A national survey of consultants, specialists and specialist registrars in restorative dentistry for the assessment and treatment planning of oral cancer patients

Abstract

Aims: To investigate the approach of restorative dentists towards the assessment and treatment planning of oral cancer patients in the UK.

Material and methods: The survey was conducted at the annual meeting of the Association of Consultants in Restorative Dentistry (ACSRD) and Specialist Registrar in Restorative Dentistry group (SRRDG) in September 2011. Delegates were requested to fill in a two-section questionnaire; the first section included 16 questions, evaluating cancer service provision in their units, and the second included five questions based on a clinical scenario evaluating dental management of a patient undergoing pre-radiotherapy treatment.

Results: Ninety-four questionnaires were distributed; 65 (69.1%) were returned. Thirty (46.1%) respondents were consultants, 27 (41.5%) were specialist registrars and the remaining 8 (12.3%) were either specialist practitioners or trust grade dentists working in the speciality of restorative dentistry. Forty-eight (73%) of the respondents worked in NHS posts and the remaining 17 (27%) worked in academic posts. A total of 50 (77%) respondents carried out clinical work which regularly included the dental assessment or treatment of head and neck (H&N) oncology patients, before or post radiotherapy. Among the respondents who were involved in the dental assessment of oncology patients, 32% of them did not have a protocol for review appointments in their units. Ninety-one percent of respondents said that they used dental implants for rehabilitation post cancer surgery and 80% also used implants either always or sometimes in irradiated bone. Answers to scenario questions highlighted that all the respondents would extract very poorly prognostic tooth (that is, root stumps) before radiotherapy, irrespective of it being at the side of the planned radiotherapy field. Fifty-eight percent of respondents preferred to extract a non-functional, heavily restored, non-carious, distal maxillary molar tooth which was not in the area of radiotherapy beam and the majority (84%) chose to carry out root canal treatment (RCT) of a functional premolar tooth if considered non vital.

Conclusion: This study highlights the variability in the approach of clinicians in dental and oral rehabilitation of patients undergoing radiotherapy treatment for oral cancer patients.