Importance of Dental Care with Head and Neck Cancers
At the James Graham Brown Cancer Center, one of the first referrals made for any patient whose treatment plan includes chemotherapy or radiation to the head and/or neck is the Maxillofacial Dental Oncology Clinic. That’s because these treatments to the facial area may temporarily or permanently damage the saliva glands.
A common side effect of radiation is “dry mouth.” Saliva contains antibacterial components that fight tooth decay and gum disease. The lack of saliva opens the door for bacteria, often leading to severe damage to teeth and gums. Dry mouth can lead to other serious oral conditions in teeth, gums, salivary glands and jawbones.
These side effects can hurt and make it hard to eat, speak and swallow, affecting your quality of life. Our dental oncologist will meet with you to determine what effects the proposed cancer treatment plan will have on your mouth. The goal is to alert patients as early as possible to prevent any damage from occurring. Prevention is much more effective than trying to fix the problem after it occurs.
After your initial consultation, we will contact your dentist to discuss the recommended course of treatment.
At the Brown Cancer Center, we strongly believe your dentist is an important partner in your treatment plan.
Before your cancer treatment begins, your dentist may recommend special toothpaste, extra brushing and more frequent dental visits to monitor the situation. Your dentist may also take the following steps:
- Identify and treat existing infections, problem teeth and tissue injury or trauma.
- Stabilize or eliminate potential sites of infection.
- Remove orthodontic bands if certain types of chemotherapy are planned, or if the bands will be in the radiation field.
- Evaluate dentures and appliances for comfort and fit.
- Perform oral surgery, if needed, at least two weeks prior to the initiation of radiation therapy to allow healing, and at least seven to 10 days before myelosuppressive therapy (treatment that inhibits blood cell production) begins.
- In adults receiving radiation, extract teeth that may pose a future problem.
- In children, consider extracting highly mobile primary teeth and teeth that are expected to exfoliate during treatment.
- Instruct patients on oral hygiene, use of fluoride gel, nutrition and the need to avoid tobacco and alcohol.
We can provide you with options and recommendations, but your dentist will need to help you follow through.
Part science and part art, the Maxillofacial Dental Oncology Clinic provides head and neck cancer patients the safest and least disfiguring course of treatment. One of just a few of its kind in the country, the Clinic is led by Zafrulla Khan, D.D.S., M.S.. He is renowned nationally and internationally for providing oral/dental care for patients undergoing radiotherapy, chemotherapy and/or surgery for head and neck cancer. His ongoing clinical research contributes to the development of state-of-the-art techniques and materials used to develop prostheses.
The Maxillofacial Dental Oncology Clinic also plays an important role for patients whose conditions are disfiguring, as well as debilitating. When surgery is part of the cancer treatment plan, portions of the oral cavity and the head and neck region are removed to cure and/or control a tumor. Sometimes the surgical removal of part of the mouth or throat makes swallowing and speaking difficult or impossible. Plastic surgery to repair these areas may not be an option. They may require a prosthesis to function or to be more aesthetically pleasing.
Dr. Kahan is part of the Brown Cancer Center’s Head and Neck Working Group and is consulted before surgical treatment that will result in permanent removal of facial features, or parts of the mouth or esophagus.
In these cases, we meet with the patient before surgery and make molds to recreate the parts that will be removed. Whenever possible, the prosthesis is placed the same time the surgery is done to remove that part of the mouth or throat. We do this so that when our patient wakes up, he or she can feel as normal as possible.
When it is not possible to place the actual prosthetic device during the initial surgery, a prosthesis that can be removed for treatment is inserted. For example, a temporary mouth prosthesis is used during the period of radiation therapy. After the treatment is complete, a permanent prosthesis is placed.
Our primary goal is to help our patients return to a normal lifestyle. Patients receive follow-up care for six months to one year after treatment.
The Role of an Academic Medical Center
One of the most important aspects of the Dental Oncology Clinic is the opportunity it gives dental and dental hygiene students to rotate through an oncology clinic. As part of the teaching component of the University of Louisville’s School of Medicine, this oncology rotation provides an opportunity to educate future dentists and hygienists about the importance of proactive treatment during cancer therapy, and about the importance of screening and early diagnosis for head and neck cancers.
It is always easier for our patients if we can prevent cancer from ever occurring. When precancerous lesions are caught and removed early, the disease doesn’t progress to cancer.
Dental Oncology Clinic: 502.852.5747