In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with two comprehensive dentists, Dr. Abhishek Nagaraj and Dr. Anushka Gaglani, about common dentistry complaints and their treatments in head and neck cancer patients.

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SHOW NOTES

First, the dentists discuss the role of dental clearance before radiation or surgery initiation. Dr. Nagaraj explains that dental clearance is when dentists check for ulcers, dentures, caries, and any other issues that may bother patients from a treatment standpoint. He mentions that it is helpful for surgeons to specify which conditions they would like dentists to focus on in clearance assessments. Both dentists use a set of 5 clearance screenings and give either full or partial clearance. For minor dentistry treatments, they recommend waiting at least 14-21 days to start cancer treatment. For major dentistry treatments like root canals or wisdom teeth extraction, they recommend waiting for at least 4-6 weeks before major surgeries due to the different healing potentials of each patient.

Next, the dentists explain common side effects of radiation treatment, such as xerostomia, osteoradionecrosis (ORN), candidiasis, and mucositis. Dr. Nagaraj discusses how xerostomia can cause dental caries, which may result in a mandatory tooth extraction and ORN. He and dr. Gaglani recommend treating xerostomia with compounded mouthwashes, lubricants, xylitol, and fluoride toothpaste. They will use antifungals to treat candidiasis. For trismus, they recommend mouth stretching exercises and NSAIDs. Dr. Gaglani emphasizes the importance of upkeep dental hygiene routines in order to minimize the severity of these side effects. However, they both note that with the advent of intensity-modulated radiotherapy, less patients have complained about side effects of radiotherapy. Patients may also complain of post-radiation changes, such as ill-fitting dentures and loose dental implants due to decreased bone density and loss of osseous integration.

Finally, the ENTs and dentists speak about the importance of oral cancer screening in the dentist office. Both dentists perform a visual and tactile examination for all new patients, paying special attention to the tongue, floor of mouth, and lymph nodes. They end the episode by sharing ways how ENTs can collaborate better with dentists, such as encouraging patients to go in for regular dentist visits and specifying conditions they are concerned about during treatment.