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Department of Dentistry

Tetsuhito Konishi, Toshiro Miyata, Tomoko Kaneda

Introduction

We aim to deal with the diverse intraoral complications associated with cancer treatment and to maintain and improve patients' quality of life (QOL) in the field of dentistry.

Cancer treatment is frequently associated with a variety of intraoral complications, such as mucositis, taste disorder, dry mouth, pain, and infection. In particular, in patients undergoing treatment for head and neck cancer (chemoradiotherapy, surgery) and hematopoietic stem cell transplantation, severe intraoral symptoms may occur, and strict infection control measures are needed.

When such measures are inadequate, composite complications may result in secondary complications such as eating disorders and undernutrition, and the oral cavity may serve as a source of systemic infections, which may lead to the need for deferring or discontinuing treatment, making continuation and completion of cancer treatment difficult.

To manage and prevent intraoral complications, we evaluate and stabilize the oral status before the initiation of cancer treatment. Proactive intervention by dentists or dental hygienists to educate the patients, their families, and the attending medical staff is extremely important.

Routine activities

We undertake efforts to prevent infection of wounds and aspiration pneumonia and to reduce other complications by oral hygiene management before and after surgery. To maintain postoperative functions of jaw defects, we are attempting to correct speech-language and eating functions by preparing appropriate artificial dentition and prostheses at an early stage, thereby improving the QOL of patients after treatment. For patients receiving chemotherapy and radiotherapy, we are supporting continuation and completion of treatment by taking measures to prevent infections arising from the dentistry realm and mucositis and by reducing pain. In regard to delayed complications, we are undertaking preventive and treatment activities for multiple dental caries, osteomyelitis of the jaw, and necrosis of the jaw bone. Patients treated over the long-term with zoledronic acid or denosumab may develop Medication-Related Osteonecrosis of the Jaw (MRONJ) as a result of contamination of the oral cavity and tooth extraction; thus, we are undertaking measures to prevent/treat this complication.

By participating in multidisciplinary conferences, we apply prevailing practices and information updates to future medical care support. In 2015, the numbers of new and revisiting patients were 1,006 and 8,375, respectively, and the total number of patients was 9,381. These numbers represent an approximately 1.8-fold increase as compared to those in the first year when dentists at the National Cancer Center Hospital East began to hold full-time positions. We believe that the importance of supportive care in cancer has been recognized.

Research activities

We are participating in a multicenter study being conducted to evaluate the effectiveness of proactive use of supportive care for preventing serious oral mucositis in patients with head and neck cancer undergoing chemoradiotherapy.

We are carrying out a study on multiple dental caries and radiation-induced osteomyelitis developing after radiotherapy for head and neck cancers. In addition, we are a part of the nutrition support team.

We cooperate with other facilities for the establishment of oral care programs for patients with head and neck cancers receiving chemoradiotherapy.