By Danny Chan
According to Cancer Council Australia, around 134,000 new cases of cancer will be diagnosed in Australia this year. That number is set to reach 150,000 by 2020. If not already, it is likely that you will soon be seeing some of these patients at your dental practice.
A patient’s health and quality of life may be significantly compromised by oral complications arising from cancer treatments, including head and neck radiation or chemotherapy. Conversely, pre-existing oral diseases can also affect cancer treatment.
This brings to the fore questions on the readiness of the dental profession in caring for a steadily increasing number of cancer patients: Are you or your staff sufficiently equipped to deal with the potential side effects? Are you prepared to counsel, guide or educate patients at different stages of their treatment cycles? What is your role in patient management related to – and beyond – the oral cavity?
If these questions do not sound to you as pertinent as they should, the dental oncology team at Peter McCallum Centre believes, and rightly so, that more awareness campaigns and educational programs on the importance of dental health in oncology are necessary.
“Yes, there is a need for greater awareness on the subject within the dental profession. As a community, all dental professionals will see more and more cancer patients and survivors in practice,” notes Margaret Randles-Guzzardi, Dental Hygienist at Dental Oncology Clinic, Peter MacCallum Cancer Centre.
Equipping Australian dentists to handle cancer patients
Peter Mac is one of the world’s leading cancer research, education and treatment facilities and Australia’s only public hospital solely dedicated to caring for people affected by cancer.
The Centre’s Dental Oncology team comprises a General dentist, an Oral Surgeon, a Prosthodontist, an Oral Medicine Specialist, two Dental Hygienists, and nursing and administrative support staff. The team focuses on the prevention and management of oral complications associated with cancer and cancer treatments.
The clinic’s functions are divided into 3 core areas: 1) Education; 2) Oral examination and dental care; and 3) Research. The educational component is further divided into different target groups: Patients; Dental Professionals; as well as Medical and Allied Health personnel.
Concurring with her colleague on the need for greater awareness within the dental profession, Dr Sophie Beaumont, adds: “At risk of over generalising, I would say that Australian Dentists are not usually well equipped to deal – or are familiar – with cancer types and complications.”
Areas for improvement range from Patient Education to Patient Management, Pre- to Post-Treatment.
There is relevant information online – including from leading cancer centres Lifehouse Sydney and MD Anderson (USA) – but Margaret says the field would benefit from a “comprehensive set of recommendations and strategies that are the same in each institution.”
Equipping dental professionals with the right educational tools paves the way for informed patient management. Dentists may be required to treat and advise cancer patients on a range of oral conditions before, during and after cancer treatment.
“It needs to be understood that oral side-effects from treatments such as radiotherapy and bone modifying agents are for life,” Margaret qualifies, “These side-effects impact on quality of life and self-esteem. They don’t cease when the all clear is given or the cancer is in remission.”
Multi-faceted roles and responsibilities
Clients are referred internally by the hospital’s staff. Dr Beaumont says it may be more effective for patients to be referred prior to radiation therapy in order to allow more time for pre-treatment and healing – however, this is not always possible.
Patients are brought in 6 weeks following completion of cancer treatment, and subsequently, every 2 months for a further 6 months – typically or until ready to return to their general dentist.
At Peter Mac, the dental oncology team performs a variety of tasks that most general dentists do not, including:
- Mapping tooth loss risk: Predicting up to five years whether teeth will stay and recommending prosthetics for those that may be lost or require removal.
- Dealing with cases of osteonecrosis (in the jaw): This can result from therapy, especially some sulphur-based drugs used in treatments – “some patients have bone erosion so significant that teeth literally fall out.”
- Handling the client’s self-esteem: “Many struggle with self-image after losing dentition so the service is vital. It is also vitally important for their ongoing nutrition.”
Advocating patient education as an integral part of pre-treatment evaluation, Margaret says that it should encompass discussion of potential oral complications. She stresses on the need for patient education and oral cancer screening at every dental visit.
“Australian dentists need to understand their role in terms of prevention and early detection – they go hand in hand. From organising regular oral cancer screenings to recommending high fluoride toothpaste to providing restorations that are functional and easy to clean, the dentist plays a unique role in the preventive process.”
“The oral side-effects of many cancer treatments can affect the patient for life. As dental professionals, we need to understand how these treatments can be detrimental for teeth.”
To provide an avenue for Australian Dentists to learn more about treating cancer patients, Margaret reveals that the Centre intends to run an education program in the future. How dentists would respond to such a program, given that many suffer for being time-poor and overloaded with work and business commitments, remains to be seen.
Indeed, playing an active role in cancer treatment may seem like a chore to many dentists, Shae Beaton, the Clinic’s other Dental Hygienist, readily acknowledges, before issuing a gentle warning about measuring it in monetary terms:
“Finances should not be the consideration. A simple cancer screening should be part of every dental examination. The dental professional has an obligation to do this as the medical profession generally are not familiar with the oral cavity. That said, providing ongoing empathetic care will attract patients and lead to referrals from cancer centres that indirectly will build their practices.”
“Practice building is also about having a rewarding experience,” Dr Beaumont reminds, “like being able to positively influence the outcome for a cancer patient.”
Building bridges and team effort
Dental oncology occupies an uncharacteristic area of dentistry that spills into the medical domain. Focusing on the dental and oral manifestations of chemotherapy, radiation therapy and/or head and neck surgery, dental oncologists find themselves in a unique position somewhere in the middle of the dental-medical divide.
Operating within a multi-disciplinary dental specialist clinic means that the team works in close association with all of the oncology streams, including: Head and neck, haematology, breast, lung, and skin.
“At Peter Mac, we believe that it takes an entire village, including dental and medical professionals working alongside one another, to care for people affected by cancer,” Shae comments.
From their vantage viewpoint, the team sees the Australian dental and medical fields converging in positive ways.
“There are well established communication lines and mutual respect on both sides. Oncologists regularly discuss patients with dental staff and vice versa,” Margaret confirms.
Dr Beaumont adds: “You will find excellent team work and no real hierarchy at the Centre – there’s always good communication and respect for what we do.”
That same open-style communication and professionalism extends to the dental community with which the team regular works and liaises – including all referring specialists, community dental clinics and private dentists.
“Whether for resources or support, we want to make our department the go-to for dental and medical professionals,” the Oral Surgeon concludes.
“We work together as a team for the best patient outcomes, reduced morbidity and improved quality of life.”