dental cancer disease/infection patient care
The Dentist’s Role in the Pre-Radiation Assessment and Management of a Patient Undergoing Head and Neck Radiation Therapy Shyam A. Shah, D.M.D.; Vincent B. Ziccardi, D.D.S., M.D.
ABSTRACT An understanding of a patient’s head and neck cancer (HNC) diagnosis and planned cancer therapy is required to effectively develop a dental treatment plan. Dentists are often asked to evaluate patients who are about begin or are already undergoing radiation therapy for HNC. With adequate assessment and management of the HNC patient, radiation-related complications, such as osteoradionecrosis and radiation caries, can be minimized. This manuscript is intended to help all dentists become comfortable with current protocols in managing patients undergoing radiation therapy. A patient about to embark on treatment for head and neck cancer (HNC) has begun a journey that involves a multidisciplinary team of healthcare providers, as well as family and friends. HNC and its treatment are often accompanied by both short-term and long-term changes to a patient’s physical, mental and oral health.1 Squamous cell carcinoma is the most common malignancy of HNC cases, at a rate of 90% of all oral and oropharyngeal malignancies.2 An estimated 51,540 new cases of oral cavity and pharynx cancer and 53,990 new cases of thyroid cancer were projected in the United States in 2018, with incidence rates
more than twice as high in men than in women. The estimated numbers of deaths in 2018 from these two cancers are 10,030 and 2,060, respectively.3 Whether or not these cancers physically manifest themselves within the oral cavity, the dental provider often plays a crucial long-term role in their identification and management. HNC can be treated by any or a combination of surgical resection, chemotherapy and radiation therapy (RT). For early stage disease, single-modality treatment, with either surgery or RT, is preferred. For more advanced disease, combined therapy is recommended. In such cases, surgical resection is encouraged first, followed by adjuvant RT, which generally allows for a lower dose.4 We are all aware of the oral manifestations and complications of HNC RT. These well-documented complications include xerostomia, mucositis, trismus, caries and, potentially, radiation osteonecrosis, with greater predilection for the mandible. Dentists play an active role in the management of patients undergoing HNC RT and should be consulted by the oncology team prior to initiation of radiation therapy to prevent and minimize post-radiation complications. Consequently, dentists are often asked by the oncology team to provide some form of “dental clearance” or assessment prior to the patient beginning radiation therapy. An understanding of the HNC diagnosis and planned cancer therapy is required to effectively develop a dental treatment plan. This manuscript will review the dental management of a patient undergoing RT for HNC, as well as the anticipated dental needs during and after therapy.
The New York State Dental Journal JUNE/JULY 2020 23 ●
