It may come as a surprise to some people, newly diagnosed with a malignancy (and not only head and neck malignancies), that the first step in their treatment scheme should be a visit to a dental clinic and to see a dental hygienist. It is best practice that all who are about to start systemic chemotherapy treatment schemes, radiotherapy applied to the head and neck region, and ahead of major oral and maxillofacial surgery interventions should be seen in such a clinic as a first step.
The purpose of this first step is to optimise oral health ahead of treatment, and thus to minimise any later complications arising from dental problems during or after treatment. The two components in this process are to carry out any necessary dental work ahead of treatment, and to establish a good regimen of self-care and daily oral hygiene.
Dental status and interventions
It is crucial to understand at this stage that the normal highly prevention orientated mindset of dental professionals (very much a give it a chance and see what happens with minor and even major potential dental interventions) is completely inappropriate under these circumstances. This is most true of someone undergoing chemo/radiotherapy of the head and neck region. This is not simply because of the acute-phase mucositis (painful mouth ulcers; this will be experienced by those receiving most forms of systemic chemotherapy) and the need to avoid developing infections in the immunosuppressed, or performing even minor surgery in someone with no platelets. These are important considerations but understanding the nature of the permanent damage done to salivary glands and bone at a cellular level is essential. Teeth of dubious prognosis which may otherwise be preserved could become a threat to life, periodontal disease which could be lived with if regular treatment was continued can result in crippling osteoradionecrosis. This paradigm shift is essential in the oral and dental care of those undergoing non-surgical oncological intervention. When patients are undergoing surgical treatment for head and neck cancer, the oral and maxillofacial surgical oncologist can easily include tooth removal as part of the process but long-term optimisation and dental care is not part of that process and needs to be provided by a restorative dentist and/or hygienist trained in this area.
Prior to beginning treatment, getting into good habits in terms of daily oral hygiene practices is highly recommended. Maintaining good oral health during and after treatment has positive effects on treatment outcomes. Effective tooth brushing, interdental cleaning, and finding motivation are important for all people at all times. But ‘getting into the habit’, adopting and practicing good oral hygiene techniques are important to be established early, so that it is easier to maintain such good habits during and after treatment. Oral hygiene specialists are well placed to provide not only a thorough professional clean, but also to give advice about good techniques at home.