An audit of the baseline dental status and treatment need of individuals referred to Dublin Dental University Hospital for a pre-radiotherapy dental and oral assessment

Précis

Increasing numbers of patients are referred for pre-radiotherapy dental assessment. Advice and support regarding prevention of dental disease will maintain oral health and reduce the need for surgical intervention in the future.

Abstract

Objectives: The objectives of this audit were to establish the baseline dental status and treatment need of pre-radiation head and neck cancer patients in Ireland.

Material and methods: A review was carried out of the dental status and treatment need of 746 adult patients who were scheduled to commence radiation therapy for head and neck cancer. These patients were referred to the Dental Oncology Treatment Centre and there were 76% male and 24% female individuals.

Results: The numbers attending the clinic increased from 20 in 1998 to 239 in 2013. The age range was 17 to 89 years, with a mean age of 57.4 years, standard deviation (SD) = 13.0 years. The diagnosis was of squamous cell carcinoma in 85% of cases and the main subsites were the larynx and tongue. Some 51% of patients smoked or had very recently quit smoking, and 25% had never smoked. A total of 97% were dentate, of whom 65% had more than 16 remaining teeth. Of the dentate patients, 66% had dental decay. Some 12% had vertical mouth opening of less than 30mm, complicating access for dental care. Moderate to severe chronic periodontitis was noted in 21%. Dental treatment need was as follows: (1) oral health instruction (OHI), diet and dry mouth advice, and jaw exercises – all dentate patients; (2) periodontal and caries preventive treatment – 86%; (3) dental extractions – 72%; (4) restorative dental care – 59%; and, (5) radiation stents – 5%.

Conclusion: This study highlights the increasing numbers of referrals for dental assessment and treatment prior to radiation treatment. The group was dentate but its oral health was generally poor. A significant number of individuals required dental extractions, and restorative and periodontal care, to render them dentally fit prior to radiation treatment. Pre-radiation dental assessment and necessary care must be provided without delay to prevent delay with the start of radiotherapy.

Journal of the Irish Dental Association 2017; 63 (5): 269-276

Dr Denise MacCarthy
BDS NUI FDS RCS (Edin) MDentSc
Head of Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital

Dr Mary Clarke
FFDRCSI FDSRCPS MDentCh (OS) Dip Con Sed
Oral Surgeon/Lecturer in Conscious Sedation, Dublin Dental University Hospital

Dr Myra O’Regan
PhD
Associate Professor of Statistics, Department of Statistics, Room 142 Lloyd Institute, Trinity College, Dublin 2

Corresponding author: Dr Denise MacCarthy, Head of Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Lincoln Place, Dublin 2. E: denise.maccarthy@dental.tcd.ie