Shrita Lakhani, Kelvin Mizen
The Hull & East Yorkshire Trust provides tertiary services to a catchment population of 1.25 million. Weekly head and neck Multi-Disciplinary Team (MDT) meetings. Head and neck patients requiring radiotherapy are referred to HRI for oral assessment and extraction of teeth with poor prognosis. The 2012 RCSEng Guidelines, "Oral Management of Oncology patients requiring Radiotherapy," outlines timescales of when extractions prior to commencing radiotherapy should be completed. The guidelines specify that extractions should be performed ideally 21 days before and at least 10 days before DXT commences.
This audit aims to assess if the timing of pre-radiotherapy dental extractions at HRI in 2016 met the recommendations outlined in the 2012 RCSEng guidelines.
The audit reviews 180 head and neck patients for whom the decision to treat with radiotherapy was made in 2016.The following standards were set;
- 100% of the extractions meet the minimum timescale
- 75% of the extractions comply with the ideal timescale
The following information was gathered using HRI's electronic patient record system;
- Decision to Treat with Radiotherapy Date
- Dental Assessment Date
- Extraction Date
- Radiotherapy Start date
29% (53/181) patients treated with radiotherapy in 2016 required dental extractions. 89% (47/53) of those extractions met the minimal timescale and 36% (19/53) complied with the ideal timescale. Unfortunately 11% (6/53) did not meet either timescale. For these 6 patients the window between the decision to treat with radiotherapy and the radiotherapy start date was 14-22 working days.
To improve adherence to guidance, elements of the patient's pathway have been revised. This includes coinciding the dental assessment with the MDT and having a weekly, designated pre-radiotherapy extraction appointment.
Reference: Royal College of Surgeons England. (2012). Oral Management of Oncology patients requiring Radiotherapy (DXT), Chemotherapy and/or Bone Marrow Transplantation . [Accessed 10th June 2017]