Oral Health in Patients with History of Head and Neck Cancer: Complexity and Benefits of a Targeted Oral Healthcare Pathway

Abstract

Purpose of review: This work consists in a literature review on the current state of knowledge regarding the oral management of patients with a history of head and neck cancer (HNC), corroborated by clinical cases and illustrated by clear infographic summaries. It aims to provide healthcare professionals with a comprehensive overview of the oral health status of HCN patients.

Recent findings: Head and neck cancers (HNCs) represent the seventh most common type of cancer worldwide, with over 660,000 annual new cases. Despite the significant negative impact of HNCs on oral health, patients often receive no or inappropriate oral care while the significant impact of oral pathologies on cancer prognosis is commonly underestimated. This work (i) describes the oral cavity during and after HNC through the prism of care complexity and (ii) highlights several potential key factors that could worsen long-time patients' prognosis and quality of life. By investigating the biological, microbiological, functional, and psychological dimensions of the interrelationships between HNCs and oral health, the authors explored the barriers and benefits of a targeted oral healthcare pathway. This article emphasizes the importance of multidisciplinary care and highlights the need for further research elucidating the intricate relationships between oral health and HNCs, particularly through the microbiota.

Keywords: Critical pathways; Dental care; Head and neck neoplasms; Oral health; Quality of life; Radiotherapy.

Fig. 1

Carious disease in HNC patients. A Initiation of the carious process leading to pulpitis. B Progression of the carious process until pulp necrosis. C Systemic impact of carious disease. D Specific features of HNC carious disease. E Clinical features of HNC carious disease. Patient in remission from undifferentiated carcinoma of nasopharyngeal tumor (UCNT) treated in 2015 in Tunisia with radiochemotherapy. The dose received is estimated at 50 Gy for the teeth in the posterior sectors and 35 Gy for the teeth in the anterior sectors. No dental treatment was ever provided. The carious lesions are typical of those described in the literature in HNC patients. Dark cervical lesions, which progress centripetally until tooth fracture, are observed

Fig. 2

Periodontal disease in HNC patients. A Pathophysiology of periodontal disease. B Systemic impact of periodontal disease. C Specific features of periodontal disease in HNC patients

Fig. 3

The intricacies of ORN diagnosis. A Panoramic X-ray of a patient with acinar cell carcinoma of the right submandibular gland treated in 2000 and recurrences in 2003, 2004, 2012, 2017, and 2020. Treatment consisted in multiple surgeries, radiotherapy, chemotherapy, and proton therapy. The clinical oral examination is complicated by the significant limitation of mouth opening. Tooth no. 37 clinically showed suppuration, suggestive of endodontic or periodontal infection, associated with a periapical radiolucency image (blue arrows). Given the patient’s history, she was referred to the oncology team for an opinion. The diagnosis of ORN was confirmed. B–D Clinical views and panoramic X-ray of a patient with a history of squamous cell carcinoma of the right tonsil treated by radiochemotherapy in 2007. He presented with two foci of ORN in the posterior mandibular sectors, suggesting traumatic mucosal ulceration due to his removable dental prosthesis. Early diagnosis and drug therapy resulted in stabilization of the situation

Fig. 4

Negative impact of HNCs on nutrition. A–F Patient in remission from a mandibular squamous cell carcinoma with maxillary extension treated in 2006 by radiotherapy and surgery. Maxillectomy, mandibulectomy, and reconstruction using a free fibula flap left severe functional sequelae. Severe hyposialia and swallowing disorders are also present. Dental treatments must be carried out in a seated position to prevent choking. In the absence of adapted oral care, the situation progressively worsened. In 2021, following the loss of multiple dental restorations, the patient suddenly lost 8 kg as a result of eating difficulties

Fig. 5

Interrelationships between oral health and HNC

Fig. 6

Patients’ voice. A Patient with a history of a well-differentiated carcinoma of the soft palate with posterior extension treated with radiochemotherapy (2012). The patient consulted after 10 years of erratic dental care. She arrived at our specialized consultation with advanced, untreated periodontitis associated with extensive ORN of the maxilla requiring inferior maxillectomy. The links between the two conditions were not determined. The patient had consulted five different practitioners who were unable to provide a solution for her painful teeth presenting severe mobility. She felt “abandoned” and was in considerable psychological distress. B Patient in remission from a squamous cell carcinoma of the left lingual junction area treated with surgery and radiochemotherapy (2018). At the first consultation, the patient broke down in tears when he was informed that a specialized team was going to take charge of him. Apart from his medical team, he had never met a dentist familiar with HNCs and thought he was in a unique situation that no one knew about. C Patient with a history of a right posterior pelvi-mandibular cancer treated with surgery and radiochemotherapy. She had a limited mouth opening and had seen four dentists in private practices who were unable to treat her. In the absence of any viable solution, the clinical situation worsened over the years, with recurrent infectious episodes due to tooth 46, which was necrotic. This dental infection caused an extraoral fistula which was treated by extracting the causal tooth under general anesthesia. She broke down and cried profusely when the team of specialists took charge of her case because she thought she would never find a solution