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Cancer treatment, by definition, is highly cytotoxic: radiotherapy and chemotherapy cause death of or damage to cells of the oral cavity, and the side effects vary from patient to patient. In a free webinar on Friday, 4 September, researcher and dental surgeon Dr Juliana Schussel, who is also an adjunct professor in the graduate dentistry programme at the Universidade Federal do Paraná in Curitiba in Brazil, will be teaching dental professionals how to prevent and treat cancer complications before, during and after treatment. A special focus will be placed on oral mucositis, as well as medication- and radiation-related osteonecrosis of the jaws.
Dr Schussel, how do oral problems related to cancer usually manifest in the mouth?
There are two possible scenarios. One is when cancer impacts the mouth directly. Oral cancer is usually associated with tobacco and alcohol use and unfortunately is frequently diagnosed only in advanced stages. It usually starts as a painless ulcer and, for that reason, often goes unnoticed. Other types of cancer can affect the mouth too, such as leukaemia, when spontaneous bleeding or oral lesions related to malignant leucocytes appear in the gingiva. Multiple myeloma can cause lesions in the maxillary bone, as well as other bone tumours. Also, metastatic lesions can occur in the mouth and are associated with worse prognosis of the disease.
The second scenario is treatment-related. Cancer therapies do not distinguish between healthy cells and cancerous cells, which results in side effects. Mucous membranes are often affected, including the oral mucosa. This often causes discomfort and pain, which can also affect the patient’s diet.
Is there a way to prevent such complications during cancer therapy?
The best way to prevent or at least minimise complications is by consulting with the dentist before starting treatment in order to receive guidance regarding prevention or treatment of complications. Also, during cancer treatment, the dentist can help to lessen the severity of the side effects of different therapies. It is also important to note that, especially in the case of radiotherapy, side effects can be delayed and therefore post-treatment follow-up is essential.
Would you say that this is a role for the general dentist or the dental hygienist?
Managing cancer patients is a specialised treatment area, but is largely based on improving patients’ oral health through oral hygiene instruction and elimination of foci of infection, caries and traumatic factors that can be performed by the general dentist and dental hygienist.
Do you feel that dentists are sufficiently knowledgeable about screening patients for cancer?
Unfortunately, we often see uncertainty among dentists when it comes to diagnosing oral lesions. Diagnosing oral lesions is not easy and requires particular knowledge and experience. But the most important thing is that the dentist, even without knowing the diagnosis, is able to identify suspicious lesions and make the appropriate referral.
A professor at our university used to say that “you may never have seen cancer, but a cancer has seen you”. It is this that we need to avoid. Dental professionals must always be alert, and when in doubt about how to proceed, they must know when and to whom to refer.
To which extent is there a need for greater interdisciplinary collaboration?
Cancer is a complex disease with an equally complex treatment. As I said earlier, cancer treatment affects all systems of the body. Interdisciplinary collaboration is essential for successful treatment and minimising side effects, so patients get the best possible quality of life. The world’s major oncology centres have multidisciplinary teams that work together to monitor patients at all stages of treatment, and this is the best way to succeed in the fight against cancer.
Lastly, what do you want dental professionals to take from your webinar?
The most important takeaway message is prevention. Patients with better oral health tend to have fewer complications during and after cancer treatment. Knowledge is another important message. Many resulting conditions, mainly related to osteonecrosis, are associated with dentists being unaware of or under-estimating risks. They should possess the knowledge to propose treatments based on the best scientific evidence so as to maximally benefit the patient.
I prepared the lecture with general practitioners and the basic concepts they need to know in mind. There is a vast and rich scientific literature on the subject, and I hope that my talk will spark listeners’ interest in the subject and stimulate a search for more knowledge.
Dr Schussel’s 1-hour webinar, titled “Complications and side effects of cancer therapy: How to prevent and treat”, will be broadcast live on Friday, 4 September at 6 p.m. CET. Participants will be able to ask questions via a chat window and have the opportunity to earn a continuing education credit by completing a multiple-choice questionnaire on the topic.
Dental professionals who wish to take part in the webinar can register free of charge on the Curaden Campus website.