WALLY IS 60-YEARS-OLD and twelve months ago was diagnosed with a low-grade squamous cell carcinoma on the posterior lateral margin of the tongue. This was linked to his lifetime habits of heavy smoking, and a high intake of alcohol. Following the removal of his mandibular molars, Wally underwent a course of head and neck radiotherapy which produced a useful result.

It nevertheless left him effectively de-salivated and since that time, he has suffered from a profound reduction in salivary output, both at rest and upon stimulation. His dentition is now showing significant areas of demineralization, and these are recurring in a cervical and ring-barking pattern. A major contributor to tooth structure loss has been dental erosion from the low salivary pH. This has affected the labial surfaces of the incisor teeth.

Wally suffers from mild gastric reflux disease, and since his de-salivation from radiation therapy, he has noticed sensitivity developing on the palatal surfaces of the maxillary incisor teeth which showed dentine exposure from erosion.

Aggressive caries and loss of tooth structure from dental erosion and accelerated tooth wear are common complications following head and neck radiotherapy for oral and nasopharyngeal malignancies. These patients require symptomatic relief of their oral dryness, e.g. using GC Dry Mouth Gel applied after each meal, and before retiring. The high likelihood of dental erosion and dental caries in these de-salivated patients makes a strict homecare protocol mandatory, and included within this should be a remineralizing agent which can deliver all the requisite calcium, phosphate and fluoride ions despite a depressed resting salivary pH. The appropriate topical treatment in patients in this group therefore is Tooth Mousse Plus which contains 900ppm fluoride in addition to bioavailable calcium and phosphate in the appropriate ratio for remineralization of tooth structure.