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The role of the general dental practitioner in managing the oral care of head and neck oncology patients Suzanne Moore Mary C Burke Michael R Fenlon Avijit Banerjee Dental Update 2024 39:10, 707-709.
Professor of Prosthodontics, Hon Consultant in Restorative Dentistry, KCL Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, UK
Professor of Cariology & Operative Dentistry, Hon Consultant in Restorative Dentistry, King's College London Dental Institute at Guy's Hospital, KCL, King's Health Partners, London, UK
The general dental practitioner (GDP) plays a critical role in managing head and neck cancer patients. The first and most important role is to offer preventive services, particularly to smokers and to patients who drink alcohol to excess. It is of critical importance that every patient has a systematic examination of oral soft tissues when seen by a GDP. All patients with suspicious lesions should be referred for urgent attention to a specialist centre. Once oral cancer has been diagnosed, GDPs may be presented with patients requiring urgent dentistry, including extractions before commencement of treatment, requiring palliation of symptoms during treatment, or requiring general dentistry after treatment. Radiotherapy provides increased survival but has serious adverse consequences, which may be lifelong, including dry mouth, radiation caries, limitation of mouth opening and high risk of osteonecrosis after extractions. Extraction of teeth in irradiated bone should be referred to specialist centres. Improving survival rates and an ageing population mean that GDPs will see many more survivors of head and neck cancer in the future, with an increased burden of dental care in the longer term and an increased need for monitoring and secondary prevention.
Clinical Relevance: The management of patients with head and neck cancer is complex and involves a multi-disciplinary team, both in the primary treatment but also in the long-term care. This paper reviews the consequences of treatment for head and neck cancer and gives practical advice for GDPs and their team in the long-term care of these patients.
Article
Management of orofacial carcinomas, including prevention, detection and oral care before, during and after treatment of the cancer, should involve the dental team. This paper gives practical advice throughout the care pathway.
An important role of the primary dental care team is the prevention of oral diseases. In this regard, the two most important environmental risk factors in head and neck cancers are tobacco and alcohol.1 In addition, a well-managed smoking cessation programme can be successful when delivered by the dental team.2 The Department of Health has produced guidelines to assist the dental team in aiding their patients to stop smoking (Smokefree and Smiling, Helping Dental Patients to Quit Tobacco, Department of Health publication, 2007) and some of these techniques can be modified to encourage patients to moderate their alcohol intake.
The role of nutritional factors in preventing oral cancers is controversial. Nevertheless, NICE guidance encourages the promotion of a healthy diet.3
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