The timelines and types of activities in terms of oral hygiene and dental (rehabilitation) treatments during and after treatment(s) for malignancies vary. Not only do these two arms of activities follow different patterns of high and low activity at different stages, but the exact nature of interventions strongly depends on the type and stage of the malignancy and the respective pursued treatment modalities.
Our main focus are restorative dentistry and oral hygiene during and after treatment of head & neck malignancies. However, treatment for other malignancies, mainly haematological malignancies treated with systemic chemotherapies and/or stem cell transplants may require support and treatment for oral hygiene issues and/or dental rehabilitation. These needs could be short- and/or long-term needs.
Dental status and interventions
The essential differences following treatment of head and neck cancers are based around whether or not radiotherapy has been used.
If surgery is/was the only treatment modality, then the challenges for dental interventions are essentially mechanical. Is mouth opening limited, is attached gingivae (gums) present or has skin covered this area? Are cervical margins (area between crown and root of a tooth) exposed and painful? Each of these and more have specific restorative dentistry solutions.
If radiotherapy has been used, the above has a significant additional challenge. The bone, mucosa and any new (flap) tissue has been exposed to sufficient radiation to create a risk when asking cells to divide and reproduce. Put simply, if the irradiated cells are not asked to do much, they may well be fine. If they are asked to work because of surgery – even something as apparently simple as a tooth removal, they might necrose (die); this remains a life-long risk. The restorative dentistry challenge here is complex and must aim to avoid this. This is why a pre-treatment dental assessment by someone who understands this position is so important.
The role of systemic chemotherapy in both children and adults creates risk of acute reduction in red blood cells, white blood cells and platelets . Together and individually they can create serious issues with regard to bleeding and infection if any hidden dental pathology presents itself at this time. For children, depending on the age when they are treated with systemic chemotherapy, this may damage the dental development with stunted growth of teeth and resulting long-term needs for restorative dentistry interventions.
The skills learned and practiced in terms of a personal oral hygiene regimen continue to be of great importance during and following cancer treatment. Different types of treatment bring with them new challenges in terms of oral hygiene and maintaining good oral health. Some such difficulties are temporary, other challenges are permanent. For example, difficulties resulting from surgery tend to be temporary in nature and resolve to a degree of new (or very nearly old) normal over fairly short periods of time. In contrast, oral health issue related to chemotherapy or radiotherapy to the head and neck region tend to build up slowly, take a longer time to resolve, or (especially after radiotherapy) will remain a life-long concern.
Having the right information for the particular situation at all times, skills and motivation are essential, as is the willingness to help oneself by adapting to the new situation. The oral hygiene team are well placed to give help, advice and encouragement at all stages during and after treatment. Their helping hand may literally be a helping hand to learn new techniques and/or to provide the best possible professional clean, but they are also a great source of information about practical tips and general advice.
Next section: Dentistry & oral hygiene
Further reading: Restorative dentistry