Christine Wanis, Arpan Tahim, Zaid Sadiq
Dental assessment for Head and Neck Oncology patients is part of the multidisciplinary team approach which takes place prior to operative surgery or primary/adjuvant radiotherapy and chemotherapy. Treatment planning at this stage is based around assessment of the risk of developing post-treatment long-term complications: altered anatomy, trismus, hyposalivation, radiotherapy associated caries and osteoradionecrosis.1
A survey was carried out covering 5 NHS Trusts and across 3 specialties including Oral and Maxillofacial Surgery (OMFS), Oral Surgery (OS) and Restorative Dentistry (RD). Depending on the departmental setups within different Trusts, these are the specialties that routinely carry out dental assessments. A set of 5 orthopantogram radiographs were sent out to 20 OMF surgeons, 20 OS specialists and 10 RD specialists. With each radiograph a full diagnosis was described and a set of questions were asked to determine which teeth required extractions, whether they would recommend restorative work for any of the teeth, and a box to qualify both answers.
Out of the 50 questionnaires, we had 96% compliance. There was significant variation in extraction patterns among specialties. OMF surgeons were more likely to consider less frequent post-operative complications such as trismus, and occasionally all molar teeth would be considered for pre-emptive extractions, irrespective of their long-term prognosis. More OS surgeons would consider sending patients for restorative treatment if there was a RD specialist within their department. It was found that RD specialists were more conservative in their approach to extractions versus restorative work, and were more likely to incorporate preventative advice within their assessment for example, Duraphat toothpaste.
The R-D UK clinical guideline1 published in November 2016 highlights the importance of pre-operative dental assessments in Oncology patients and includes a more holistic patient approach including preventative dentistry, salivary substitutes and jaw exercises for trismus. This survey simply shows the discrepancies of these assessments made amongst different specialties, and across different Trusts.
References: 1. http://www.restdent.org.uk/uploads/RD-UK%20H%20and%20N%20guideline.pdf accessed May 2017