Mouth Cancer for Clinicians. Part 1: Cancer

The impact of the cessation of primary dental care services on oral cancer diagnosis at a single institution in the UK's epicentre during the COVID-19 pandemic

Aims

COVID‐19 put an unprecedented strain on healthcare services that was complicated by the widespread cessation of all face‐to‐face primary care dental activity from 23 March 2020 for 7 weeks. This led to a focus on telephone triage and remote prescribing that potentially impeded urgent referrals for suspected oral cancer. Guy's and St Thomas' NHS Foundation Trust (GSTFT) screens and diagnoses potential head and neck cancer patients via a 2‐week wait (2 WW) clinic and provides access to patients with urgent oral health needs through an Acute Dental Care (ADC) service. The current service evaluation aims to assess and report on the impact of COVID‐19 and the cessation of primary care dentistry on oral cancer diagnosis at GSTFT during a period of time where patients had extremely limited access to healthcare.

Materials and Methods

Data regarding oral cancer diagnoses were collected retrospectively from secure logbooks and clinical records from the point at which routine dental practice was nationally halted (23 March 2020) to the date at which services were permitted to resume (08 June 2020). Individual patient pathways prior to diagnosis and through to treatment were recorded.

Results

Sixteen new diagnoses of oral cancer were made during the described timeframe. Findings suggest that the paralysis of routine dental services resulted in delayed referral of suspicious lesions and highlights the limitations of a predominately telephone‐based assessment service in primary care.

Conclusion

The importance of the role of the primary care practitioner in the early identification of oral cancer has been emphasised.

Protocols for management of oral complications of chemotherapy and/or radiotherapy for oral cancer: Systematic review and meta-analysis current

BACKGROUND AND OBJECTIVE

Considering the high possibility of dentist consult a patient with oral complications of chemotherapy and/or radiotherapy for oral cancer because of the advances in this area, this study aims to systematically review the literature to identify and suggest effective and safe protocols for the managements of oral complications in oncology patients.

MATERIAL AND METHODS

The systematic review was designed by PICO and PRISMA including eligibility and exclusion criteria; the source of information and search strategy in PubMed according MeSH: "Mouth Neoplasms and Radiotherapy" and "Mouth Neoplasms and Drug Therapy" the period from 2010 to 2015; selection and data collection of study was carried form blind and independently by two researchers; risk of bias and methodological quality: ensured by the PEDro scale; synthesis of data: of oral complications were evaluated by adapted version of associative direction classification proposed by Costigan and collaborators; and data analysis was performed by the meta-analysis of BioEstat program (5.0) in the included studies.

RESULTS

2,700 articles found, 2,371 were selected after removal of duplicate and elected 40 full-text articles. Of these, only 06 articles were included in the systematic review with exclusion of others, per obtain punctuation ≥ 7 with high methodological quality for synthesis of the managements of oral complications. Since 05 articles were associated with low risk of bias composing the protocols suggestive for managements and the meta-analysis in odds ratio (0.916) to cure and relative risk (1.049) for the development of oral mucositis and pain.

CONCLUSIONS

The protocols suggestive for managements of oral mucositis and pain with MuGard - mucoadhesive hydrogel; PerioAid Tratamiento® antiseptic mouthrinse with chlorhexidine and cetylpyridinium chloride; Episil® plus benzydamine - bioadhesive oromucosal gel; 0,03% of Triclosan mouthwash Colgate Plax; and Diode Laser Therapy of low-level are safe for oncology patients applied according to adopted clinical parameters.