Maxillofacial Dental Oncology
If you have just been diagnosed with a cancer in the head and neck
region, you probably are trying to learn as much as you can about
your condition, researching the best treatment options and coping
with your range of emotions. You may not be thinking about getting
a good dental check-up, but you should.
Avoiding a Serious Side Effect
At the James Graham Brown Cancer Center, the first referral made
for any patient whose treatment plan includes chemotherapy or radiation
to the head and/or neck will be the Maxillofacial Dental Oncology
Clinic.
That’s because these treatments to the facial area may temporarily
or permanently damage the saliva glands. A common side effect of
radiation is “dry mouth.” Saliva contains antibacterial
components that fight tooth decay and gum disease. The lack of saliva
opens the door for bacteria, often leading to severe damage to teeth
and gums. Dry mouth can lead to other serious oral conditions in
teeth, gums, salivary glands and jawbones. These side effects can
hurt and make it hard to eat, speak and swallow, affecting quality
of life.
Prevention
Our dental oncologist will meet with you to determine what effects
the proposed cancer treatment plan will have on your mouth. The
goal is to alert patients as early as possible to prevent any damage
from occurring. Prevention is much more effective than trying to
fix the problem after it occurs.
After your initial consultation, we will contact your dentist to
discuss the recommended course of treatment, which may include special
toothpaste, extra brushing and more frequent dental visits to monitor
the situation. At the Brown Cancer Center, we strongly believe your
dentist is an important partner in this treatment plan. Before cancer
treatment begins, your dentist may take the following steps:
• Identify and treat existing infections, problem teeth and
tissue injury or trauma.
• Stabilize or eliminate potential sites of infection.
• Remove orthodontic bands if certain types of chemotherapy
are planned or if the bands will be in the radiation field.
• Evaluate dentures and appliances for comfort and fit.
• Perform oral surgery, if needed, at least two weeks prior
to the initiation of radiation therapy to allow healing and at least
seven to 10 days before myelosuppresive chemotherapy begins.
• In adults receiving radiation, extract teeth that may pose
a future problem.
• In children, consider extracting highly mobile primary teeth
and teeth that are expected to exfoliate during treatment.
• Instruct patients on oral hygiene, use of fluoride gel,
nutrition and the need to avoid tobacco and alcohol.
We can provide you with options and recommendations, but your dentist
will need to help you follow through.
Restoration
The Maxillofacial Dental Oncology Clinic also plays an important
role for patients whose condition is disfiguring, as well as debilitating.
When surgery is part of the cancer treatment plan, portions of the
oral cavity and the head and neck region are removed to cure and/or
control a tumor. Sometimes the surgical removal of part of the mouth
or throat makes swallowing difficult or impossible. Plastic surgery
to repair these areas may not be an option. They may require prosthesis
to function or to be more aesthetically pleasing.
Our dental oncologist is part of the Brown Cancer Center’s
Head and Neck Working Group and is consulted before surgical treatment
that will result in permanent removal of facial features or parts
of the mouth or esophagus.
In these cases, we meet with the patient before surgery and make
molds to recreate the parts that will be removed. Whenever possible,
the prostheses is placed into the patient at the same time the surgery
is done to remove that part of the mouth or throat. We do this so
when our patient wakes up, he or she can feel as normal as possible.
When it is not possible to place the actual prosthetic device during
the initial surgery, a prosthesis that can be removed for treatment
is inserted. For example, temporary mouth prosthesis is used during
the period of radiation therapy. After the treatment is complete,
a permanent prosthesis is placed.
The primary goal is to help our patients return to a normal lifestyle.
Patients receive follow-up care for six months to one year after
treatment.
Education
One of the most important aspects of the Dental Oncology Clinic
is the opportunity it gives dental students and dental hygiene students
to rotate through an oncology clinic. As part of the teaching component
of the University of Louisville School of Medicine, this oncology
rotation provides an opportunity to educate future dentists and
hygienists about the importance of proactive treatment during cancer
therapy and about the importance of screening and early diagnosis
for head and neck cancers.
It is always easier for our patients if we can prevent cancer from
ever occurring. When precancerous lesions are caught and removed
early, the disease doesn’t progress to cancer.
One of a Kind
Part science and part art, the Maxillofacial Dental Oncology Clinic
provides head and neck cancer patients the safest and least disfiguring
course of treatment. One of just a few of its kind in the country,
the Clinic is led by Zafrulla Khan, D.D.S., M.D. He is renowned
nationally and internationally for providing oral/dental care for
patients undergoing radiotherapy, chemotherapy and/or surgery for
head and neck cancer. His ongoing clinical research contributes
to the development of state-of-the-art techniques and materials
used to develop prostheses.
For more information about the Maxillofacial Dental Oncology
Clinic at the James Graham Brown Cancer Center, call 502.852.5747.