Not long ago I had the opportunity to listen to one of my dental school classmates present information on the dentist’s role in cancer treatment. Dennis M. Abbott, DDS is the founder and CEO of Dental Oncology Professionals and is passionate about caring for cancer patients and survivors.
Seeking dental care prior to beginning cancer treatment can improve your quality of life and the likelihood treatment will proceed as planned. I hope the following provides guidance for you should you or a loved one become a cancer patient/survivor.
Historically, the symptoms associated with cancer were treated. Minimizing pain and keeping the patient comfortable were our goals. Eventually evidence-based protocols were developed. What type of cancer? Where the cancer was located, how it “acted” on the body, and medical research determined what mode of treatment was utilized. Today there is a better understanding of how our cells function and the role of genetics. Understanding how cells interact with each other and how enzymes, DNA, RNA, etc. influence the growth of the cancer cells is crucial. Now a comprehensive plan can be devised for each patient. Just as important, treatment of cancer is a team effort that requires great coordination and communication. It is critical that both medical and dental professionals work together to formulate a comprehensive, coordinated, individualized treatment plan for our cancer patients.
The Cancer Treatment Team should consist of:
Oncology Nurses and Nurse Navigators
Radiation Therapy Team
Dental Oncology Team
Counselors and Mental Health Team
A comprehensive dental evaluation is essential. Medical records that include history of present illness, the cancer treatment plan, and bloodwork should be provided to the dentist prior to the first dental visit. A thorough evaluation includes a baseline of current conditions. The dentist will then develop an individualized treatment plan to meet specific needs of the patient. Identification of dental issues prior to cancer treatment can prevent problems during treatment!
There may be “tiers” to the treatment plan and your dentist may propose to provide care both before and after treatment. Reducing the number of bacteria residing in your mouth, eliminating sharp and jagged surfaces, and cleaning the teeth should be near the top of the treatment plan. Removing bad teeth and teaching how to care for teeth are important. Reducing the number of bacteria in your mouth significantly reduces the risk for issues during and after treatment.
Cancer treatment has multiple effects on oral health. Dry mouth (xerostomia), oral mucositis, and infections from fungi, viruses, and bacteria are common during cancer therapy. Following the treatment plan your dentist designs to meet your specific needs will improve the likelihood cancer therapy will not be interrupted due to oral health concerns.
Xerostomia, more commonly called “dry mouth” can lead to severe decay and systemic health issues. Dry mouth is a common side effect of cancer treatment. It lowers the pH of your mouth which increases the opportunity for decay to begin. Oftentimes dry mouth compromises digestion. Xerostomia may be temporary or permanent. It increases the likelihood of infections and creates aversion to some foods, drinks and oral health products. Food and drink don’t taste the same and it can be more difficult to swallow. Your ability to eat nutritious foods may be compromised by these conditions. It may also be difficult to take medications and/or difficult to wear dentures.
Oral Mucositis (mouth sores) is a condition that happens as a direct result of cancer therapy. Mouth sores can be deep, severe and painful. They pose a risk for infection. Sores typically appear anywhere in the mouth, on the lips, or in the throat. Oral Mucositis appears 5-10 days following the start of therapy and last 7-14 days. The severity is based on the medications used, dose, route of administration, duration, and frequency. An increase of severity may be experienced if chemotherapy is being utilized at the same time as other forms of treatment. Oral Mucositis may affect your ability to adhere to the cancer treatment schedule.
Fungal Infections such as Candidiasis are common and may cause a burning or scalding sensation, distort taste, and interfere with swallowing. Bacterial and Viral infections (dental abscesses, gum disease, herpes) may develop in your oral cavity and become a life-threatening systemic infection.
Osteonecrosis is dead bone exposed in your mouth that can be extremely painful and increase the risk of systemic infection. Osteonecrosis can lead to loss of the jaw if severe! It is very difficult to manage and treat, sometimes taking up to two years. Not only does osteonecrosis of the jaw interfere with proper nutrition, you may suffer psychologically, experiencing a failure to thrive, depression, and withdrawal from family and friends.
Dr. Abbott stated, “I’m not into scare tactics but I am into full disclosure.” I believe an informed patient is an empowered patient who will make decisions based on what they know instead of what they fear. Seeking care from the patient’s dentist prior to beginning cancer treatment can improve quality of life and the likelihood treatment will proceed as planned. It is my hope the care patients receive in our office reflects our dedication to providing comprehensive, compassionate, and coordinated care during the journey from cancer patient to survivor!
Dr. Abbott has a simple questionnaire on his website that helps patients understand when they should seek evaluation by a dentist with experience in dental oncology prior to their cancer treatment-
If you answer YES to any of the following questions, you owe it to yourself to have an experienced dentist on your cancer care team.
Will your treatment involve chemotherapy?
Will your treatment involve radiation therapy to your head or neck?
Will your treatment include a class of drugs known as bisphosphonates?
Has it been more than one year since your last dental cleaning?
Do you want an oral health care provider for any oral issues throughout your treatment?
I invite you to learn more about Dr. Dennis Abbott at www.dentaloncology.com.
Aaron A. Huslig, DDS
Sunflower Smiles, PA