How do dentists support oncology (cancer) teams during cancer treatment?

How Dentists Support Oncology Teams During Cancer Treatment

Dentists serve as essential partners in cancer care by conducting mandatory pre-treatment oral assessments, preventing medication-related complications, and managing treatment-induced oral toxicities through coordinated care protocols with oncology teams. 1

Pre-Treatment Dental Coordination

Dentists must perform a comprehensive oral evaluation before cancer therapy begins to identify and eliminate potential sources of infection or complications that could derail treatment. 1

Key pre-treatment responsibilities include:

• Conducting complete oral and head/neck examinations with panoramic and full-mouth intraoral radiographs to assess periodontal disease, dental caries, periapical pathology, and oral hygiene status 1
• Completing medically necessary dental extractions at least 2 weeks before radiation therapy or bone-modifying agents (BMAs) to prevent medication-related osteonecrosis of the jaw (MRONJ) 1
• Developing a coordinated dental care plan with the oncologist to ensure all medically necessary procedures are completed before therapy initiation 1

This pre-treatment window is critical because once cancer therapy begins, invasive dental procedures become significantly more dangerous and may need to be avoided entirely. 1, 2

Prevention of Treatment-Related Complications

The dentist's primary preventive role focuses on MRONJ risk reduction through early identification and modification of risk factors. 1

• Addressing modifiable risk factors including poor oral health, invasive dental procedures, ill-fitting dentures, uncontrolled diabetes, and tobacco use before therapy begins 1
• Advising oncology teams that elective dentoalveolar surgical procedures should not be performed during active BMA therapy at oncologic doses unless reviewed by a dental specialist with MRONJ expertise 1
• Providing antibiotic prophylaxis and antiseptic mouth rinses (chlorhexidine) when extractions are unavoidable, with regular follow-up every 6-8 weeks until complete mucosal healing 2

The coordination between dentist and oncologist is essential here because the oncologist may not be aware of oral risk factors that could lead to dose-limiting complications. 3, 4

During Active Cancer Treatment

Once cancer therapy begins, dentists transition to a surveillance and supportive care role with scheduled monitoring every 6 months, or more frequently for high-risk patients. 1

• Conducting complete dental examinations with orthopantomography and intraoral radiographs to identify oral complications early 1
• Communicating treatment recommendations to the oncology team regarding extractions, restorations, periodontal health, and urgent needs 4
• Instructing patients on intensive oral hygiene protocols: brushing teeth and gums four times daily with a soft brush and mild fluoride-containing, non-foaming toothpaste 1
• Recommending alcohol-free mouthwash at least four times daily after brushing, or saline-containing mouthwashes for patients on targeted therapy due to increased infection risk 1

The evidence shows significant variability in practice patterns, with only 50% of dentists feeling adequately trained to treat oncology patients and 46% infrequently following established guidelines. 4 This highlights the importance of dentists seeking specialized training or consultation when managing cancer patients.

Management of Oral Complications

When complications arise, dentists provide specialized diagnostic and therapeutic interventions that directly impact cancer treatment continuity. 5, 6

For MRONJ diagnosis and management:

• Diagnosing MRONJ requires current or previous BMA/angiogenic inhibitor treatment, exposed bone or bone probeable through fistula persisting >8 weeks, and no history of jaw radiation or metastatic disease 1
• Initiating conservative treatment with antimicrobial mouth rinses, antibiotics when indicated, effective oral hygiene, and conservative surgical interventions (e.g., superficial bone spicule removal) 1
• Following up on an 8-week schedule with the dental specialist to monitor progression or resolution 1

For other oral complications:

• Managing oral mucositis, salivary gland hypofunction, odontogenic infections, pain, soft tissue fibrosis, trismus, and osteoradionecrosis that significantly affect quality of life and cancer survivorship 5, 7
• Addressing increased risk for dental caries due to hyposalivation, dysgeusia, dysphagia, and mucosal lesions that develop during therapy 7

Communication and Integration Challenges

A critical pitfall in oncology dental care is inadequate communication between dental and medical teams. 3, 4

• Dentists report minimal correspondence from oncology teams during referrals, creating gaps in coordinated care 4
• Major barriers include insufficient time for dental care before therapy starts (61% of dentists), lack of patient education on oral complications (56%), and lack of dental insurance (31%) 4
• Effective integration requires dentists to proactively communicate with oncology teams beginning at cancer diagnosis, not waiting for formal referrals 3

The complexity of cancer and its treatment demands that dentists have specialized knowledge and experience, as correct diagnosis and evidence-based oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs. 3, 6