Caring for oral health before, during,
and after cancer treatment—a growing focus at NYU College of Dentistry (NYU
Dentistry)—can minimize complications.
Cancer treatment often takes a team of health
professionals—oncologists, nurses, surgeons, radiologists, pathologists and
social workers—to coordinate and provide comprehensive support for patients. At
NYU, dentists are increasingly being considered an important part of the cancer
When faced with a cancer diagnosis, many patients push other
health care to the side to focus on addressing the disease. But people with
cancer can experience unique issues related to their oral health. For instance,
radiation to the head and neck can damage the salivary glands, hurting their
ability to produce saliva, which can lead to tooth decay or cavities. Radiation
and chemotherapy can also cause painful mouth sores. Patients with cancer that
has spread to their bones, or who are undergoing treatment that can weaken
their bones, may be prescribed high doses of antiresorptive medications such as
bisphosphonates. These medications can cause a rare condition called
osteonecrosis of the jaw, in which the jawbone is exposed through the gums.
Other treatments—including chemotherapy and bone marrow
transplants—lower the immune system, leaving patients susceptible to infection.
Infections in the mouth during cancer treatment are especially dangerous, given
the immune system’s inability to fight back.
“An abscessed tooth may mean having to stop chemotherapy to
treat the infection,” says Denise
D.D.S., Clinical Professor and Chair of the Department of Oral and
Maxillofacial Pathology, Radiology and Medicine at NYU Dentistry.
“Fortunately, intervening early to eliminate infection can
minimize complications during the course of therapy,” says Dalal Alhajji, D.M.D., M.S.D., clinical instructor in the Department of
Oral and Maxillofacial Pathology, Radiology and Medicine at NYU Dentistry.
Bridging the Gap Between Cancer Care and Dental Care
centers lack services and protocols related to oral health; Drs. Trochesset
and Alhajji are part of a small but growing number of oral health professionals
working to change this.
“We need to give dentists a primary role on the cancer care
team,” says Dr. Alhajji, who completed a fellowship in dental oncology and now
specializes in treating cancer patients.
Over the past few years, NYU Dentistry has strengthened its
connections with cancer providers at NYU Langone’s Perlmutter Cancer Center,
particularly those treating head and neck cancers and diseases requiring bone
marrow transplants. A growing number of patients with certain cancers are
referred to the NYU Dentistry for an exam prior to starting treatment. They’re
seen at the NYU Dentistry Oral Health Center for People with Disabilities,
where Dr. Alhajji oversees their care.
“We might not think of cancer patients as having a
disability, but they may be medically disabled, even if for just a short period
of time,” explains Dr. Trochesset.
During an exam and cleaning, Dr. Alhajji and dental students
check for any signs of infection or other issues that could complicate cancer
care. After the initial exam, patients can either return to their regular
dentist or continue their care at the Oral Health Center for People with
Disabilities, where general dentists and specialists are under one roof.
Closing this gap in care is not only transformative for
patients, but for dental students as well. Because all NYU Dentistry students
rotate through the Oral Health Center for People with Disabilities during their
third and fourth years, they now gain experience with a patient population
being treated for cancer.
“Our dental students already learn about cancer in their oral
medicine and pathology courses—but now, it’s no longer just something they read
about in their textbooks, which is unique for a dental school,” says Dr. Trochesset.
What Cancer Patients Can Do to Keep Their Mouths Healthy
Keeping up oral hygiene before, during and after cancer treatment is critical,
according to Drs. Alhajji and Trochesset. They recommend that people diagnosed
with cancer take the following steps to protect their oral health:
a dentist before beginning cancer treatment for an exam, radiographs
and cleaning. The dentist may check for infections in the mouth, which can
complicate cancer care that lowers the immune system. If the dentist finds
an infection, they can treat it—through filling a cavity, extracting a
tooth or performing a root canal—prior to cancer treatment.
a patient will be receiving radiation for cancer of the head or neck, Dr. Trochesset
recommends they ask their dentist about creating a custom mouth guard
to wear during radiation treatments. A mouth guard can protect areas of the
mouth from unnecessary radiation and may be particularly useful for those
with metal fillings and crowns. Patients may also benefit from jaw
exercises or a referral to a physical therapist.
up oral hygiene
during cancer treatment. Dr. Alhajji recommends that patients continue
brushing their teeth, perhaps switching to a very soft toothbrush. They
may also need to take a break from alcohol-based mouthwash if they develop
should stay hydrated, especially if they are experiencing dry mouth.
Courtesy of NYU College of
Published on August