The importance of dental visits before head and neck oncology treatment

 With September being Oral Health Month, Dr Michael Michael explains why it’s vital to have dental visits before head and neck oncology treatment.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

A diagnosis of cancer is a life-altering event for those being diagnosed as well as for those closest. This comes with the reality and emotion of facing mortality and the path of treatment ahead. There is little time to grasp and accept what this means as multiple visits are scheduled with various practitioners. This is particularly true for patients diagnosed with cancer in the head and neck region. 

The initial thoughts and discussions are often about the best approach to treat the disease with options of either surgery, ionising radiation, chemotherapy, or a combination. Each of these options have effects beyond the aim of curing the disease. 

Effective management of head and neck cancer needs to focus not only on curing the disease, but additionally on rehabilitation of acquired defects, and limiting and preventing the adverse effects of this treatment. The role of a prosthodontist that is part of a Head and Neck Oncology Group is centred around enhancing patients’ quality of life during and after treatment. 

The elements of oral health-related quality of life include being able to eat comfortably, being able to speak confidently, and maintaining a positive self-image.

Effect of cancer treatment

Cancer treatments, including radiation and chemotherapy, can weaken the immune system, leaving patients more susceptible to dental and oral infections, periodontal (gum and bone) disease and other oral complications, such as pain or difficulty when swallowing. 

The direct effect of radiation on the dentition (arrangement or condition of teeth) and jawbone is crucially important. 

Literature shows that teeth exposed to radiation can be up to 200x at greater risk for developing decay. This is related to the direct exposure of the dentition to ionising radiation which weakens the junction between the enamel and dentine compromising the integrity. Salivary glands exposed to radiation have a reduced efficacy in producing saliva, which is vital in tooth health by buffering acid pH levels.

When the jawbone is irradiated, there is a future risk of osteoradionecrosis. This is a serious condition characterised by bone necrosis (bone death) following radiation. Radiation disrupts and compromises blood flow to the bone preventing adequate oxygen and nutrient supply to the bone tissue. In the presence of infection (periodontal disease) or trauma (dental extraction), the risk of osteoradionecrosis increases. While this isn’t a common occurrence, this can have a profound impact on overall well-being and in severe instances require resection of bone.

In essence there is a higher risk of radiation-induced tooth decay which may necessitate extraction, which increases the risk of osteoradionecrosis. Pre-emptive dental visits play a crucial role in improving oral health and preventing these complications.

Dental treatment

Extractions of compromised and at-risk dentition before radiation (when bone healing is still normal) can help prevent osteoradionecrosis. Rehabilitation with fixed implant-supported prosthetics will help to maintain and enhance oral health-related quality of life during and after cancer therapy.

Close collaboration and communication between patients, the oncology team and dental team help decide on dental care specific to treatment needs. This comprehensive care aimed at optimising treatment outcomes through: minimising complications, managing treatment side effects, and maintaining better overall oral health and quality of life. These decisions weigh the risk of dental disease, osteoradionecrosis, the predictability of treatment options and the prognosis of cancer treatment.

When jaw resection is planned as part of cancer management, the dental team (prosthodontist, maxillofacial and oral surgeon) plan extensively for more complex rehabilitation with the surgical team. Early dental visits and a proactive approach help reduce treatment delays in establishing oral health and the planning phases.

Life-long maintenance and regular oral hygiene visits are of paramount importance in achieving optimal oral health, minimising complications, and improving overall well-being throughout the cancer journey.

Image by stock.adobe.com