Acute and community services work together to avoid complications

11 February 2019

Dental and oncology consultant teams in parts of south Wales have worked together to prevent patients with head and neck cancers developing a complication of chemotherapy and radiotherapy. 

The increasing use of bisphosphonate chemotherapy and immunotherapy for bone metastasis is leaving patients at risk of developing osteonecrosis of the jaw bone. This prevents the jaw bone healing – for example after tooth extractions. Patients find it difficult to talk or eat and in extreme cases the jawbone can disintegrate. This is a rare but serious complication. 

James Owens, lead consultant in restorative dentistry and oral rehabilitation with the Abertawe Bro Morgannwg University Health Board (ABMU), says the condition was first recorded more than a century ago. 

“Workers in munitions factories during World War I were exposed to phosphorous in the weapons they were making. Some of them started to develop what was then called ‘phossy jaw’.”

While the new cancer treatments have enormous clinical benefits, dentists and oncologists have recognised the difficulties that could arise if patients later have teeth extracted. National guidelines emphasise the need for patients starting this therapy to have an urgent dental assessment and ongoing dental prevention care. 

ABMU developed a clinical pathway for rapid dental assessment and treatment for patients with head and neck cancers scheduled for anti-resorbative chemotherapy/immunotherapy. Patients’ dental health is screened and high risk teeth are extracted before the oncology treatment. 

Owens said: “We employed a dental nurse two days a week in a coordinator role. Oncology colleagues give her details of new patients scheduled for treatment and she liaises with each patient and their dentist or gets in touch with the community dental service if they don’t have a dentist. 

“At the restorative dental service we provide support if dentists have questions or they can make urgent referrals to us or to oral surgery if they are not sure about a particular tooth or there is a complicated extraction.” 

With speed of the essence for these patients, the system helps fast-track referrals into oral surgery “as we work closely with them in the same clinics”. 

Satisfaction rates among patients who were assessed and treated by community dental services or by Owens and his colleagues reached 100%. However, that figure was lower, 78%, for those seeing their own dentist – something Owens puts down to the fact such professionals are often isolated and difficult to reach for training.

“With the community dental service it was relatively easy for us to organise and provide training as they are salaried staff working together. That was far more difficult with independent dentists working alone.” Despite that, only around 8% of patients were referred for extractions at the acute service.

Resources Primary/Community Services

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