Leading dental hygienist Rachel Pointer discusses how to help patients on the “road to recovery” after oral cancer
It is likely that you will be seeing more patients who are facing new challenges as a result of an oral cancer diagnosis. In 2014, there were over 11,000 new cases of head and neck cancer in the UK, which equates to around 30 diagnoses made every day.
Most forms of oral cancer are treated with surgery and/or radio or chemotherapy or chemoradiation (a combination of the two), depending on type and stage of the disease. Pain following treatment may not last, but it can make swallowing and cleaning uncomfortable while it does. If it is sore to eat, healing can be affected if the diet lacks variety and freshness. Persistent, painful ulcer-like sores are an indication of oral mucositis, common after radiation therapy. Chemotherapy can lead to xerostomia and other salivary gland dysfunctions. Chronic xerostomia will leave the patient prone to radiation caries if the quality and quantity of saliva fails to improve. Other possible complications from chemo/radiotherapy include a loss or distortion of taste (dysgeusia) and vulnerability to both oral and systemic infection. If the surgeon had to remove a lot of tissue a prosthesis may have been required and your patient will need support to learn how to live with it.
Difficulty with eating, communicating or breathing after treatment can lead to social withdrawal. Halitosis is often a by-product of chronic xerostomia, which can cause problems in relationships and an unwillingness to speak to others. The emotional impact of oral cancer is a serious issue: a recent survey has found that female head and neck cancer, patients were 31% more likely to be hospitalised for depression; for men the figure stood at 28%.
There is a great deal that a dentist can do to help. Feeling clean and cared for is important for anyone who is convalescing and maintaining a good standard of oral hygiene will boost confidence. Frequent appointments alongside gentle, effective daily brushing will avoid future complications and encourage a full recovery. For example Tandex has a range of brushes and adjunctive products that are kind to teeth and gums and will remove maximum amounts of bacteria more efficiently. Xerostomia can be eased if the patient avoids alcohol-based mouth rinses, sips water regularly and avoids food and drink with high sugar content. Above all, communication has to be open and honest. A patient’s full compliance with your post-cancer schedule is essential for a full return to health.
There is a wealth of literature about the role of the dental practitioner in spotting signs of oral cancer. But once a diagnosis has been made, the dentist is an integral part of the support team that will help the patient along the road to recovery. Although work is being done to educate people on how to avoid oral cancer, especially if they indulge in high-risk behaviour such as smoking, dental teams need to face the reality of rising statistics for this disease, and get prepared.
Rachel Pointer qualified from Guys Hospital as a dental hygienist and began work in general dental practice in Hertfordshire. After working as staff hygienist for Professor Naylor she was appointed tutor dental hygienist at Guys Hospital before working in Australia. Rachel has experience in hospital, specialist periodontal practice and in the private sector as well as setting up a PDU within a cerebral palsy home in Essex. Working for 10 years for the British Dental Hygienists Association as their information officer plus membership and careers co-ordinator she presently works at Addenbrookes Hospital and in general dental practice, and a few year ago branched out to teach in a Montessori school setting.