03 October 2025

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Dental treatment planning and management for the mouth cancer patient

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The need to deliver cancer treatment promptly often requires modification of ideal dental treatment plans. Treatment planning and preventive care is crucial and needs to be done before radiotherapy in order to avoid complications such as osteoradionecrosis. Rapid delivery of this dental care can only be achieved if oral care is given adequate priority in the patient care pathway. Few cancer centres have the resources to provide comprehensive dental care and thus, in most circumstances, this care has to be provided by the patient’s dentist and dental care professional, with advice from the local dental oncology specialist team.

Introduction

Mouth cancer is the general term given to the variety of malignant head and neck tumours that develop in the oral cavity (mouth), pharynx (throat), larynx (voice box), salivary glands, nose and sinuses. In UK, mouth cancer is one of the top 10 most diagnosed cancers and accounts for more than 7800 new cases each year and kills more people than cervical cancer and testicular cancer combined.

Many patients with head and neck cancer will be treated with surgery, radiation, and chemotherapy and a substantial number will be subject to clinically significant short and long-term oral adverse effects, some of which can even make it difficult for a patient to continue to tolerate their cancer treatment. Therapeutic doses of radiation induce long-term irreversible damage to the salivary glands, connective tissues, vasculature, and healing potential of the jawbones, and in particular the mandible. Surgical removal of the cancer tissue can leave the patient handicapped with problems of speech, swallowing, taste and appearance. The dental management strategy is thus often determined by the potential oral complications of cancer treatment.

Many bodies, such as NICE (National Institute for Health and Clinical Excellence) in their guideline ‘Improving Outcomes in Head and Neck Cancer’, and SIGN (Scottish Intercollegiate Guidelines Network) recognize that the optimal management of these patients depends on multidisciplinary teams providing treatment, rehabilitation and support. The management of oral problems before, during and after cancer therapy can reduce the complications and assist with improving the patient’s quality of life.

The most important risk factors for oral complications of cancer therapy are oral or dental disease that already exists and poor oral care during and after cancer therapy. The status of the oral cavity in the cancer patient differs little from that found in the general population. Some will have poorly maintained dentitions, moderate to advanced periodontal disease, ill-fitting denture prostheses, and related pathologies associated with oral hygiene neglect.

The need to deliver cancer treatment promptly often requires modification of “ideal” dental treatment plans. Rapid delivery of this dental care can only be achieved if oral care is given adequate priority in the patient care pathway. Few cancer centres have the resources to provide comprehensive dental care and thus in most circumstances, this care must be provided by the patient’s dentist and dental care professionals, with advice from the local dental oncology specialist team. This is an opportunity for dentists and their teams in the community to play an important role in their patients’ dental care, while saving hospital resources. Patients often prefer to be treated by their own dentist or find it more convenient to travel to their local dentist than travel to the cancer centre for dental treatment. An off-site dental evaluation program, where the dentist performs the entire evaluation and treatment planning guided by written instructions following a protocol from the dental oncology service, could allow most treatment to be provided by the dentist in the community with the dental oncology specialist focusing on maxillofacial rehabilitation.

Author: Vinod K. Joshi

Source: https://www.sciencedirect.com/