Oral and Dental Management Before Cancer Therapy
Poor oral health has been associated with increased incidence and severity of oral complications in cancer patients, hence the adoption of an aggressive approach to stabilizing oral care before treatment.[1,2] Primary preventive measures such as appropriate nutritional intake, effective oral hygiene practices, and early detection of oral lesions are important pretreatment interventions.
There is no universally accepted pre-cancer therapy dental protocol because of the lack of clinical trials evaluating the efficacy of a specific protocol. A systematic review of the literature revealed two articles on oral care protocols prior to cancer therapy. One study examined the benefits of a minimal intervention pre-cancer therapy (mostly chemotherapy) dental protocol, and the other examined the impact of an intensive preventive protocol on patients undergoing chemotherapy. Both studies had several flaws, including small sample size or the lack of comparison groups.
The involvement of a dental team experienced with oral oncology may reduce the risk of oral complications via either direct examination of the patient or in consultation with the community-based dentist. The evaluation should occur as early as possible before treatment.[4,5] The examination allows the dentist to determine the status of the oral cavity before cancer treatment begins and to initiate necessary interventions that may reduce oral complications during and after that therapy. Ideally, this examination should be performed at least 1 month before the start of cancer treatment to permit adequate healing from any required invasive oral procedures. A program of oral hygiene should be initiated, with emphasis on maximizing patient compliance on a continuing basis.
Oral evaluation and management of patients scheduled to undergo myeloablative chemotherapy should occur as early as possible before initiation of therapy (refer to the list on Oral Disease Stabilization Before Chemotherapy and/or Hematopoietic Stem Cell Transplantation below). To maximize outcomes, the oncology team should clearly advise the dentist as to the patient's medical status and oncology treatment plan. In turn, the dental team should delineate and communicate a plan of care for oral disease management before, during, and after cancer therapy.
Oral Disease Stabilization Before Chemotherapy and/or Hematopoietic Stem Cell Transplantation
- Data provided by oncology team to dental providers:
- Underlying disease:
- Cancer: type, stage, prognosis.
- Aplastic anemia status, complete blood count (CBC).
- Type of transplant:
- Allogeneic donor types:
- Matched related and unrelated.
- Mismatched related.
- Mismatched unrelated.
- Hematopoietic stem cell source:
- Bone marrow.
- Peripheral stem cells.
- Cord blood stem cells.
- Conditioning regimen:
- Reduced-intensity conditioning (including nonmyeloablative regimens).
- Planned date of transplant.
- Conditioning regimen:
- Total-body irradiation.
- Radioactive antibodies.
- Current hematologic status and immunologic status.
- Present medications.
- Other medical considerations:
- Cardiac disease (including murmurs).
- Pulmonary disease.
- Indwelling venous access line.
- Coagulation status.
- Data provided by dental providers to oncology team:
- Dental caries (number of teeth and severity, including designation of number of teeth that should be treated before cancer treatment begins).
- Endodontic disease:
- Teeth with pulpal infection.
- Teeth with periapical infection.
- Periodontal disease status.
- Number of teeth requiring extraction.
- Other urgent care required.
- Time necessary to complete stabilization of oral disease.