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Brief Overview of Oral Complications of Cancer Treatment

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It is a popular humorous saying at DCG that dentists diagnose three conditions: cancer, infection, and ugly.  As far as the management of infection, we have entire courses on operative dentistry, oral surgery, periodontics, endodontics, etc.  To treat “ugly” we learn principles of esthetics and develop an eye for creating and recreating a patient’s dentition.  And, for cancer, we learn to recognize what is not normal and refer the patient for appropriate continued treatment.  However, I have noticed a gap so far in my program and in some of my friends’ programs at other dental schools.  This gap includes learning basic biopsy techniques and tissue handling as well as training on the management of patients who have received chemotherapy and head and neck radiation.  

  

Now, I am in the middle of third year, so these topics could very well be covered in upcoming courses, but as a student who is particularly interested in oral medicine, oral cancer, and management of patients who have oral complications of cancer, I thought it seemed about time that I started seeking out training in these areas.    

  

I won’t go too into depth about biopsy techniques here, but some great information can be found in this publication by the Oral Cancer Foundation:  http://www.oralcancerfoundation.org/dental/pdf/oral_biopsies.pdf 

The main takeaway is that biopsies are a useful and valuable service you can provide for your future patients, but training is necessary to be able to perform a high quality procedure, provide an excellent specimen for the pathologist, and discern when a patient should be referred for more advanced biopsy techniques.  

  

Often, patients who have undergone cancer treatment, even treatment not focused on the head and neck area, can experience some severe and debilitating side effects.  Common oral problems occurring after radiation and chemotherapy include mucositis, dehydration, malnutrition, difficulty swallowing, and increased susceptibility to infection, bleeding, and pain.  Specifically, radiation therapy to the head and neck can contribute to xerostomia, hypovascularization of the maxilla and mandible, trismus, osteoradionecrosis, and cause an increased risk of caries and periodontal disease.   It is routinely recommended for teeth in the path of radiation to be extracted prior to starting therapy in order to avoid post therapy extraction complications, which can be severe and life-threatening.   Proper management of these conditions can drastically improve the quality of life experienced by cancer survivors.  

  

These patients also present unique challenges in restoring function after treatment. Head and neck cancer patients often have areas of tissue resection that can present an impediment to proper speech and nutrition.  Removable prosthetic devices called obturators and other advanced maxillofacial prosthetics can help fill areas of tissue resection and give the patient some measure of improvement in speech, nutrition, and esthetics, once again improving quality of life.   

  

In summary, patients who have received treatment for head and neck cancer may not be your usual patient in dental school, but we all will likely see at least one or two in our lifetime of practicing.  Understanding the multifaceted nature of oral problems experienced by these patients can help us to better serve these individuals and provide a measurable impact on their quality of life.