An Expert Explains: Oral and Dental Care for Head and Neck Cancer Patients

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Topics include: Treatments and Understanding

Patient Power founder Andrew Schorr is joined by Dr. Dennis Abbott, founder and CEO of Dental Oncology Professionals (DOP), to discuss treatment strategies for head and neck cancer and potential side effects, risk factors for infection, and how oral health is affected. Dr. Abbott explains why oral health is critical to living well with head and neck cancer, how to maintain optimal dental care, and treatments available to protect the mouth and a person’s ability to salivate. Dr. Abbott also shares tips to help patients find a dentist that’s right for them, important questions to ask, and what’s essential for a health practitioner to know before doing dental work. Watch now to find out more.

Sponsored through an educational grant from Cumberland Pharmaceuticals Inc.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

One thing that usually some people mistake is they think, well, I have a thyroid cancer.  That must be included in head and neck, and it's actually a separate category altogether.  So it's really from the larynx up but not including the thyroid.  

But also then the next kind of phase is radiation therapy.  So that can be used either as supportive for the surgery that might have taken place, or it itself can also be a definitive type of treatment.  Some practitioners will choose to include chemotherapy regimens with that as well.  There are now some new immunotherapies that are designed for head and neck, and those are just really beginning to get to the market as well.  

There are also risks for developing what we call oral mucositis, which are very deep ulcerated lesions that happen essentially because of a destruction of the bottom layer of the soft tissue in the head and neck or in the mouth or the oral pharynx, and then work its way up.  And so what we're left with is a very, very deep ulcer, very profound.  A lot of time it comes with a lot of pain.   

And then there are just some lingering side effects that patients need to be aware of.  For example, some of the effects that happen on the bone and the need to take special precautions if, for example, a patient were to have to have a tooth extracted or something of that nature following neck radiation.  There's a real risk for developing a condition called osteoradionecrosis, which is actually a situation where the bone dies and then can subsequently become infected.   

The next step would be really to get the teeth clean.  I know that sounds extremely elementary and very basic, but whenever we've found in our hands and it's been proven in the literature that when we actually lower that bacterial load we can actually do a lot of good for the patient by reducing the severity of the side effects and sometimes even minimizing the side effects themselves in a very clean environment.  So getting the teeth cleaned is going to be essential.  

Getting teeth taken out that are what we would consider to be hopeless.  So those would be ones that are decayed to a point where they couldn't be restored or are broken down.  

And then from a standpoint of being preventive and trying to make sure that the patient is doing everything that he or she can to try to keep their oral health good on the back side of this cancer, in the survivorship years for sure is going to be talking about things with their dentist like perhaps using a prescription strength remineralizing fluoride.  So one that we use, for example, has not only 5 parts per million fluoride, which is almost five times as strong as the fluoride that you would get in a normal toothpaste in the grocery store, for example, but also has calcium and phosphate ions that are naturally found in saliva to remineralizing teeth, which is a process that is really necessary as the patient goes through as well.   

I think another thing that they may want to talk about that they may not know is to—and this would be a discussion to have really with the radiation oncologist and/or the medical oncologist, would be to use medications like amifostine, for example, which is administered either IV or subcu shot, and it's found to be protective in some patients with head and neck cancer to kind of protect the salivary glands from losing the function.  

So with the saliva comes a lot of protection.  It's going to buffer acids so when the saliva is lost acid production in the mouth is going to reach a low pH, which is an acidic environment.  That begins to break down the enamel of the teeth.  It makes the teeth more susceptible to decay.  It makes the teeth harder to keep clean, and it reduces things like the natural protections in saliva that are found to combat different types of bacteria, different types of yeast that may come up during the process of treatment, different types of viruses.  So this really is a critical line of first defense for our natural defense system to the outside world.  So, not to mention it wets your whistle and provides that lubricant we talked about a minute ago.   

It also helps with taste. So there are little molecules in the saliva called gustins that actually transport the taste from the food to the chemoreceptors on the taste buds, and when saliva goes, all those things are lost. So it really is very, very critical in really not only maintaining good oral health and systemic health but also high quality of life.  

For example, normally about tengray(?), which in normal head and neck treatment can be realized maybe at the end of the first week, we're going to start seeing some changes in salivary composition and then eventually flow.  So I think it's critical that patients are aware of this and that they talk about these options with their radiation oncologist or their medical oncologist, because a lot of times these discussions are not introduced and the patient doesn't know to bring them up.  

And then I think to talk about the options of do you offer some medications to help me through this? What are you going to do if I get sick and nauseous?  Because, again, that process of vomiting is going to bring a whole bunch of gastric acid up into the oral environment and, again, wreak havoc on the teeth and the structures that are out there as well as the tissues.  So I think that those kinds of questions are necessary as they're beginning to kind of understand the journey that they're about to embark on. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on October 3, 2018