Dental Practice Patterns for Oral Care in Medical Oncology Patients - a Survey-Based Assessment of Massachusetts Dentists

Oral complications associated with chemotherapy are linked to a significant deterioration of oral health and overall quality of life. The primary aim of this study is to assess dental practice patterns followed by dentists for oral care of medical oncology patients along with identifying potential barriers to recommended care. We hypothesize that there is variability in the referral patterns, knowledge and practice protocols among dentists and medical oncologists leading to inconsistent oral care in oncology patients.

A questionnaire was developed to be filled out by all dentists registered with an active email address with the Massachusetts Dental Society (MDS). The questionnaire was constructed online using the platform called Qualtrics (Provo, Utah) and was distributed by the MDS. The questionnaire consisted of 10 questions with all of them being closed ended and one question having the option of an open ended response. A total of two follow up reminder emails were sent, each after a two week period. Descriptive statistics were computed automatically by Qualtrics.

A total of 363 responses (10.7%) were received. Dentists reported that they either rarely or never received correspondence from the oncology team during referrals in terms of cancer diagnosis (50%), start date of chemotherapy (47.4%), medications (56.2%) or complete blood counts (66.1%). A majority of dentists however always provided treatment recommendations to the oncology team with regards to extractions required (74.6%), restorations required (66.7%), periodontal health (68.8%) and other urgent needs (73.5%). When questioned about potential obstacles to providing care, insufficient time to provide dental care before start of therapy (61%), lack of patient education on oral complications associated with therapy (56%) and lack of dental insurance (31%) were most frequently cited. From the total respondents, 40% believed that 2 weeks was sufficient time to provide medically necessary dental care and 81% counselled for possible oral complications associated with cancer therapy. However, only half of the dentists (50%) felt adequately trained to treat oncology patients and 46% of dentists either did not or infrequently followed the recommendations set by the National Institute of Dental and Craniofacial research (NIDCR) for oral care in cancer patients.

The key findings of this study indicate variability in the referral patterns and practice protocols followed by dentists and oncologists for necessary dental care in cancer patients. The major barriers to following established guidelines for care could be attributed to lack of correspondence between provider teams, inadequate training of professionals and financial/insurance factors associated with increased cost of supportive care. We recommend that further studies be conducted to develop an evidence based standardized protocol for referrals and strategies be developed to overcome the various barriers to care so that research findings may be translated into clinical practice.

References:

1)    Patel, Y., et al., Survey of Michigan dentists and radiation oncologists on oral care of patients undergoing head and neck radiation therapy. J Mich Dent Assoc, 2012. 94(7): p. 34-45.

2)    Epstein, J.B., et al., Cancer-related oral health care services and resources: a survey of oral and dental care in Canadian cancer centres. J Can Dent Assoc, 2004. 70(5): p. 302-4.