The division between medicine and dentistry in cancer care

We have a problem. There is a disturbing divide between the medical and dental communities when it comes to cancer care. As a result, caregivers and their patients experience a lot of frustration about the lack of dental care for patients with cancer.

dr. alhajjic

During my training, I met a middle-aged man who had been diagnosed with adenoid cystic carcinoma of the left nasal cavity, for which he underwent surgery and electron beam irradiation.

The cancer came back six years later, warranting another round of radiation therapy. As a result of his cancer treatment, he developed severe trismus to such an extent that he was unable to remove his prosthesis. This limited our ability to conduct an adequate head and neck exam and deal with the chronic intra-oral pain he initially came to our clinic complaining about. Despite limited evaluation, we were able to establish clinical evidence of osteoradionecrosis. The peak of oral complications he suffered not only led to chronic pain but also affected his speech and ability to eat.

Such catastrophic cases can be prevented or at least minimized with a simple dental assessment while awaiting a patient’s cancer treatment, and supportive oral care throughout their cancer journey. If our team had been involved earlier, we could have facilitated a referral to a physical therapist to minimize the progression of his trismus.

Dentists play an important role in improving the quality of life of their patients and instilling hope in their cancer journey. It’s hard enough going through cancer; it is one of the most difficult experiences imaginable for our patients and their loved ones. Once a patient has made it to the other side, the last thing they want to deal with at that point is fighting major oral complications that can inevitably arise from cancer treatment, especially when those complications were completely avoidable.

The reality is that this is not how things work. Such as cancer network observed, some cancer centers “let the patient take care of it” when it comes to dental care. In addition, a population study found that only 35% of oral cancer patients have a regular dentist and routine dental care.1 In a survey of oral health support services for the National Cancer Institute-Designated Cancer Centers, 56% said they didn’t even have a dental ward, nor did they have any kind of oral care protocol to address any health concerns while treating cancer. cancer.2 This is a problem.

There are a few factors that can be attributed to this problem.

The first and perhaps most notable reason is the lack of access to care, mainly characterized by the fact that medical and dental insurance is based on separate insurance models; Medicare usually does not cover dental procedures and many dentists do not accept Medicaid.

The second cause of this discrepancy is a limited number of dentists with a good understanding of oncology. The current reality is that dental school curricula do not emphasize dental oncology. For that reason, general dentists are unwilling to treat this patient population.

On the other hand, our medical counterparts are not trained enough to consider the impact of cancer and its treatment on a patient’s oral and overall health.

Making matters worse, dentists often lack administrative support, or a lack of cross-trained billers (CDT vs. CPT coding), to support them with reimbursement.

Finally, a third explanation for our challenge could be described as ‘individual patient barriers’. They include lower socioeconomic status that affects the ability to be released from work or access transportation, language difficulties that hinder effective communication, and patient education. After all, dental care is not the first thing that comes to mind when you are diagnosed with cancer.

What is the solution?

There are a number of patient groups working on these conundrums, such as the Oral Cancer Foundation and the Santa Fe Group. This has recently been brought to the attention of the Lancet Series on Oral Health3, 4 and NYU Dentistry designated as a WHO Collaborating Center for Quality Improvement and Evidence-Based Dentistry5

There are also a limited number of facilities and programs that attempt to bridge the gap between medicine and dentistry. I am grateful to be a part of one of them. Opened in 2019, the Oral Health Center for People with Disabilities (OHCPD) at NYU Dentistry is aimed at patients with very prominent and visible physical disabilities, such as those using wheelchair transportation. While society doesn’t often consider cancer a disability, it can certainly affect a person’s quality of life, just like other disabilities. As a result, it deserves proper attention and care, which is why at the OHCPD we include the care of this patient population in our protocol as a mechanism to bridge this gap. Another way that NYU Dentistry acts as a bridge is by waiving the cost of pre-cancer dental care for those who do not have insurance. We also promote the professional education of our students by adapting the protocol for the OHCPD to include comprehensive dental care for cancer patients, expanding the curriculum and educating the next generation of dentists.

In short, at NYU Dentistry’s new Oral Health Center for People with Disabilities, we are leading the way in bridging the gap between medicine and dentistry by ensuring that dentists are available, visible and accessible to this patient population. The goal is not only to survive and beat cancer, but to thrive afterward. As Benjamin Franklin reminds us, “an ounce of prevention is worth a pound of cure.”

dr. Dalal Alhajji, DMD, MSD, received her DMD from Boston University Henry M. Goldman School of Dental Medicine, Certificate in Advanced Education in General Dentistry and Master of Science in Dentistry, in Oral Medicine degree from Case Western Reserve University School of Dental Medicine. She also completed a fellowship in dental oncology at Memorial Sloan Kettering Cancer Center and is now a clinical instructor in the New York University College of Dentistry’s Division of Oral and Maxillofacial Pathology, Radiology, and Medicine.

1 Groome, Patti A., et al. “A Population-Based Study of Factors Associated with Early vs Late Diagnoses of Oral Cavity Cancer.” Oral Oncology 47.7 (2011): 642-647.2 Epstein, Joel B., et al. “A Review of National Cancer Institute-designated Comprehensive Practices and Resources for Oral Health Supportive Care at Cancer Centers in the US.” Supportive care for cancer 15.4 (2007): 357-362.

3 Peres, Marco A., et al. “Oral Diseases: A Global Public Health Challenge.” the lancet 394.10194 (2019): 249-260.

4 Watt, Richard G., et al. “Ending Global Oral Health Neglect: Time for Radical Action.” the lancet 394.10194 (2019): 261-272.

5https://dental.nyu.edu/faculty/epidemiology-health-promotion/who-cc.html#


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