Department of Dentistry

Tetsuhito Konishi, Terumi Takeuchi, Tomoko Kanata, Reiko Kishi, Yurika Mizutani

Introduction

We are working to address the diverse intraoral complications associated with cancer treatment and to maintain and improve the patients’ quality of life (QOL) in the field of dentistry.

Cancer treatment is frequently associated with a variety of intraoral complications, such as mucositis, taste disorders, dry mouth, pain, and infection. In particular, in patients undergoing treatment for head and neck cancer (chemoradiotherapy, surgery) and hematopoietic stem cell transplantation, severe intraoral symptoms may occur, and strict infection control measures are needed.

When such measures are inadequate, composite complications may result in secondary complications such as eating disorders and undernutrition, and the oral cavity may serve as a source of systemic infections; these may lead to the need to defer or discontinue treatment, making continuation and completion of cancer treatment difficult.

To manage and prevent intraoral complications, we evaluate and stabilize the oral status before the initiation of cancer treatment. Proactive intervention by dentists or dental hygienists to educate the patients, their families, and the attending medical staff is extremely important.

The Team and What We Do

We strive to prevent infection of wounds and aspiration pneumonia and to reduce other complications through oral hygiene management before and after surgery. To maintain postoperative functions of jaw defects, we are working to correct speech-language and eating functions by preparing appropriate artificial dentition and prostheses at an early stage, thereby improving the QOL of patients after treatment. For patients receiving chemotherapy and radiotherapy, we are supporting continuation and completion of treatment by taking measures to prevent infections arising from the dentistry realm and mucositis and by reducing pain. In regard to delayed complications, we are undertaking preventive and treatment activities for multiple dental caries, osteomyelitis of the jaw, and necrosis of the jaw bone. Patients treated over the long-term with zoledronic acid or denosumab may develop Medication-Related Osteonecrosis of the Jaw (MRONJ) as a result of contamination of the oral cavity and tooth extraction; thus, we are undertaking measures to prevent/treat this complication.

By participating in multidisciplinary conferences, we apply prevailing practices and information updates to future medical care support.

In 2021, the numbers of new and revisiting patients were 1,431 and 12,088 respectively, and the total number of patients was 13,519. We believe that the importance of supportive care in cancer has been recognized.

Research activities

We are participating in a multicenter study being conducted to evaluate the effectiveness of proactive use of supportive care for preventing serious oral mucositis in patients with head and neck cancer undergoing chemoradiotherapy.

We are carrying out a study on multiple dental caries and radiation-induced osteomyelitis developing after radiotherapy for head and neck cancers. In addition, we are a part of the nutrition support team.

We cooperate with other facilities toward the establishment of oral care programs for patients with head and neck cancers receiving chemoradiotherapy.

List of papers published

Journal

1. Katsura K, Soga Y, Zenda S, Nishi H, Soga M, Usubuchi M, Mitsunaga S, Tomizuka K, Konishi T, Yatsuoka W, Ueno T, Aragaki T, Hayashi T. A cost-minimization analysis of measures against metallic dental restorations for head and neck radiotherapy. Journal of radiation research, 62:374-378, 2021