As an emerging and growing specialty, oral medicine is still largely inaccessible to many patients with cancer, as well as patients with autoimmune or inflammatory conditions. Commonly, patients with these health concerns experience poor quality of life due to mouth sores, pain, burning, mouth dryness, or other oral conditions. However, we know from experience that with appropriate and timely identification of potential problems, we can help eliminate or reduce the incidence and severity of complications attributed to cancer therapy and illness.

Over 2 million new cancer cases are expected to be diagnosed in the US in 2024.

 Among all patients with cancer, approximately 40% who receive chemotherapy, 80% who undergo a stem cell transplant, and 90% of those who received radiation for head and neck malignancies experience oral complications.

When you consider the number of patients with cancer—along with the conservatively estimated 23.5 million Americans at increased risk for oral health problems due to autoimmune diseases such as lupus, rheumatoid arthritis, Type 1 diabetes, celiac disease, and psoriasis— the need to improve access to oral medicine specialists is clear. It’s also necessary to broaden the understanding of how we can be of benefit to patients.

As the only board-certified cancer center–based oral medicine specialist in South Florida, I care for patients with problems of the lips, roof of the mouth, tongue, salivary glands, and the inner lining of the cheeks. At Miami Cancer Institute, we treat oral lichen planus, aphthous ulcers, dry mouth, jaw osteonecrosis, burning mouth syndrome, temporomandibular disorders, and oral infections (herpes simplex virus and candidiasis), as well as oral precancers, such as leukoplakia, and oral toxicities of targeted therapies and immunotherapies.

Procedures performed include biopsy of oral lesions, intralesional steroid injections, nonsurgical sequestrectomy (of the jawbone), topical and systemic medical treatments, and trigger point injections.

Dental evaluations are particularly important for patients with cancer who are scheduled for bone marrow transplants or head and neck radiation, as an issue in this area during or after treatment can lead to severe complications or death. We are working to build our relationships with the local dental community and have developed a dental education packet for patients to bring to their dentists to obtain x-rays or clearance prior to starting treatment for head and neck cancers.

We urge anyone who has a sore, bump, or colored lesion in the mouth that doesn’t go away, or a dry or painful mouth or canker sore that doesn’t heal, to seek the care of an oral medicine specialist. It’s also our responsibility to continue to educate the public about the importance of receiving the human papillomavirus vaccine because the virus is responsible for the majority of cases of oropharyngeal cancer.

Working together, dentists, primary care providers, and specialists can deliver the best quality care to our medically complex patients, improving quality of life and preventing life-threatening complications.

Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/ caac.21820

Leukemia & Lymphoma Society. Dental and Oral Complications of Cancer Treatment Facts. September 2016. Accessed July 18, 2024.xw bit.ly/3Y9wuMV

Articles

Oral medicine remains largely inaccessible to many cancer patients and those with autoimmune conditions, despite its potential to mitigate oral complications and improve quality of life. With over 2 million new cancer cases expected in the US in 2024, a significant portion will experience oral complications from treatments. The need for improved access to oral medicine specialists is evident, especially for those at risk due to autoimmune diseases. Collaborative efforts among healthcare providers are essential to enhance patient care and prevent severe complications.

Alessandro Villa, DDS, PhD, MPH, discusses the importance of oral medicine in cancer treatment.

The Importance of Oral Medicine in Cancer: Evaluation and Treatment

Alessandro Villa, DDS, PhD, MPH, discusses the incidence of oral toxicities in patients with head and neck cancer.  

Dr Villa on the Incidence of Oral Toxicities in Patients With Head and Neck Cancer

Alessandro Villa, DDS, PhD, MPH, chief, Oral Medicine, Oral Oncology, Dentistry, Miami Cancer Institute, Baptist Health, discusses changes in the incidence of oral toxicities in patients with head and neck cancer.

The management of oral complications arising from cancer treatment is crucial for improving quality of life (QOL) for patients with head and neck cancers, Villa begins. Any patients with this diagnosis who are scheduled to undergo radiation therapy should see a dental specialist for dental screening, Villa emphasizes. Dental screenings prior to and during radiation therapy are essential for preventing odontogenic infections and mitigating the risk of developing oral complications, he explains.

Furthermore, the advent of new chemotherapeutic drugs and immunotherapy for patients within this population has brought both promise and challenges, Villa continues. Although these treatments have improved patient outcomes, they also contribute to an increase in oral complications such as oral mucositis, lichenoid-like lesions, and severe dry mouth, he outlines. Villa adds that such complications can have a significant impact on patients' QOL, affecting their ability to eat, speak, and maintain proper oral hygiene. Additionally, conditions such as hyposalivation and dryness of mouth can lead to the development of secondary issues such as dental caries and oral candidiasis, creating further complications, Villa notes.

Managing these oral complications requires a multidisciplinary approach involving dental specialists, oncologists, and supportive care teams. Regular screenings, proactive measures, and targeted interventions can help alleviate symptoms and prevent complications during and after cancer therapy, Villa states. Ongoing research efforts are focused on developing new medications and treatment strategies to address these challenges. Clinical trials are evaluating novel therapies aimed at preventing and managing oral mucositis and other treatment-related complications, offering hope for improved outcomes and enhanced quality of life for patients with oral cancer.