Dentist, lecturer and founder of a dental practice specialising in treating cancer patients, Dr. Kyle Ash answers eight questions on how best to care for dental oncology patients.
According to statistics, one in three people will develop cancer in their lifetime, and this serious disease with its long-term treatments usually affects all aspects of a patient’s life. From the dental professional’s point of view, caring for oncology patients can be challenging, it can be rewarding, but most of all, it’s very needed.
Dentists are on the front line in terms of being able to spot oral cancer, and so their role in the early detection phase is fundamental. According to statistics, 80% to 90% of oral cancer cases are curable if detected in the early stages. Nonetheless, 70% of all cases are diagnosed when already in the late stages. As Dr. Kyle Ash says, however: “We as oral health providers and oral systemic health partners can really change that number through the early detection of oral cancer.” As in all cases, the sooner detected, the quicker the patient will get the necessary treatment, and thus the higher the likelihood of survival.
For over a decade, Dr. Kyle Ash has cared for oncology patients who are suffering from head and neck cancer. As a key opinion leader in the field of dental oncology, he supports others seeking knowledge in this field, and those gaining extra education credits.
During his webinar, Dental oncology: Your role in caring for the oncology patient, he answered a number of questions asked by dental professionals from around the world. Read a selection of these questions, and Dr. Ash’s answers about oral cancer lesions and treating oncology patients in general, below.
1. What is the right protocol to follow for papilloma-like lesions on a tonsil?
Once you observe the lesion, give it two weeks while treating it with antibiotics. If it doesn’t heal within this time, establish a connection with an ENT doctor and follow with a biopsy.
2. What treatment do you suggest for haematology patients with multiple oral ulcerations, besides the interruption of chemotherapy?
The regular interruption of chemotherapy is not recommended at all; once you take a patient off chemo, the likelihood of their beating the cancer goes way down. 60% of chemotherapy patients develop oral mucositis and ulcerations.
“Using a surgical toothbrush by Curaprox is a must to clean the adjacent areas. The cleaner you keep the ulcers, the better.”
The best way to manage it, besides prevention of course, is with medicaments. Mugard, for instance, is an excellent type of medicine to drink. It coats the mouth and oral cavity and acts as a bandage. Using a surgical toothbrush by Curaprox is a must to clean the adjacent areas. The cleaner you keep the ulcers, the better. Any type of 20% Lidocaine will help numb the pain and will help the patient overcome it. Your oral medical oncologist can advise you on the latter.
3. Are there certain oral hygiene products you consult with the oncologist on prior to prescribing them to a patient?
Generally there is no need to do so. Drawing from experience, I recommend that patients try to avoid very strong mint flavours and other harsh things that could cause pain. Enzycal toothpaste, for instance, has a very mild mint flavour.
4. With regards to oncology patients, which toothbrush is better to use – an electric or a mechanical one?
More than the brush, it is the technique that is most important to pay attention to. There is a whole content series by Curaden that analyses mechanical vs. electronic toothbrushing in detail. Overall, however, electronic toothbrushes tend to be a little too rough for oncology patients.
5. What are your thoughts on the use of lasers for oral cancer patients?
If your ambulance can afford them, low level laser therapy – especially on oral mucositis – is very efficient. Use it for oral mucositis sores to minimise some of the pain the patients experience.
6. When should tooth extraction be done when dealing with an oncology patient?
Never extract a tooth immediately after radiation, and also do not remove any teeth immediately before chemotherapy – ensure at least seven to fourteen days of healing time before the patient starts the treatment. You should not remove teeth at all following 30Gy of radiation to the affected tooth region. Sometimes interfering with a tumour can cause it to spread to other places, so make sure you plan any extractions well with regards the radiation therapy.
“Never extract a tooth immediately after radiation, and also do not remove any teeth immediately before chemotherapy – ensure at least seven to fourteen days of healing time before the patient starts the treatment.”
7. When should I do the cleaning?
Never do a cleaning whilst a patient is undergoing chemotherapy. The correct timing is very important when treating cancer patients. The white blood cell counts need to come back up after they receive any kind of chemotherapy. Give them about two to three weeks after any treatment, and then you can do the cleaning.
8. Is high fluoride toothpaste recommended, or one that contains triclosan?
Triclosan is not encouraged at all. It has been attributed to cancer in mice. Even though it is antibacterial, never use it in oral mucosa. The best way to manage radiation caries is by using fluoride. You can either use the fluoride trays, or recommend your patients to use a high fluoride toothpaste.