cirugía, 64(6), 586–598.

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Management of Bruxism with Night Guards: An Updated Guide for Dental Professionals

Bruxism is a common parafunctional activity characterized by involuntary clenching or grinding of teeth, occurring during sleep or wakefulness. It is associated with tooth wear, temporomandibular disorders (TMD), muscle pain, and restorative complications.

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Current evidence indicates that bruxism has a multifactorial etiology, including central nervous system regulation, psychosocial factors, and sleep-related mechanisms.

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Night guards (occlusal splints) are widely used in dental practice as a conservative management approach. However, it is essential to emphasize that night guards do not cure bruxism; instead, they protect oral structures and reduce the clinical consequences of excessive occlusal forces.

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✅ Understanding Bruxism: Clinical Considerations
Bruxism is classified as:

▪️ Sleep bruxism, a sleep-related movement disorder.
▪️ Awake bruxism, often associated with stress and behavioral factors.
Clinical diagnosis relies on patient history, clinical signs (wear facets, fractures), muscle tenderness, and, in selected cases, instrumental assessments. Accurate diagnosis is essential to avoid overtreatment and to select appropriate management strategies.

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✅ Role of Night Guards in Bruxism Management
Night guards act as protective and biomechanical devices, reducing direct tooth-to-tooth contact and redistributing occlusal forces. Their main clinical roles include:

▪️ Prevention of enamel wear and fractures
▪️ Reduction of muscle hyperactivity
▪️ Protection of restorations and prostheses
▪️ Symptom relief in TMD-related discomfort
Importantly, night guards do not modify the central mechanisms responsible for bruxism, reinforcing the need for patient education and realistic expectations.

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✅ Types of Night Guards
Commonly used appliances include:

▪️ Hard acrylic stabilization splints, typically fabricated for the maxilla
▪️ Soft or dual-laminate splints, often used for short-term protection
▪️ Anterior bite appliances, indicated in selected cases under strict monitoring
Material selection and design should be based on occlusal stability, symptom severity, and patient compliance.

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✅ Clinical Indications and Limitations
Night guards are indicated for patients with:

▪️ Moderate to severe tooth wear
▪️ Recurrent restoration failure
▪️ Muscle-related pain associated with bruxism
▪️ Temporomandibular discomfort

Limitations include:
▪️ Lack of effect on bruxism frequency
▪️ Possible occlusal changes if poorly designed or improperly monitored
▪️ Dependence on patient adherence

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✅ Multidisciplinary Management Approach
Optimal bruxism management requires a multimodal strategy, combining:

▪️ Occlusal protection (night guards)
▪️ Behavioral counseling and stress management
▪️ Sleep hygiene optimization
▪️ Referral to medical professionals when sleep disorders are suspected

💬 Discussion
Current literature supports night guards as an effective method for damage control rather than etiologic treatment. Their value lies in preventing irreversible dental damage and improving patient comfort. Dentists must clearly communicate their protective role and integrate them into a broader management plan tailored to individual risk factors.

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✍️ Conclusion
Night guards remain a cornerstone in the conservative management of bruxism, offering significant protection against dental and muscular complications. However, they should be prescribed with a clear understanding of their limitations and supportive role within a comprehensive, evidence-based treatment strategy.

🎯 Clinical Recommendations
▪️ Perform a thorough clinical assessment before prescribing a night guard
▪️ Educate patients that night guards control consequences, not causes
▪️ Ensure regular follow-up to monitor occlusion and appliance wear
▪️ Integrate behavioral and medical interventions when indicated

📊 Comparative Table: Treatment Options for Bruxism

Treatment Approach	Clinical Benefits	Limitations
Night Guards (Occlusal Splints)	Protect teeth and restorations; reduce muscle load; improve comfort	Do not eliminate bruxism; require patient compliance
Behavioral Therapy	Addresses stress-related triggers; useful in awake bruxism	Limited effect on sleep bruxism; requires long-term commitment
Pharmacological Management	May reduce muscle activity in selected cases	Not recommended for routine use; potential side effects
Physiotherapy	Improves muscle function and reduces pain	Supportive role only; does not prevent tooth wear

📚 References

✔ Lobbezoo, F., Ahlberg, J., Glaros, A. G., et al. (2018). Bruxism defined and graded: An international consensus. Journal of Oral Rehabilitation, 45(11), 837–844.
✔ Manfredini, D., Winocur, E., Guarda-Nardini, L., Paesani, D., & Lobbezoo, F. (2013). Epidemiology of bruxism in adults. Journal of Orofacial Pain, 27(2), 99–110.
✔ Klasser, G. D., & Greene, C. S. (2009). The changing field of temporomandibular disorders. Journal of the Canadian Dental Association, 75(7), 507–512.
✔ Dao, T. T. T., & Lavigne, G. J. (1998). Oral splints: The crutches for temporomandibular disorders and bruxism? Critical Reviews in Oral Biology & Medicine, 9(3), 345–361.

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Antimicrobial Resistance in Pediatric Dentistry: Rational Antibiotic Use in Childhood Infections

Antimicrobial resistance (AMR) has emerged as a critical global public health challenge, directly affecting dental practice. In pediatric dentistry, inappropriate or excessive antibiotic prescribing contributes significantly to the development of resistant microbial strains.

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Since most odontogenic infections in children can be managed through local operative measures, antibiotics should be prescribed only when clinically justified. This article reviews the mechanisms, clinical implications, and principles of rational antibiotic use in pediatric dental infections, emphasizing prevention of antimicrobial resistance.

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✅ Antimicrobial Resistance: Mechanisms and Clinical Impact
Antimicrobial resistance occurs when microorganisms survive exposure to antibiotics through adaptive mechanisms such as:
▪️ Enzymatic inactivation of antibiotics
▪️ Alteration of bacterial target sites
▪️ Reduced membrane permeability
▪️ Efflux pump activation
In pediatric patients, AMR may result in treatment failure, prolonged infections, increased hospitalization, and limited therapeutic options. Resistant oral pathogens may also disseminate systemically, posing serious health risks.

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✅ Common Pediatric Odontogenic Infections
Most dental infections in children originate from:

▪️ Dental caries progressing to pulpal necrosis
▪️ Periapical and periodontal infections
▪️ Acute dentoalveolar abscesses
▪️ Cellulitis of odontogenic origin
Importantly, antibiotics alone do not eliminate the source of infection. Definitive treatment involves pulp therapy, drainage, or extraction.

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✅ Principles of Rational Antibiotic Use in Pediatric Dentistry
Rational antibiotic prescribing is based on the following principles:

▪️ Accurate diagnosis
▪️ Assessment of systemic involvement
▪️ Use of narrow-spectrum antibiotics when possible
▪️ Correct dosage based on body weight
▪️ Appropriate duration of therapy
▪️ Avoidance of antibiotics for localized infections without systemic signs
Antibiotics are indicated only in cases presenting with fever, facial swelling, lymphadenopathy, malaise, or risk of systemic spread.

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✅ Most Commonly Used Antibiotics in Pediatric Dentistry
First-line antibiotics typically include penicillin derivatives, due to their efficacy and safety profile. Alternatives are reserved for patients with allergies or specific clinical conditions.

✅ Prevention of Antimicrobial Resistance
Preventive strategies include:

▪️ Emphasizing early caries management
▪️ Educating parents on the limited role of antibiotics
▪️ Following evidence-based clinical guidelines
▪️ Avoiding prophylactic antibiotic misuse
▪️ Promoting oral hygiene and preventive programs
Dentists play a crucial role in antimicrobial stewardship within the pediatric population.

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💬 Discussion
Despite well-established guidelines, antibiotics continue to be overprescribed in pediatric dental care. Misconceptions among caregivers and fear of complications often contribute to unnecessary prescriptions. Integrating clinical judgment, updated guidelines, and patient education is essential to curb antimicrobial resistance. Pediatric dentists must act as stewards of responsible antibiotic use.

🎯 Recommendations
▪️ Prescribe antibiotics only when systemic involvement is present
▪️ Prioritize local operative treatment over pharmacological management
▪️ Use weight-based dosing and shortest effective duration
▪️ Document antibiotic indication clearly in clinical records
▪️ Educate caregivers about antibiotic resistance and adherence

✍️ Conclusion
Antimicrobial resistance in pediatric dentistry is preventable through rational antibiotic use and adherence to evidence-based protocols. Dentists must prioritize definitive dental treatment, reserve antibiotics for clearly indicated cases, and actively participate in antimicrobial stewardship to protect pediatric patients and public health.

📊 Comparative Table: Commonly Used Antibiotics in Pediatric Dentistry

Antibiotic	Clinical Indications	Limitations and Risks
Amoxicillin	First-line treatment for acute odontogenic infections with systemic involvement	Increasing resistance; ineffective without source control
Amoxicillin–Clavulanic Acid	Infections caused by beta-lactamase–producing bacteria	Higher risk of gastrointestinal adverse effects
Clindamycin	Alternative for penicillin-allergic patients	Risk of Clostridioides difficile infection
Azithromycin	Selected cases with penicillin allergy	Limited anaerobic coverage; resistance concerns

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Guideline on antibiotic therapy for pediatric dental patients. Pediatric Dentistry, 45(6), 357–364.
✔ World Health Organization. (2023). Global antimicrobial resistance and use surveillance system (GLASS) report. WHO.
✔ Robertson, D., & Smith, A. J. (2009). The microbiology of the acute dental abscess. Journal of Medical Microbiology, 58(2), 155–162. https://doi.org/10.1099/jmm.0.003517-0
✔ Sweeney, L. C., Dave, J., Chambers, P. A., & Heritage, J. (2004). Antibiotic resistance in general dental practice—a cause for concern? Journal of Antimicrobial Chemotherapy, 53(4), 567–576. https://doi.org/10.1093/jac/dkh137

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Tongue Cancer: Early Warning Signs, Prevention, and the Role of Self-Examination

Tongue cancer is one of the most common malignancies of the oral cavity and represents a significant global health concern. Early detection remains a decisive factor for patient survival and quality of life.

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Dentists play a critical role in identifying early warning signs, promoting preventive strategies, and educating patients about oral self-examination. This article reviews the clinical features, risk factors, prevention measures, and pre- and post-treatment care related to tongue cancer.

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✅ Etiology and Risk Factors
Tongue cancer is predominantly classified as oral squamous cell carcinoma (OSCC). Its development is multifactorial and strongly associated with:

▪️ Tobacco use (smoked and smokeless)
▪️ Excessive alcohol consumption
▪️ Human papillomavirus (HPV), especially HPV-16
▪️ Chronic mechanical irritation
▪️ Poor oral hygiene
▪️ Immunosuppression
▪️ Nutritional deficiencies (iron, folate, vitamin B12)
The synergistic effect of tobacco and alcohol significantly increases carcinogenic risk.

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✅ Early Warning Signs and Clinical Manifestations
Early recognition is essential for improving prognosis. Warning signs of tongue cancer include:

▪️ Persistent ulceration lasting more than two weeks
▪️ Indurated or non-healing lesions
▪️ Red (erythroplakia) or white (leukoplakia) patches
▪️ Pain or burning sensation
▪️ Difficulty chewing, swallowing, or speaking
▪️ Unexplained bleeding
▪️ Palpable cervical lymphadenopathy
Lesions often appear on the lateral borders and ventral surface of the tongue, areas that require meticulous clinical examination.

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✅ Importance of Oral Self-Examination
Oral self-examination is a simple and cost-effective strategy that empowers patients to identify suspicious changes at an early stage. Patients should be instructed to:

▪️ Inspect the tongue under good lighting
▪️ Palpate both lateral borders
▪️ Observe color changes, ulcers, or masses
▪️ Seek professional evaluation if abnormalities persist beyond 14 days
Self-examination complements professional screening but does not replace routine dental examinations.

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✅ Pre-Treatment Care
Before initiating oncologic treatment, dental management aims to minimize complications:

▪️ Comprehensive oral examination
▪️ Elimination of active infections
▪️ Extraction of non-restorable teeth
▪️ Oral hygiene instruction
▪️ Fluoride therapy to reduce post-treatment caries risk
Pre-treatment dental care is essential in patients scheduled for surgery, radiotherapy, or chemotherapy.

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✅ Post-Treatment Care and Oral Management
Post-treatment complications may significantly affect oral function and quality of life. Dental professionals should monitor and manage:

▪️ Xerostomia
▪️ Mucositis
▪️ Dysgeusia
▪️ Trismus
▪️ Osteoradionecrosis
Long-term follow-up includes regular oral examinations, salivary substitutes, topical fluoride use, and reinforcement of oral hygiene practices.

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✅ Prevention Strategies
Primary prevention focuses on reducing exposure to known risk factors:

▪️ Smoking cessation and alcohol moderation
▪️ HPV vaccination
▪️ Nutritional counseling
▪️ Regular dental check-ups
▪️ Public education on early signs of oral cancer
Secondary prevention emphasizes early diagnosis through routine screening and self-examination.

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💬 Discussion
Despite advances in oncologic therapies, tongue cancer continues to present diagnostic challenges due to late patient presentation. Dentists are strategically positioned to detect early lesions and initiate timely referral. Integrating patient education, preventive counseling, and systematic oral examination significantly improves outcomes.

🎯 Recommendations
▪️ Perform systematic tongue examination during every dental visit
▪️ Educate patients on oral self-examination techniques
▪️ Refer suspicious lesions promptly for biopsy
▪️ Collaborate with oncologists in pre- and post-treatment dental care
▪️ Promote preventive public health strategies

✍️ Conclusion
Tongue cancer remains a potentially life-threatening condition, yet it is highly curable when detected early. Dentists play a fundamental role in prevention, early diagnosis, and long-term oral management. Emphasizing self-examination, risk factor control, and regular dental screening is essential to reducing morbidity and mortality associated with this disease.

📚 References

✔ Warnakulasuriya, S. (2020). Oral potentially malignant disorders: A comprehensive review. Oral Oncology, 102, 104550. https://doi.org/10.1016/j.oraloncology.2019.104550
✔ World Health Organization. (2023). WHO classification of head and neck tumours (5th ed.). IARC Press.
✔ National Comprehensive Cancer Network. (2024). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. NCCN.
✔ Rivera, C. (2015). Essentials of oral cancer. International Journal of Clinical and Experimental Pathology, 8(9), 11884–11894.

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