The case for having dentists on your cancer care team

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 care team.

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 Trochesset, clinical professor and chair of the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry.

"Fortunately, intervening early to eliminate infection can minimize complications during the course of therapy," says Dalal Alhajji, clinical instructor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry.

Bridging the gap between cancer care and dental care

Many cancer centers lack services and protocols related to oral health; 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 Alhajji, who completed a fellowship in dental oncology and now specializes in treating cancer patients.

Over the past few years, NYU College of 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 College of Dentistry for an exam prior to starting treatment. They're seen at the NYU Dentistry Oral Health Center for People with Disabilities, where 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 Trochesset.

During an exam and cleaning, 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 dental students rotate through the Oral Health Center for People with Disabilities during their third and fourth years of training, 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 Trochesset.

What cancer patients can do to keep their mouths healthy

Keeping up your oral hygiene before, during, and after cancer treatment is critical, according to Alhajji and Trochesset. They recommend that people diagnosed with cancer take the following steps to protect their oral health:

• Visit a dentist before you begin cancer treatment for an exam, X-rays, and cleaning. The dentist may check for infections in your mouth, which can complicate cancer care that lowers your immune system. If your dentist finds an infection, they can treat it—through filling a cavity, extracting a tooth, or performing a root canal—prior to your cancer treatment.
• If you'll be receiving radiation for cancer of the head or neck, Trochesset recommends asking your dentist about creating a custom mouth guard to wear during radiation treatments. A mouth guard can protect areas of your mouth from unnecessary radiation, and may be particularly useful for those with metal fillings and crowns. You may also benefit from jaw exercises or a referral to a physical therapist.
• Keep up your oral hygiene during cancer treatment. Alhajji recommends that you continue brushing your teeth, although you may want to switch to a very soft toothbrush. You may also need to take a break from alcohol-based mouthwash if you develop mouth sores.
• Stay hydrated, especially if you are experiencing dry mouth.