Importance of Collaboration to Maintain Oral Health

S-09 The importance of collaboration between the oncology team members for maintenance of oral health

The objective of this presentation is to stimulate improvement in the collaboration between physicians, nurses, and dentists working in supportive care in cancer. This collaboration is important for the maintenance of oral health and patient quality of life during all stages of cancer therapy.

Oncology and cancer therapy are constantly evolving fields in medicine. Medical oncologists, radiation oncologists, and hematologist-oncologists are developing new techniques, new medications, and combinations of cancer therapy that can be cytotoxic for the oral tissues, resulting in severe complications for the patient.

The dental oncologist must remain current relative to these changes in order to diagnose, prevent, and treat these complications.

However, supportive care in cancer is not a subject thought in dental school curriculums. Therefore, dentist with interest in oncology must take additional training to become proficient in this area of medicine.

On the other hand, physicians and nurses are not well trained in the diagnosis and treatment of oral disease.

Thus, if these professionals do not maintain current their knowledge in the field, and do not work together, diseases that could have been prevented will be missed, oral diseases may go undiagnosed and could become a threat to the patient.

Acute and chronic complications of cancer therapy affect the oral cavity of patients receiving high-dose chemotherapy, radiation therapy, hematopoietic stem cell transplantation or a combination of several therapies.

The acute complications include oral mucositis, opportunistic infections like oral candidiasis, bacterial, and herpetic infections, alteration of saliva and salivary gland functions, taste functions and bleeding.

Chronic long-term complications in the oral cavity may put the patient at risk of permanent xerostomia, chronic infections, graft versus host disease and oral cavity necrosis.

A dental professional with knowledge in oncology, and well integrated in the oncology team could help in the prevention, the diagnosis, and the treatment of these complications, improving oral and general health. It is well recognized that a cancer patient undergoing therapy shouldmaintain good oral health, perform oral hygiene procedures and be educated about possible complications of therapy that might affect the mouth.

In order to achieve and maintain oral health, a patient must be evaluated and treated by a dentist prior to starting cancer therapy.

The referral between professionals working in oncology should be part of a routine protocol. Proper referrals should include key information about the type of tumor that will be treated, the staging of the disease, the treatment protocol that will be used, and the expected complications.

Although there are oncology centers around the world where this collaboration already exists, unfortunately a large number of patients with cancer do not have access to a well-integrated multiprofessional team.

These patients will not be placed on preventive protocols for oral complications, will have poor oral health control, and will be at risk of developing side effects thatmight be untreatable.

In addition, the presence of the dental oncologist in the cancer center will be important when patients develop oral diseases that need prompt diagnosis and treatment.

The same type of integrated care should be available when patients complete cancer therapy. The development of integrated protocols to support the cancer patient throughout therapy will help them to complete treatment, having acceptable quality of life.

We will discuss aspects of this inter-professional collaboration and how it can improve patient care, oral and general health, contributing for the success of cancer therapy.

C.A. Migliorati NSU College of Dental Medicine, Fort Lauderdale - Florida, USA

MASCC Abstract, 2007

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