Dental Management of Patients with Cancer in GP Dental Practices
Dr. Jessica Metcalfe
General Dentist
In this episode of CDA Oasis Live, Dr. Jessica Metcalfe, a general dentist at the Princess Margaret Cancer Centre in Toronto, joins Dr. John O’Keefe to discuss the role of the GP dentist in the care of patients undergoing treatment for cancer.
Dr. Metcalfe highlights the importance of oral health for anyone undergoing radiation therapy or chemotherapy, and gives specific tips on how to best manage their dental care through all phases of their treatment.
Here are the key takeaways from the conversation:
The GP dentist has a significant role to play in the management of patients undergoing cancer care. This role extends through the pre-, during, and post-treatment phases of radiation therapy and chemotherapy.
Pre Treatment
- Gather as much information about the patient’s primary diagnosis as possible. This will help to identify dentition that may be exposed to high levels of radiation.
- Make decisions on the condition of exposed teeth and whether the patient will be able to maintain them for life. It is important to avoid removing teeth post-radiation.
- Update baseline clinical and radiographic exams.
- Take impressions and create custom fluoride trays to help prevent post-radiation caries.
During Treatment
- Radiation and chemotherapy typically lasts for 5-7 weeks. During this time the patient may experience oral side effects including mucositis, sticky saliva, dry mouth, increased sensitivity in teeth, difficulty swallowing, and general soreness in the mouth.
- Focus of oral care during this phase is supportive. Usually avoid restorations or hygiene.
- Consider prescribing a magic mouth rinse to help with side effects - 1:1 ratio of nystatin and lidocaine viscous or a baking soda, saline and water rinse.
Post Treatment
- Once the patient has completed their treatment and their mouth is feeling more comfortable, it is important that they get back to regular hygiene routines and necessary exams.
- Post-radiation caries in a dry mouth progress much faster compared to a patient with an abundance of saliva. If a patient has moderate or severe xerostomia, consider seeing them every 3-4 months instead of every 6-9 months.
- Reinforce oral hygiene habits and use of fluoride trays.
- Restore small carious lesions quickly.
- After one year post-treatment the saliva doesn’t usually change much more, however the xerostomia due to radiation treatment is indefinite.
We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.
Until next time!
CDA Oasis Team
Do you have any comments on the use of at home application of fluoride varnish by the patient instead of custom made fluoride trays? I’ve found compliance compliance to be difficult for some post radiation patients using custom fluoride trays.