The Case for Having Dentists on Your Cancer Care Team
Cancer is common in the UK; each year, more than 385,000 new cases are diagnosed. Overweight and obesity are the leading cause of cancer after smoking in the UK (2015). Breast cancer is the first most common cancer in females in the UK, with 59,517 new cases diagnosed in 2021. Prostate cancer is the second most common cancer in males in the UK, with 51,575 new cases diagnosed in 2021. Bowel cancer is the third most common cancer in the UK, with 49,914 new cases diagnosed in 2021. Lung cancer is the fourth most common cancer in the UK, with 48,904 new cases diagnosed in 2021. Other common cancers in the UK include melanoma of the skin, cancer of the uterus (a common cancer in females), and non-Hodgkin lymphoma (a common cancer in males).
Cancer treatment often requires a team of health professionals (oncologists, nurses, surgeons, radiologists, pathologists, and social workers). They coordinate and provide comprehensive patient support. Dentists are increasingly being considered an important part of the cancer care team. Dental care plays a vital role in the health of cancer patients. It helps maintain dental and mouth health before, during and after cancer treatment. It can significantly reduce complications, improve treatment tolerance and enhance a patient’s quality of life.
When a person is diagnosed with cancer, many patients consider other health care and may neglect dental care. However, people with cancer can experience unique issues related to their oral health. Radiation and chemotherapy are the most common treatments for treating cancer. It can damage the salivary glands and reduce their ability to produce saliva, which can cause tooth decay or cavities. Radiation and chemotherapy can also cause painful mouth sores. If cancer is spread to the bones, then patients are treated with high doses of antiresorptive medications such as bisphosphonates. These medications can cause a rare condition called Osteonecrosis of the jaw, in which the jawbone is exposed through the gums.
Cancer Therapies and Oral Effects
Oral complications of cancer therapy can be developed during treatment or delayed months to years after treatment, local or systemic, or functional. Cancer treatments such as surgical procedures or radiation therapy can cause direct damage to salivary glands, bony structures, or tissues. The indirect effects of therapies on rapidly dividing bone marrow cells or loss of protective salivary factors cause bleeding or infections. The acute toxicity caused by cancer chemotherapy typically resolves after discontinuation of therapy and recovery of damaged tissues.
The most common oral complications related to cancer therapies are mucositis, salivary gland dysfunction, opportunistic infection (viral or fungal), taste disturbance, and pain. Radiation therapy can also induce permanent tissue damage, resulting in lifelong risk for the patient. These complications can make it difficult for patients to eat, talk or even swallow, and they may suffer from dehydration, dysphagia (difficulty swallowing), dysgeusia (change in taste), and nutritional compromise. Certain types of chemotherapy (vinca alkaloids) can cause dental neurotoxicity. It can cause persistent deep aching or burning pain in a tooth without a dental or mucosal source.
Radiation, especially for head and neck cancer, can induce oral damage, resulting in permanent dysfunction of salivary glands, muscle, connective tissue, bone, and vasculature. One of the main concerns is Osteonecrosis of the jaw, particularly for patients undergoing radiation to the head and neck region or those taking bisphosphonates or VEGF (vascular endothelial growth factor) inhibitors. Osteonecrosis occurs when the blood supply to the jaw bone is reduced, leading to bone death, which these treatments can cause. Other adverse effects of radiotherapy, such as mucositis, bone exposure, trismus, xerostomia, dysphasia/dysgeusia and soft tissue fibrosis, may develop.
Dental Care Before Treatment
Dental care is essential before beginning any cancer therapy. A thorough dental evaluation allows dentists to address any preexisting conditions, such as gum disease, cavities, or infections, that could worsen during treatment. The National Cancer Institute (NCI) recommends that patients undergoing cancer treatment see their dentist four weeks before cancer treatment to help heal if any dental work is required. Having untreated dental issues before starting cancer treatment puts patients at a higher risk of developing serious complications. Because your body’s immune system will weaken, and if an infection begins in the mouth, it can spread quickly, becoming much harder to manage.
The involvement of dental care experienced with oral oncology may reduce the risk of oral complications. Directly examining the patient or consulting with the patient’s community-based dentist may help address oral health issues beforehand. Dental work should prioritize the treatment of teeth that have a risk of infection or decay to help avoid the need for dental treatment during cancer treatment. Removing non-restorable teeth is crucial as they could be a source of infection during cancer treatment.
Dental Care During Treatment
Once cancer treatment begins, maintaining oral hygiene is crucial to prevent complications from arising. Good oral hygiene and regular professional cleanings during treatment can help reduce the risk of infections. Because many cancer therapies decrease the body’s ability to fight infections, the mouth can become a breeding ground for bacteria and fungi. The dentist may recommend patients brush with mild or non-flavoured toothpaste, use saline/bland mouth rinses, and stay hydrated to maintain saliva production. They also provide tips on managing dry mouth, including using saliva substitutes.
Oral mucositis (oral sores) is common in cancer patients. It is a painful and potentially debilitating adverse effect of cancer therapy. In this condition, working with both oncologists and dentists is essential. The oncologist manages the cancer treatment, and the dentist focuses on minimizing the oral side effects of cancer therapy. So patients can continue eating and receiving their therapies without too much disruption. They may recommend avoiding hard, rough-textured, acidic, or spicy foods, alcohol, and tobacco. Eating soft, moist foods that are easy to swallow or chilled foods. The goal is to keep patients as comfortable as possible throughout their cancer journey.
The NCI considers routine and oral hygiene important before and throughout cancer treatment. It helps to reduce the occurrence and severity of adverse oral effects of cancer therapy. Patients should use a soft, nylon-bristled toothbrush and a mild-flavoured fluoride toothpaste twice daily, with frequent rinsing. If not possible, foam toothbrushes may be used. If toothpaste is not tolerated, 0.9% saline or water may be used. Antimicrobial rinses may be used where routine brushing and interdental cleaning are impossible. It is recommended to avoid mouth rinses containing alcohol.
Post-treatment Dental care
After cancer treatment, patients may continue to experience oral health issues due to the lingering effects of their therapies. Patients need to remain vigilant even after treatment ends. Cancer treatments can have long-lasting effects, and addressing oral health issues promptly can prevent them from becoming more serious later on. Some patients may have long-term symptoms like dry mouth or an increased risk of oral cancer, especially if they have undergone bone marrow transplants.
Regular dental checkups are crucial for catching and managing these late effects. Oncologists and dentists work together to manage cancer patients’ overall health. They can improve oral health and quality of life for cancer patients if they address oral health before treatment starts, monitor it closely during treatment, and manage any late effects afterwards. Ultimately, oral health is an essential part of comprehensive cancer care, and one can not neglect its significance.