Table 1.
Stage of treatment | Role of primary dental care team |
---|---|
♣ Prior to surgical, systemic anti-cancer therapy ♣ or radiological intervention |
• Providing prevention and information about the risks of cancer treatment on oral health. • Eliminating any oral sources of infection to avoid risk of systemic spread (e.g. sepsis) • Eliminating any teeth of particularly poor prognosis in an attempt to reduce the need for extractions or minor oral surgery in the future in situations where the patient may be at risk of: • Medication related osteonecrosis of the jaw (MRONJ) • Osteoradionecrosis (ORN) |
♣ During systemic anti-cancer therapy or radiological intervention |
• Addressing acute problems including dental pain and infection. • Management of dry mouth or oral mucositis. • Managing oral manifestations of bacterial, fungal and viral infections due to increased risk of infection. • Consideration of increased bleeding and infection risk if treatment is being carried out. • Ongoing prevention |
♣ After surgical, systemic anti-cancer therapy or radiological treatment |
• Prevention of dental disease • Managing reduced mouth opening (trismus due to effect of radiotherapy on muscles and other soft tissues can cause problems with access to oral cavity for self-performed plaque control and executing dental treatment) • Management of dry mouth and associated oral soreness. • Management of patients at risk of MRONJ or ORN who need dental treatment. • Diagnosis and referral of patients with MRONJ or ORN. • Head and neck cancer surveillance - particularly for patients who have had oral or oropharyngeal cancer. • Consideration of laryngectomies or tracheostomies and any dietary considerations. • Maintenance of prosthodontic rehabilitations including implant supported or retained prostheses. |