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Dental students’ knowledge of characteristics and management of oral complications of cancer therapy

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Abstract

Objective

The aim of this study is to investigate the level of Turkish senior dental students’ knowledge regarding the orodental complications and their treatment methods of cancer patients.

Study design

A 15-item questionnaire which was obtained from National Institute of Dental and Craniofacial Research that contained information about the orodental complications of the cancer therapy and the dentists’ role to provide their treatment protocols was used. Seventy-seven senior dental students answered the questionnaire and the replies were analyzed with stratified and logistic data analyses.

Results

Overall, correct replies ranged from 5.2 to 98.7 %. The students knew the basic knowledge of the complications of cancer therapy; however, they failed to answer to the questions (ranging between 1.3 and 94.8 %) about the required clinical practices. The respondents preferred not to answer the questions about the prophylactic measures dentist shall take during a precancer treatment oral evaluation (9.1 %), management of pain in cancer treatment (6.5 %), and necessary considerations before a dental procedure in a chemotherapy patient (3.9 %). The multiple logistic regression analysis revealed that gender had no statistically significant effect on the correct or false answers to the questions (p > 0.05).

Conclusion

Our results disclosed that dental students’ knowledge about oral complications of cancer therapy and the modalities to manage these complications vary. Reevaluation of current undergraduate curricula and continuing education for graduates might address the gaps identified and an educational program about oral and dental management of patients who are to receive/receiving/have received cancer therapy can be prepared and augmented into dental curriculum.

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Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Radiology, Ege University Faculty of Dentistry, 35100, Izmir, Turkey

    Esin Alpöz, Pelin Güneri & Hülya Çankaya

  2. Department of Oral Medicine, City of Hope National Medical Center, Duarte, CA, USA

    Joel B. Epstein

  3. Cedars Sinai Medical Center, Los Angeles, CA, USA

    Joel B. Epstein

  4. Faculty of Dentistry, Ege University, Izmir, Turkey

    Damir Osmic

  5. Department of Statistics, Faculty of Science, Ege University, Izmir, Turkey

    Hayal Boyacıoğlu

Authors
  1. Esin Alpöz
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  2. Pelin Güneri
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  3. Joel B. Epstein
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  4. Hülya Çankaya
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  5. Damir Osmic
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  6. Hayal Boyacıoğlu
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Corresponding author

Correspondence to Esin Alpöz.

Appendix 1

Appendix 1

Original questionnaire

  1. 1.

    Which of the following statements about the oral complications of chemotherapy and head and neck radiation is not correct?

    1. (a)

      Oral mucositis can increase the risk of oral pain and systemic infection.

    2. (b)

      Oral complications may lead to lowering the dosages and possibly discontinuing cancer treatment.

    3. (c)

      High dosages of chemotherapy or radiation therapy cannot affect dental, craniofacial, or skeletal development in children.

    4. (d)

      Patients undergoing cancer treatment may experience alterations in taste perception.

  2. 2.

    Dental decay occurs more rapidly after head and neck radiation treatment because

    1. (a)

      there is a change in the flow rate for saliva

    2. (b)

      there is a change in the composition of saliva

    3. (c)

      the ability to taste is impaired

    4. (d)

      a and b only

  3. 3.

    What population is most likely to experience oral complications from cancer therapy?

    1. (a)

      Patients with melanoma treated with chemotherapy.

    2. (b)

      Patients with oral and pharyngeal cancer treated with radiation.

    3. (c)

      Patients with breast cancer treated with chemotherapy.

    4. (d)

      Patients with prostate cancer treated with radiation.

  4. 4.

    When oral care is added to the pretreatment regimen, which of the following is true?

    1. (a)

      There is an increased risk of oral complications.

    2. (b)

      The patient will have no oral complications from cancer therapy.

    3. (c)

      Pre-existing oral health problems will get worse.

    4. (d)

      It is more likely that the patient will be able to complete his or her optimal cancer treatment regimen.

  5. 5.

    What specific health information should an oral health professional have as part of the oral evaluation of a patient with cancer?

    1. (a)

      Cancer diagnosis and treatment plan

    2. (b)

      Medical history

    3. (c)

      Dental and periodontal oral examination data

    4. (d)

      All of the above

  6. 6.

    Which of the following oral complications may occur during and/or after head and neck radiation and chemotherapy?

    1. (a)

      Dry, friable oral tissues

    2. (b)

      Abnormal dental, craniofacial, or skeletal development

    3. (c)

      Oral mucositis

    4. (d)

      All of the above

  7. 7.

    Select the statements that apply (more than one answer may be correct): at a precancer treatment oral evaluation, the dentist will

    1. (a)

      Instruct the patient about the importance of proper oral hygiene during cancer treatment

    2. (b)

      Request that the patient stop wearing dentures during cancer treatment, even if there are no problems with fit or comfort

    3. (c)

      Examine hard and soft tissues and expose radiographs to detect oral conditions that may become problematic during cancer treatment

    4. (d)

      Remove all teeth that may present a problem in the future for patients undergoing head and neck radiation

  8. 8.

    For a patient experiencing xerostomia, recommend all of the following except

    1. (a)

      Sipping water

    2. (b)

      Chewing sugarless gum

    3. (c)

      Eating spicy foods to stimulate the salivary glands

    4. (d)

      Using liquid to soften foods

  9. 9.

    What can help a patient who is experiencing mouth pain?

    1. (a)

      Mouth rinse containing alcohol

    2. (b)

      Lip balm

    3. (c)

      Topical anesthetics

    4. (d)

      Chewing ice

  10. 10.

    Which of the following statements is true?

    1. (a)

      In general, high-dose radiation to the head and neck will not permanently alter salivary functioning.

    2. (b)

      Patients are at risk for osteonecrosis after receiving high-dose radiation treatment to the mandible.

    3. (c)

      Patients who have received high dose radiation to the mandible can safely undergo invasive surgery at this site 5 years after radiation therapy.

    4. (d)

      Patients who have received radiation to the head and neck are not at greater risk for caries than other patients receiving radiation treatment for cancer.

  11. 11.

    When should daily oral hygiene be suspended?

    1. (a)

      When the patient experiences mouth pain

    2. (b)

      When the patient has difficulty swallowing

    3. (c)

      When the patient has an oral infection

    4. (d)

      Never

  12. 12.

    Oral hazards of cancer treatment specific to children are

    1. (a)

      Osteonecrosis

    2. (b)

      Abnormal growth and development of the teeth and cranial bones

    3. (c)

      Complications from highly mobile primary teeth

    4. (d)

      Dental caries

    5. (e)

      b and c

  13. 13.

    Which of the following is not necessary before a dental procedure in a chemotherapy patient?

    1. (a)

      Completing all blood work, including platelet count, clotting factors and absolute neutrophil count 24 h before dental treatment

    2. (b)

      Prescribing 7 days of fluoride gel treatment

    3. (c)

      Scheduling myelosuppressive therapy more than 7–10 days after dental treatment

    4. (d)

      Considering a prophylactic antibiotic regimen for patients with a central venous catheter

  14. 14.

    The timing of dental procedures in relation to cancer treatment is very important. Which of the following is incorrect?

    1. (a)

      Dental evaluation: schedule it every 4–8 weeks for the first 6 months after radiation.

    2. (b)

      Oral surgery: allow 7–10 days of healing before the patient receives myelosuppressive chemotherapy.

    3. (c)

      Blood work: perform 24 h before dental treatment for chemotherapy patients.

    4. (d)

      Post-stem cell transplantation dental recalls, including dental scaling: perform regularly for the first 3 months after treatment.

  15. 15.

    The oral cavity is often subject to complications from cancer treatment because

    1. (a)

      All foods aggravate weakened tissues

    2. (b)

      Many patients experience hypersalivation

    3. (c)

      Tissue in the oral cavity thickens

    4. (d)

      Soft tissues in the mouth become easily desiccated, damaged, and infected

Correct answers: 1, c; 2, d; 3, b; 4, d; 5, d; 6, d; 7, a–d; 8, c; 9, d; 10, b; 11, d; 12, e; 13, c; 14, a; 15, d

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Alpöz, E., Güneri, P., Epstein, J.B. et al. Dental students’ knowledge of characteristics and management of oral complications of cancer therapy. Support Care Cancer 21, 2793–2798 (2013). https://doi.org/10.1007/s00520-013-1856-x

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  • DOI: https://doi.org/10.1007/s00520-013-1856-x

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