Coordinated Oral Health Care in Patients with Cancer
|9382||April 2, 2013||9|
Cancer therapy, either with ionizing radiation or chemotherapeutic agents, is based on the principle of destruction of rapidly replicating cancer cells. Although it has been effective in holding back or eradicating cancer growth, it also causes unavoidable damage to normal cells.
The short-term and long-term effects of cancer therapy on oral and adjacent tissues, including mucositis, oral infections, hyposalivation, taste disorders, and soft tissue and jaw bone necrosis, can be painful, life threatening, and intolerable to the patient. These morbidities can contribute to the disruption or discontinuance of the cancer therapy and directly affect the success of treatment. For those who survive, these morbidities adversely affect the quality of life of the patient and family members, and drive up the cost of health care.
Many of these complications can be minimized by good oral health care before, during and after the cancer therapy. Advances in cancer therapy can also limit the damages to normal tissues. The key to overcoming oral complications and their consequences is the coordination of care among the oral health care providers, oncologists, and other supporting groups, especially before the initiation of cancer therapy. Eliminating dormant dental infections before head and neck radiation therapy and chemotherapy has moderate success in curtailing oral complications.
Intravenous bisphosphonate (zoledronic acid, Zometa) and subcutaneous denosumab (Prolia or Xgeva) have been used as adjuncts to cancer therapy to treat bone metastasis, to prevent skeletal related events (SREs), or to increase bone mass in certain types of cancer. Although effective in cancer therapy due to anti-bone-resorptive nature, they carry a low risk of osteonecrosis of the jaw (ONJ), which is similar to osteoradionecrosis but refractory to hyperbaric oxygen therapy. The exact risk of ONJ is unknown at this time and there is no test for physicians or dentists to predict who will or who will not develop ONJ. Since many of the ONJ occurred after dental invasive procedures, elimination of dental problems through tooth extraction or other surgery before the initiation of these antiresorptive agents become an important strategy in preventing ONJ.
This resource will revisit the oral complications of conventional radiation therapy and chemotherapy. It will update the new technology and pharmacological improvements in minimizing the oral tissue damage that have arisen in recent years, as well as the interventions used to remedy the damage. Most of all it will emphasize the importance of the coordination of care and provide a mechanism for improving communication among the health care disciplines.
This resource will also highlight IV bisphosphonate and denosumab associated jawbone necrosis (ONJ) in cancer patients to raise awareness of this new complication of cancer therapy. It will provide strategies for minimizing the risk of ONJ and optimizing the outcome of cancer therapy through dental preparation before the initiation of these agents.
This resource has been developed and used in dental education in the field of cancer patient care. The resource was presented to the 3rd and 4th dental student Oral Medicine courses and also converted to a section of the online clinical manual which students and faculty refer to when managing dental patients who have had cancer therapy, are undergoing it, or will undergoing it in the near future. Communications with oncologists have been improved based on the instructional material in this section of the clinical manual. We have published our results on the effectiveness of this material in the publications listed below. The resource has been updated and tailored for the Building Oral Health in Medicine Model Curriculum project in MedEdPORTAL, AAMC.
Geist R, Geist J. Coordinated oral health care in patients with cancer. MedEdPORTAL Publications. 2013;9:9382. http://dx.doi.org/10.15766/mep_2374-8265.9382
Contains Information Suitable for Patient Education
- To explain biomedical bases of radiation therapy for head and neck cancer.
- To identify the oral health impacts of H&N radiation therapy.
- To describe possible complications of H&N radiation therapy.
- To provide strategies in prevention and/or management of complications of H&N radiation therapy.
- To provide strategies in improving patients’ oral health during and after H&N radiation therapy.
- To recognize the importance of coordinated care between oral health care providers, radiation oncologists, and other supporting groups.
- To prescribe mechanisms in coordinated care among patients’ care team.
- To provide biomedical bases of cancer chemotherapy.
- To identify the oral health impact of cancer chemotherapy.
- To describe possible complications of cancer chemotherapy.
- To provide rationales for the prevention and/or management of complications of cancer chemotherapy.
- To provide strategies in prevention and/or management of complications of cancer chemotherapy.
- To provide strategies in improving patients’ oral health during and after cancer chemotherapy.
- To describe the importance of coordinated care between oral healthcare providers, oncologists, and other supporting groups, especially before IV bisphosphonate or SC denosumab use.
- To provide mechanisms for coordinated care among patient’s care team.
- Chemotherapy, Radiation Therapy, Mucositis, Hyposalivation, Xerostomia, Osterradionecrosis, Diphosphonates, Denosumab, Osteonecrosis of the Jaws, Cancer, Building Oral Health Capacity (BOHC) Collection
This information is made available under the Creative Commons license.
- Geist SMRY, Geist JR. Improvement in medical consultation responses with a structured request form. J Dent Educ 2008;72(5):553-61
- Geist RY, Geist JR, Aksu M. Jaw osteonecrosis related to bisphosphonates: a new concern for dentistry. J Mich Dent Assoc 2005;87(11):40-2 (Reprinted in Today's FDA 2006;18:27, 34-5)
Power V, Din FM, Acharya A, Torres-Urquidy MH, ed. Integration of Medical and Dental Care and Patient Data. Springer, 2012. http://dx.doi.org/10.1007/978-1-4471-2185-5
The author contributed three sections to this book:
a. Physicians' dental data needs and dental provider's medical data needs: the clinical rationale.
b. The importance of standardized structured communication messages and limitations of structured message communication
c. Designing and implementing efficient structured communication among patient's medical and dental providers
Authors & Co-Authors
University of Detroit Mercy School of Dentistry
University of Detroit Mercy School of Dentistry
Sponsorship or Funding Source
This project is also sponsored in part by funding from the Health Resources and Services Administration/Maternal Child Health Bureau grant #U44MC20223