What is dental oncology?

Aim 

Dental oncology focuses on the oral and dental needs of cancer patients immediately before, during and after treatment 

Treatment

Management of cancer via surgery, chemotherapy, radiotherapy, novel biologics and supplemental medications can impact the mouth, gums and teeth

Teamwork

Dentists aim to assess and provide oral and dental treatment as a member of the  multi-disciplinary cancer team to optimise the patient's oral health

Oral & Dental Guidance

In the UK, these four guidance documents are the most common resource considered when managing oncology patients

Royal College of Surgeons, England (2018)

Royal College of Surgeons, England (2018)

SDCEP (2017)
Jaw Osteonecrosis

Novel Targeted Cancer Therapies

Monoclonal Antibodies

Suffix : -mab


E.g: Denosumab


Administered:  intravenous or subcutaneous


Indications: multiple medical conditions


Relevant complications for dentistry: neutropenia, thrombocytopenia, medication related osteonecrosis of the jaw

Biologics

Tyrosine Kinase Inhibitors

Suffix : -nib


E.g: Sunitinib


Administered:  oral


Indications: leukaemia, renal cell carcinoma, gastro-intestinal stomal tumours


Relevant complications for dentistry: neutropenia, thrombocytopenia, medication related osteonecrosis of the jaw

Fusion Proteins

Suffix: -cept


E.g: Aflibercept


Administered:  intravenous or subcutaneous or intravitreal


Indications: colorectal cancer, renal cell carcinoma


Relevant complications for dentistry: neutropenia, thrombocytopenia, medication related osteonecrosis of the jaw

Proteasome Inhibitors

Suffix: -mib


E.g: Bortezomib


Administered:  intravenous or subcutaneous or oral


Indications: multiple myeloma


Relevant complications for dentistry:  thrombocytopenia

Phosphoinositide 3-kinase inhibitors

Suffix: -lisib


E.g: Duvelisib


Administered:  intravenous or oral


Indications: lymphoma, leukaemia


Relevant complications for dentistry: neutropenia

Histone deacetylase inhibitors

Suffix: -inostat


E.g: Vorinostat


Administered:  intravenous or oral


Indications: T cell lymphoma, multiple myeloma


Relevant complications for dentistry:  thrombocytopenia

mammalian target of rapamycin

Suffix: -limus


E.g: Everolimus


Administered:  intravenous or subcutaneous


Indications: renal cell carcinoma, mantle cell lymphoma, neuroendocrine tumours


Relevant complications for dentistry: neutropenia, medication related osteonecrosis of the jaw

Hedgehog Pathway Blockers

Suffix: -gib


E.g: Vismodegib


Administered:  oral


Indications: basal cell carcinoma, glioblastoma, prostate cancer, renal cell carcinoma


Relevant complications for dentistry: taste disturbance, thrombocytopenia, medication related osteonecrosis of the jaw

Nadir
Low point in reference to the blood count particularly the white blood cell count and platelet count

Chemotherapy affects rapid turnover cells which includes both cancer cells and blood cells

Blood count normalises within 3-4 weeks 

Nadir time about 10-14 days after treatment (drug dependent)

Next dose of chemotherapy is given only after a patient's blood count emerges from nadir to a safe level


A general rule of thumb is when a patient is ready for chemotherapy their blood cells have returned to safe level for a dental extraction

BUT take into consideration ...
  • Will the patient  heal in time for their next chemotherapy cycle?
  • Will the dental extraction cause delay to the next chemotherapy cycle?
Communicate with the oncologist