Cancer is a very serious disease which often requires immediate intervention and treatment. In a situation like this oral care during cancer treatment can be relegated to the background only to become major problems down the line.
The treatment of cancer can involve the use of radiotherapy and/or chemotherapeutic drugs both of which affect the body in long-lasting ways . This means that the treatment plans for cancer patients must be made keeping their specific condition in mind. Permanent tooth replacement in cancer patients is something that is often needed because the severity of oral diseases increases dramatically and leads to tooth loss .
Dental implants in cancer patients
There is no question that the best method of permanent tooth replacement available to patients right now is through the use of dental implants. These dental implants are drilled into the jawbone and then require the bone to heal around them in a process called as osseointegration .
In most patients that are unaffected by other systemic diseases this is a relatively predictable process but that is absolutely not the case with cancer patients who have undergone radiotherapy in the head and neck area or have undergone chemotherapy .
The intent of radiotherapy or chemotherapy is to kill the cancer cells and stop them from dividing further. This also means that the normal unaffected cells in the region of the treatment also get destroyed. With respect to the jawbone, direct radiotherapy or chemotherapy destroys the blood vessels in the area and does not allow the normal transport of healing cells after an injury that occurs during implant drilling or even a routine extraction.
Such a non-healing bone wound can be very serious and lead to a condition known as osteoradionecrosis .
Of course, there is a certain timeline on this effect after which the body’s healing mechanism should return to normal. Unfortunately, this timeline can vary from person to person. Currently, it is advised that no surgical procedure or extraction be undertaken for 6 months after the completion of chemotherapy or radiotherapy.
Doctors can be quite conservative in such cases and can insist on waiting a minimum of a full year after the completion of cancer treatment before attempting any kind of invasive procedure. There are some case reports where osteoradionecrosis has occurred multiple years after the completion of cancer treatment .
All of this, however, does not mean that dental implants are not an option for cancer patients at all. It only means that dentists must take prior opinion from the attending oncologist and take the necessary procedures before attempting the treatment.
Hyperbaric oxygen therapy has also been proven to be quite effective in helping re-vascularise the bone so that surgical treatment like dental implants becomes possible .
Apart from bone health, however, other considerations like the salivation of the cancer patients must also be taken into consideration when planning for dental implants. In some patients, the salivation becomes only a fraction of what it used to be and can lead to a shift of the microbiota towards a disease-causing one .
This will make the development of infection around the implants more likely and increases the chance of failure.
If, however, the recovery of cancer patients is complete then they can go ahead with dental implant treatment with suitable precautions and enjoy a vastly improved quality of life .
Dental crowns and bridges in cancer patients
Dental crowns and bridges are excellent options for permanent tooth replacement in cancer patients because of their non-invasive nature. In fact, this would be one condition where crowns and bridges should be the first choice of treatment rather than a second alternative to dental implants.
The fabrication of crowns and bridges does not involve anything to do with the underlying bone which can be severely affected by cancer treatment. The presence of firm teeth in the mouth is all that is required to forego any potential complications like osteoradionecrosis or waiting on long healing times in cancer patients.
A few additional measures have to be taken into consideration though.
The margins of the crowns and bridges must be kept such that the patient is able to clean them easily. Plaque accumulation can increase in cancer patients because of a decreased amount of salivation and thus the incidence of gum disease can increase rapidly.
Care also must be taken to ensure that there are no irritating edges that can cause ulcers in the mouth or tongue .
These are relatively small complications though and do not pose much of threat. This is why dental crowns and bridges are an excellent option for permanent teeth replacement in cancer patients.