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.
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
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
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
In order to achieve and maintain oral health, a patient
must be evaluated and treated by a dentist prior to starting
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
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.
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.
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.
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.
NSU College of Dental Medicine, Fort Lauderdale -
MASCC Abstract, 2007
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