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Mucosal microflora in head and neck cancer patients

Journal article
Authors Annica Almståhl
Caterina Finizia
Anette Carlén
Bodil Fagerberg-Mohlin
Torgny Alstad
Published in International Journal of Dental Hygiene
Volume 16
Issue 4
Pages 459-466
ISSN 1601-5029
Publication year 2018
Published at Institute of Odontology
Institute of Clinical Sciences, Department of Otorhinolaryngology
Pages 459-466
Language en
Keywords buccal mucosa, head and neck cancer patients, hyposalivation, microflora, radiation therapy, tongue, patients receiving radiotherapy, radiation-therapy, oral ecosystems, carcinoma patients, salivary flow, risk-factors, colonization, candidiasis, microbiome, mucositis, Dentistry, Oral Surgery & Medicine
Subject categories Dentistry


Objective: To analyse the tongue and buccal microflora prospectively in head and neck cancer patients treated with radiation therapy (RT). Methods: In 33 dentate patients, microbial samples from the tongue and buccal mucosa were collected pretreatment, during treatment, and 6 months, 1 year and 2 years post-treatment. Microorganisms associated with oral health and oral disorders were analysed using cultivation technique. Oral mucositis was scored at the appointment during treatment. Results: Compared with pretreatment, lactobacilli and Candida increased on the tongue, while streptococci and Neisseria decreased during treatment. Two years post-treatment, Neisseria and Prevotella were decreased and Candida increased. On the buccal mucosa, an increased growth of lactobacilli and increased detection frequencies of the opportunistic bacteria Staphylococcus aureus, Gram-negative enteric rods and enterococci were seen during treatment compared with pretreatment. Seventy per cent showed severe mucositis during treatment. Two years post-treatment the total count as well as streptococci, Neisseria and Fusobacterium nucleatum were decreased and lactobacilli increased compared with pretreatment. Conclusion: Despite improvements in treatment for cancer in the head and neck region, microorganisms associated with oral health decrease during treatment and mucosal pathogens increase. Two years post-treatment, levels of acid-tolerant (lactobacilli and Candida) were increased, while acid-sensitive microorganisms (Neisseria and F.nucleatum) were decreased, plausibly due to persisting decreased salivary secretion rate.

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