DENTISTRY FOR ONCOLOGY PATIENTS

In 1989, the Consensus Development Conference at the National Institute of Health met to decide the standard of care for Cancer Patients.

Their main decision at that time was that ALL ONCOLOGY PATIENTS THAT RECEIVE CHEMOTHERAPY AND HEAD AND NECK RADIATION should see their dentist before any cancer therapy is begun.

We are in an age when the treatment for cancer is progressing with impressive cures and many lives are being saved. The doctors and centers that are involved with these therapies are often excellent and precise with their treatment. However, the side effects of these modalities often inflict terrible pain and suffering during and after the treatment. When cancer patients die from infection that occurs during Chemotherapy and Head and Neck Radiation, the causative factors are viruses, fungus or bacteria from the mouth and related structures 56 % of the time.

When Chemotherapy is instituted, most infections and breakdown of the mouth, teeth and surrounding tissues will heal completely if treated early with Head and Neck Radiation, they are often permanent.

It is crucial that before any therapy is begun, the patient should visit his dentist first and have all sources of infection in the mouth eliminated. This includes, decayed teeth, periodontal disease, teeth that have been treated with root canal treatment where the prognosis is questionable and any other infection that is seen in the mouth. People who have had mouth sores frequently must be treated with medications prior to Cancer treatment. A history of yeast infection, salivary gland problems, high blood pressure medication or any factor that contributes to dry mouth must be regulated.

Not only is it important to cure the cancer but to provide a reasonable quality of life during and after treatment. Doctors very often do not caution patients about these things and the patients themselves are so devastated by their diagnosis that neither they nor their family think of the problems that could occur because of the above.

Nutrition is crucial but where the mouth is concerned, there are specific foods to eat and ways to keep the mouth from being dehydrated. Doctors tell their patients early in treatment. “YOU MUST EAT TO LIVE.” How can the patient eat when their mouths are in so much pain from infections that they are screaming just from this situation. If you have ever had a cold sore, you know how uncomfortable this is. Now imagine one four times the size and twice as deep.
This can be prevented or treated .

One of the first things a doctor or his staff will tell the cancer patient is that they may lose their hair. A bevy of people then prepare them for that with measurements for wigs, etc. etc. This is important. Most people don’t care about their hair when they can’t eat or drink and maybe never will be able to open their mouth again. The patient could die from oral infections.

Doctors often say that to have dental care prior to therapy will delay treatment They must understand that prevention and early treatment of dental related infections can and will save many lives. In France, Cancer treatment cannot begin until there is clearance from the dentist.
In Florida, there have been large malpractice settlements against physicians who have not referred their patients who will have chemotherapy or Head and Neck Radiation for dental care prior to treatment.

A dental office must be prepared to handle this type of patient with understanding and compassion. Cancer patients are rightfully frightened and deserve all the kindness and time that a dental staff is capable of delivering. There are many precautionary measures that a patient can be taught and there are many new medications that are available to prevent and treat the side effects of Chemotherapy and Head and Neck Radiation. Radiation below the chest is not really a concern for the dentist but patients who are medically compromised in some ways may need to be sure that their health is optimum prior to treatment.

The United States used to be the envy of the world in standard of treatment. Now we are second rate with the pre- treatment standard of care.. Patients are not covered by their medical insurance policies for treatment of the mouth and related tissues prior to therapy. (With a lot of work and time by the dental office this sometimes can be overcome) However, we should work together as a nation to mandate that any pre-cancer treatment that will save lives should be covered by medical insurance. THE MOUTH IS PART OF THE BODY.

We all will be a part of the population that suffers from these conditions, either as patients, family or friends. It is important that everyone be educated about the Dentist’s role in the treatment of Cancer.

-Dr. Marshall Polan received his DDS degree from Columbia University, School of Dental and Oral Surgery in 1968.
-He was a resident in General Dentistry at Long Island Jewish Medical Center where he
remained on the teaching staff for over 15 years.
-He served as an Assistant Professor of Clinical Dentistry at SUNY, Stony Brook for five years.
- His research has been published in many journals and he lectures with CE
certification at many dental societies.
-Dr. Polan maintains a full-time private practice in Huntington, NY. He can be reached
at 631 423-5533 or [email protected].

Website: http://www.drmpolan.com/