Cancer patients need to undergo a comprehensive oral examination and if necessary, receive dental treatment prior to chemotherapy or radiotherapy. This is referred to as “Dental Clearance” as good oral health minimizes the side effects of cancer therapy and responds better to treatment by the head and neck surgical team.
Head and Neck Surgery, irradiation immediately puts the patient with head and neck cancer at high risk for treatment-related complications including dry mouth (xerostomia), oral infections, Difficulty in mouth opening, (oral muscle fibrosis) and jawbone destruction (osteoradionecrosis), Radiation caries, increase in sensitivity in teeth.
- Pre radiation fluoride treatment – to prevent caries and sensitivity – Application of fluoride varnish twice yearly.
- Oral prophylaxis and polishing – Professional dental cleaning to remove tartar and calculus which can cause periodontal disease.
- Minor oral surgical procedure – removal of the movable tooth, partially erupted third molar. removal of grossly carious teeth, removal of root stamps.
- Prosthetic rehabilitation: – intraoral and extraoral prosthesis, guiding flange (to guide the lower jaw in its original position), obturator (a prosthesis that can be used to close defects or voids in the roof of the mouth.)
- Endodontic therapy – if pain persists root canal treatment is done at least one week before radiation therapy.
Oral screening is an exam to look for signs of cancer in your mouth. Oral cancers include areas of the mouth, jaw cancer and tongue cancer. Dental practitioners use oral examination to look for signs of cancer and they do it on regular basis. If your dental professional finds anything suspicious, they’ll refer you to a cancer surgeon for further testing, diagnosis and treatment.
The areas examined during an oral screening include:
- Cheek lining.
- Floor and roof of your mouth.
Oral cancer has various signs and symptoms that may be mistaken for common problems or changes in your mouth.
- White or Red patches in your mouth
- Ulcer or sores on lips or inside your mouth that’s does not heal.
- Reduced mouth opening
- Rough spots on lips, inside your cheeks or tongue.
- Pain or swelling inside your mouth or face and neck.
- Sudden weight loss
- Pain in your ears
- Skin variations, such as a sore or mole that changes shape and colour
- Changes in voice tones
- The three main treatment options for oral cancers are Surgery, Radiation therapy and chemotherapy.
- Your surgical team will decide the treatment options for oral surgery, radiation therapy or chemotherapy.
- The surgical team will decide upon several factors before recommending any treatment.
- Those factors include the stage of oral cancer if cancer has spread to another part of the body, your overall health and age.
Tobacco is one of the most important risk factors for cancers globally. The World Health Organization (WHO) estimates that tobacco causes nearly 6.4 million deaths and huge economic damage worldwide each year. Tobacco includes carcinogens and cancer-promoting substances.
Tobacco in any form whether chewed or smoked has worsening effects on oral and general health. It also affects the quality of life of cancer patients’ post-treatment.
Severe use of chewing tobacco on regular basis can put you in an increased risk of oral and dental problems such as: –
- Discoloration of teeth
- Foul odor
- Plaque and tarter formation around teeth
- Gingivitis and periodontitis
- Oral cancer
- Throat cancer
- Lung cancer
Dental Professionals plays key role in the intervention of tobacco use.
Medical and dental history of patients smoking or chewing tobacco includes questions about tobacco use per day, how long has been and how much he or she smokes. Mild, moderate, and severe addiction.
Mild – 1 to 5 cigarettes per day
Moderate – up to 10 cigarettes per day
Severe – up to 20 cigarettes per day
- Ask: We Ask the patient about tobacco usage in every form (ex. Bidi, cigarettes, hukkah, pan masala etc.)
- Advice: We strictly urge the patient to stop tobacco usage in a clear and distinctive manner.
- Assess: At this point in time patient is really willing to quit the habit.
- Assist: We assist patients to quit the habit by using proper counselling methods and alternative pharmacotherapy to help them quit.
- Arrange: Scheduling follow-up visits in person or by telephone to check the progress within the first week after the quit date.
The primary treatment modality of head neck cancer is surgery and that can have a major impact on patients’ mental, physical, psychological, and social well-being. After the treatment in a longer term, there is a shift towards improving and maintaining patients’ overall quality of life.
Post-treatment dental rehabilitation is most important to patients for overall functional rehabilitation and aims to restore orofacial form and function and the general well-being of the individual.
- Despite advanced surgical treatment, sometimes sensory and motor functions are not restored.
- Patients may feel difficulty in chewing, speaking and swallowing, limited tongue mobility, and Poor oral hygiene.
- Nasal regurgitation of food and liquids from the mouth into the nose.
- Achieve the oral rehabilitation there are several treatment options:
- Intraoral and extra oral prosthetic Rehabilitation: –
- There are three phases for oral rehabilitation of cancer patients: Surgical, interim and definitive.
- Oro-nasal and oro-antral communication present prosthetic palatal obturator plate is advised.
- Removable and fixed partial dentures.
- Surgical obturator prosthesis reestablishes palatal contour, restoring speech, and swallowing function.
- Guiding flange prosthesis: – Guide flange prosthesis is given to patients who has removed their half or full lower jaw due to various reason. It will help to re-educate the muscles of lower jaw to re-establish an acceptable original occlusal relationship.
- Occlusal guard: – is also referred to as a nightguard, bite guard, or bite splint an occlusal guard is a removable appliance that fits over your upper or lower teeth. It helps to prevent damage to flap reconstruction.
- Radiation stents:- Radiation stents fabricated by the dental oncologist under the direction of the radiation oncologist which helps to minimize radiation dose to the adjacent normal oral structures.
- Extraoral prosthesis:- facial prosthesis is aesthetically pleasing, retentive, and tissue compatible and it enhances patients overall confidence after cancer treatment. There are orbital prosthesis for eye defect, and nose and ear prosthesis to support eyewear and improve aesthetics.
- Intraoral dental implants:- Implants helps to retain maxillofacial prosthesis over osteocutaneous flap. Implants in cancer patients helps to improve speech, chewing and swallowing and other functions in the mouth.