Oral Radiology -Procedures, Side effects, Recovery time, Costs and alternatives

Oral cancer develops in the mouth tissues or throat. It belongs to a much larger group of cancers called head and neck cancers. Most of this develop in the squamous cells found in the mouth, tongue, and lips. Early detection is key to surviving oral cancer. Oral cancers includes cancers of the lips, tongue, cheek’s inner lining, gums of mouth, floor of the mouth, soft and hard palate.One of the biggest risk factors for oral cancer is the use of tobacco which includes smoking cigars, cigarette, and pipes, as well as chewing tobacco. Treatment for oral cancer depends on the type, location, and stage of the cancer at diagnosis.

Oral maxillofacial radiology is a specialty of the dental field that involves making use of radiographic images (X-rays) for the purpose of treatment and diagnosis of disorders of the mouth, jaw, face, and teeth. Oral maxillofacial radiology involves making use of a combination of x-ray films (standard) along with panoramic and digital x-rays. In the panoramic methodology, the radiographers provide a panoramic view of the lower and upper temporomandibular joints and arches. Oral maxillofacial radiology also finds use in the treatment of diseases of the mouth and jaws like oral cavity and oropharyngeal cancer using radiation. In the treatment of mouth cancers, high energy x-rays are used for either slowing growth rate of the cancer cells or destroying the cancer cells. In the case of small oral cancers oral radiation therapy can be used as the main line of treatment.

Oral radiology makes use of advanced imaging technologies like magnetic resonance imaging (MRI), digital x-ray, ultrasound, pain, and computed tomography.

• Magnetic resonance imaging: it is a radiology technique that makes use of the radio waves, magnetism, and computer for providing supremely detailed images of the structure of the body. It is a painless process. It does not require any exposure to the x-rays thus has no side effects associated with it. MRI is very helpful in providing pinpoint accuracy in detecting the abnormalities that are affecting the patient. After the conduction of the MRI scan, the surgery can be guided more efficiently. The cost of undergoing MRI scanning is high. The closed-in- structure may have a claustrophobic effect in a patient. In people that have a pacemaker implanted in their body are never advised to undergo MRI scanning. Similar is the case for the presence of any other foreign materials like metal implants.
• Digital x-ray: digital x-ray imaging far better and easier than the traditional x-rays. A high definition and three-dimensional digital imaging is obtained with less than 90 percent radiation exposure by making use of x-ray digital sensors. It can help in diagnosing a wide variety of problems. For obtaining a better diagnostic detail and accuracy the digital images of the x-rays can be enhanced and enlarged.
• Ultrasound: this technique is also referred to as sonography. This technique is used for obtaining an image from inside the body by making use of sound waves of high frequency. The echoes of the sound waves are recorded and displayed. This process does not involve any exposure to radiation. This technique helps by providing pinpoint accurate diagnostic results. Ultrasound does not have any side effect associated with its use.
• Plain and computed tomography: the two-dimensional imaging produced by plain tomography and three-dimensional images produced by computed tomography are very helpful in the diagnosing of the several oral maxillofacial disorder. A doctor can plan the treatment of these diseases based on the imaging provided by this procedure. This process is particularly helpful in analyzing whether this appropriate bone structure required for implant placement exists or not.
• A CAT scan (computerized axial tomography) is a procedure for diagnosing disorders associated with the muscles, bones, soft tissue and tumors by obtaining cross-sectional images. These components are displayed by the computer in the form of detailed three-dimensional images that have only minimal distortion. Ct scans are particularly helpful in the diagnosis of oral cancer as it not provide the actual location of the tumor but also described the exact size and density of the tumor. A couple of disadvantages of CT scan include radiation exposure along with the use of contrast dye injections.

Oral or mouth cancers can get treated with the help of radiation therapy. An oral radiologist plays a pivotal role in the treatment of oral cancers using radiation therapy. One of the main lines of treatment for curing small oral cancer is through radiation. In patients suffering from advanced stages of mouth cancer, radiation therapy is given in combination with a surgical procedure for the treatment. Radiation may also be used for shrinking a big tumor so that less extensive surgery is required for removal of that tumor. Radiation therapy can be given in two ways

• External beam radiation therapy: in this therapy, an external beam of radiation which is coming from an outside machine is concentrated on the tumor or cancer cells from outside the body. The exact dose of the radiation along with the correct angle for targeting the cancer cells is decided by the oral radiologist. This is the most common method of giving radiation to cancer affected area of the mouth. This treatment is usually prescribed for 5 days a week and it continues for approximately 7 weeks.
• Brachytherapy: this is another line of treatment belonging to the category of radiation therapy. In this line of treatment, the radiation is given to the patient by placing the radioactive material near the cancer site. This line is treatment is thus referred to as internal radiation. With the advent of a newer approach like IMRT for radiation therapy in treating mouth, cancer brachytherapy is not that commonly used in today’s scenario. It is usually combined with external radiation for treating the cancers of the lip in their early stages.

A treatment through any means usually has some minor or major side effects associated with it.

The minor side effects occur only for a short duration of time and disappear. While in case of serious side effects a doctor must be consulted immediately. Some of the short-term side effects of the radiation therapy of the mouth and throat area include:

• The skin appears to besunburned.
• Soreness and redness along with pain the mouth and throat
• Hoarseness
• Loss of taste.

  There are some long-term side effects of radiation therapy as well. some of the long lasting side effects that may be experienced by a patient include

• Damage to the pituitary glands
• Damage to the salivary glands
• Damage to the jaw bone . In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialistimmediately.

A patient may be referred to an oral maxillofacial radiologist due to any of the reasons given below

• For the diagnosis andtreatment planning of oral cancer.
• If a patient is experiencing facial pain
• For the surgical planning of the tooth extraction, tooth implantation, and oral surgery.
• Evaluating the calcifications of soft tissue in the neck and head.
• Planning of orthodontic treatment.
• For assessing the failed endodontic lesions.
• Assessing the condition of sleep apnea and airways.
• Evaluating the effects of osteonecrosis and bisphosphonates of the jaw.
• Evaluating the development of the tumors and cysts in the mouth.

A patient is required to see an oral maxillofacial radiologist if the dentist feels that imaging is required for the treatment of specific conditions of the mouth like implanting a tooth, evaluating the problem of TMJ along with the location of the site where the disorder of the mouth is occurring. An oncologist refers a patient to the oral radiologist to find out the location of cancer in the mouth. Then oncologist consults with the oral radiologist in the planning the radiation therapy required for the treatment of oral cancer.

The frequency of a patient undergoing oral radiological techniques for evaluating the disease depends on the risk the disease poses, signs and symptoms exhibited by the oral disease and oral health of the patient. The cells of the older patient are at greater risk of being exposed to radiation in comparison to that of children in whom the cells are still growing. The effects of the radiation take years to develop thus an older patient may exhibit the negative effects of the radiation exposure early in comparison to young people. The dose of radiation required for taking images is far less in children in comparison to the adults thus the side effects of the diagnostic radiation exposure may not be observed.

For low-dose examinations like x-rays, the potential benefit of the process outweighs the risk associated. However, in the case where a high dose of radiation may be required like in CT scans, scans involving contrast materials the medical history of the patient when exposed to x- rays must be taken into consideration. Usually, the populace of such patients is very small. Contrast material like iodine may induce side effects like metallic taste in the mouth, itching, throat swelling, breathing difficulty, and warm sensation during injection. These radiological examinations must only be conducted when advised by the doctor and theseexaminations must only be conducted by an oral radiologist as an untrained person may expose the patient to unsafe radiation levels leading to further damaging the condition along with misdiagnosing the conditions that are existing.

The cost of treating oral cancer varies Rs.2 Lacs to Rs.10 Lacs. The cost variation depends on part of the oral cavity is involved i.e. Tongue, Gum, Cheek, Jaw, Palate, Tongue base, Uvella and Stage of the Disease (Early / locally advanced / metastatic) and modality of treatment required as per treatment guidelines to achieve best treatment outcomes.