The Importance of Pre-Treatment Dental Assessments
Currently, cancer, ischaemic heart disease and pneumonia together account for approximately 60% of the total causes of death in Singapore.1
33 people are diagnosed with cancer every day and 1 in 3 Singaporeans die of cancer.2
While some people would associate oral cancer treatment (including tongue cancer) with dentists (usually oral surgeons and oncologists working together), few people realize that dentists also have a role to play for patients with other forms of cancer including head & neck cancer, breast cancer, etc.
When chemotherapy or radiotherapy is indicated for cancer patients, it is important for them to see a dentist for a pre-treatment dental assessment to identify any outstanding gum problems or decayed teeth that need to be treated prior commencing cancer treatment. In addition to the oncologist and surgeon, the dentist should be part of the patient’s core treatment team.
This is to identify and address any underlying dental issues before chemotherapy starts as the immune system will be significantly compromised once the patient starts on the chemotherapy treatment. The mouth is a cavity that contains a myriad of bacteria at any given time, even for a healthy person. Therefore, it is imperative for cancer patients to go for a thorough dental check-up and cleaning by the dentist because the presence of these bacteria increases the likelihood of it entering the bloodstream, thus increasing the risk of infection for those with decreased immunity.
Routine dental procedures such as extractions would be approached differently when cancer patients are involved. This is because the quality of bones of cancer patients may be altered from previous chemotherapy or radiation as these treatments slow down or stop the growth of new cells. The dentist should try his or her best to save a tooth where possible due to the slower healing process for wound sites after extraction. In some cases, the bone around the infection area could die (this is known as bone necrosis).
Having a dentist with the patient before, during and after treatment is a step that can help save much cost, pain and psychological trauma. It is also helpful for medical specialists to manage their cancer patients more smoothly.
What does a Pre-Treatment Dental Assessment Involve?
Typically, the dentist will go over your medical history and review your x-rays. The dentist will also conduct a physical examination of your dentition, jaw and mouth, and will discuss with you treatment options and timelines in conjunction with the schedule of upcoming major surgery or cancer treatment. Crucial pre-treatment assessment will be performed in such a way as to minimize downtime and also to keep as close to the originally scheduled medical treatment as much as possible.
The initial pre-treatment assessment consultation should take under one hour and if there are no pre-existing dental conditions that need to be addressed before the major surgery or cancer treatment, the follow up is done after medical treatment is completed.
In the event that dental treatment is required before the major surgery or cancer treatment, this should be done in a timely manner, with the patients’ best interest and comfort in mind. Patients should be able to resume usual activities on the same day without any interruption.
After the cancer episode is over, a cancer patient’s health condition is usually still weaker than that of a healthy person. Therefore, it is important to update the attending dentist about the patient’s medical history before any dental procedures are done.
Thus, continuous oral care before, during and after cancer treatment is critical in the prevention or reduction of the incidence and severity of oral complications, with the net result that patient survival and quality of life are enhanced.
Dr. Ansgar Cheng
Specialist Dental Group
Disclaimer: The views and opinions in the article are the writer’s own and do not necessarily reflect those of Mount Elizabeth Medical Centre (MEMC). The writer is fully responsible for the accuracy, completeness and usefulness of the information provided in the article. MEMC will not be liable for any errors, omissions or copyright issues with regard to the contents of the article.