While working as a dental assistant last year I learned how intertwined
oral health and oncology actually are. I did not realize a correlation existed
until I assisted a dentist with a patient that was referred from an oncologist.
It is not uncommon for an oncologist to refer their patient to
a dentist before allowing the patient to begin chemotherapy or radiation. When
a patient is referred, the dentist will likely complete an oral exam and
evaluate a set of x-rays (2). The dentist will try to determine if any there
are any preexisting conditions that involve an oral infection (2). Oral
infections are caused by accumulation of bacteria and may be correlated with periodontal
disease, caries (cavities), root problems, abscess, etc.
Because oral health has such a large effect on systemic
health, the patient will likely need to have dental treatment before undergoing
radiation or chemotherapy. It is important that the individual is as healthy as
possible during cancer treatment because they will have a suppressed immune
system. With a suppressed immune system, the individual will have a harder time
fighting off the oral infection (1). The bacteria may be aspirated into the lungs,
potentially causing pneumonia or may enter the blood stream through blood vessels
in the mouth and cause other health issues. Any pre-existing oral infections may
change and alter the outcome of cancer treatment (1). Consequently, dentists
and oncologist will recommend oral health infections be resolved before
beginning cancer treatment.
It is also beneficial to have oral health issues resolved
before undergoing treatment as an oral infection could potentially get worse
during treatment. Just as oral health can alter cancer treatment; cancer
treatment may also alter oral health. While a patient is undergoing cancer
treatment, they may notice their oral cavity becoming more sensitive and dry
(3). This alteration in the oral environment can change the bacterial
composition of the mouth and further influence the development of oral health
infections. Further, because white blood cells and platelets may be in low quantities
during treatment, the body will have a hard time fighting off the oral
infection and the healing of oral issues will be minimal (2;3). Therefore, the
infection may only get worse if not treated beforehand.
Because oral health issues and cancer treatment are highly
correlated it is important that health care providers, dental patients, and cancer
patients, be educated on this matter. Oral health infections may impact systemic
health, especially while undergoing cancer treatment. And further, cancer treatment
may alter oral health infections.
1. Dental
and oral complications [Internet]. [Updated 2013 June 8]. Oral Cancer
Foundation; [cited 2013 November 29]. Available from: http://www.oralcancerfoundation.org/dental/dental-complications.htm
2. Hancock
PJ, Epstein JB, Sadler GR. 2003.Oral and dental management related to radiation
therapy for head and neck cancer. J Can Dent Assoc. 69 (9): 585-590.
3. Lacy
Meyer: consider dental issues before beginning cancer treatment [Internet].
c2011. Cure. Available from: http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1795
Emily,
ReplyDeleteI really enjoyed reading this post!
The NY Times recently posted an article linking poor oral health to the human papillomavirus (HPV) which may go on to cause cancer. Ulcers of the mouth, gum inflammation, and sores or lesions (indicative of poor oral health) may provide entry for HPV increasing the likelihood of oral cancers. Strikingly, 20 million people in the US may have HPV, and most of these people have no clue they even have it.
How do you think dentists should address this problem with HPV before it turns to cancer, and before they have to receive cancer treatment?
Is there a plausible solution? Will education alone prevent this matter?
Ref:
Genital HPV Infection - Fact Sheet [Internet]. [Updated 2013 July 25]. Center for Disease Control; [cited 2013 December 1]. Available from:
http://www.cdc.gov/std/HPV/STDFact-HPV.htm
Catherine Saint Louis: Study Ties Poor Oral Health to Cancer-Causing Virus [Internet]. c2013. The New York Times. Available from:
http://well.blogs.nytimes.com/2013/08/21/study-ties-poor-oral-hygiene-to-cancer-causing-virus/?_r=0
Here cancer treatment and dental treatment have close relationship. Dental care is an important factor for cancer chemotherapy patient for several reasons such as chemotherapy patients who have excellent oral heath are less likely to have complications from their cancer treatment. Dental treatment is most consideration factor before, during and after cancer chemotherapy.
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However, there are many other potential links between dentistry and cancer as well as perhaps all disease states. The difficulty for me as a dental researcher is to separate the evidence, either direct or indirect, from the mere speculative.
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