Oral complications can be common after patients receive chemotherapy or radiation therapy for cancer treatment. Patients may present with oral mucositis, or inflammation and ulceration of the mouth. They may also experience fungal infections, such as candidiasis, or xerostomia (dry mouth) as a result of salivary gland dysfunction. If patients have taken bisphosphonate medication, they may also be at greater risk for osteonecrosis of the jaw (ONJ). Necrosis that is specifically related to head and neck radiation is referred to as osteoradionecrosis of the jaw (ORNJ).
As dental providers, it is possible to provide relief for several of the oral manifestations that can occur in cancer patients. Table 15 lists possible treatments to ease symptoms of mucositis, xerostomia and radiation caries.
|Table 15. Treatment for Oral Conditions Related to Cancer (1)|
|Radiation Caries (following radiation to head & neck)|
There are several modifications for dental treatment when caring for cancer patients. First, if the patient is receiving chemo or has an indwelling catheter/port present, consult their oncologist before any dental treatment is performed. The patient may need antibiotic premedication prior to treatment and this should be prescribed by the patient’s oncologist. Also, have the oncology team conduct blood work 24 hours before invasive dental treatment to determine whether the patient’s platelet count, clotting factors, and neutrophil count are sufficient to treat. Treatment must be postponed if the platelet count <50,000 platelets/mm3, abnormal clotting factors are present, or the neutrophil count < 1,000 cells/mm3.
Table 16 provides follow-up questions for cancer patients who are seeking dental care.
|Table 16. Follow-Up Questions for Current Cancer Patients Seeking Dental Care1|