As a Dental professional I have always believed strongly in the power of the right tool, right technique and right approach when it comes to oral hygiene care and motivation. with that consideration and by having the support of a team that has similar believes in the importance of oral hygiene and its impact on over all health, we can accomplish the goal of seeing generations of healthy natural smiles. When it comes to patients with special need and especially, those battling cancer, I found myself invested in the goal of giving them hope to lead normal lives after treatment and overcoming the downside of radiotherapy or chemotherapy with a healthy smile that lasts a lifetime. I came closer to my goal when visiting the Children cancer centre in Cairo, Egypt and having the honour to collaborate with the Volunteer team and the generous contribution of a great oral hygiene product company when providing 500 toothbrushes and toothpaste.
At the conclusion of this case journey, I’ve included several pictures that capture moments from this wonderful experience and the milestones that I believe mark the start of a transformation in the approach to oral health education and. motivation for oncology patients
Case Highlights
Importance of oral health care Education
A Retrospective study: Assessment of Oral Health and care in Head and Neck
oncology patients in KFSH&RC-Jeddah
The restructuring of HOPE project: Hospital Oral health Patient Education
Table of Contents
Introduction to the importance of Oral Health Education
Oral health education plays a vital role in improving patient treatment outcomes and enhancing their quality of life, particularly for individuals undergoing cancer treatment. By providing effective education, patients are empowered to manage their oral hygiene, which is essential for preventing complications during these treatments.Oral health is vital for overall health and well being, influencing nutritional intake and self-esteem. Poor oral hygiene can lead to complications, especially in patients with chronic illnesses like those undergoing chemotherapy and radiotherapy, where oral care is often neglected. A significant link has been identified between oral diseases and poor oral hygiene from scientific literature. Insufficient toothbrushing and interdental cleaning can lead to bacterial accumulation and the development of microbial biofilms, potentially resulting in periodontal disease and dental cavities. Additionally, a clear connection has been observed between poor oral health and systemic disorders.In addition, oral tissue has been reported to frequently reflect the state of general health and often indicates the presence of systemic diseases such as the toxic effects of cancer treatments on the oral mucosa. Oral mucosal cells are susceptible to therapies such as chemotherapy or radiotherapy because of their rapid proliferation rate, which results in multiple oral complications. Oral complications such as mucositis, xerostomia (from salivary hypofunction), oral opportunistic infections, dysgeusia (altered taste), dental caries, trismus, and osteonecrosis during or after chemotherapy and/or radiotherapy can affect morbidity and mortality and quality of life. Mucositis is one of the major non hematologic adverse effects of cancer treatment. The presence of oral or dental disease is considered a major risk factor for the development of mucositis during cancer treatment. Therefore, strict oral care, including professional care and a standardized oral hygiene protocol is important for patients undergoing cancer treatment to reduce contamination levels in the oral cavity.
An overview of Oral Health care in Hospital settings
Oral health concerns for hospitalized patients, particularly in intensive care units, are often overlooked. There is a risk of periodontal disease, especially in those needing mechanical ventilation. Proper oral care can prevent plaque buildup and reduce hospital infection risks, but staff training is often inadequate. The nursing staff plays a crucial role in maintaining oral health, and education for all involved—staff, patients, and caregivers—should be prioritized. Since the oral cavity can harbor pathogens, effective hygiene practices are essential, making dental hygienists vital for supporting medical teams in patient care. According to a study survey done in 2017 where oral hygiene of patiens in the ICU was evaluated, it was revealed that oral healthcare for hospitalized patients is generally inadequate and varies between ICUs and general wards. Most respondents believe dental hygienists should provide this care. There is a potential for collaboration between nurses and dental hygienists to create an evidence-based oral health care protocol for hospitalized patients. Oral complications frequently affect patients receiving cancer treatments. The Oral Care Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) has conducted nine systematic reviews covering various issues, including Bisphosphonate Osteonecrosis of the Jaw, Odontogenic/Periodontal Infection, Dysgeusia, Oral Fungal Infection, Osteoradionecrosis, Trismus, Oral Pain, Oral Viral Infection, and Xerostomia. educating patients on the importance of noting the early syptoms of these complications and the possibility to manage them is crucial in improving quality of life and ease of treatment for patients undergoing chemotherapy and radiotherapy.
Oral Health and quality of life changes post Chemo and Radiotherapy for Head and Neck Patients
Chemotherapy can lead to oral complications, including mucositis, xerostomia, and infections. Patients undergoing chemotherapy require proactive oral health education to mitigate these adverse effects. Frequent dental assessments and proper hygiene practices are essential to protect oral health during treatment. Neglecting oral hygiene can lead to an overgrowth of harmful bacteria in the mouth. This increase in pathogenic bacteria may trigger inflammation, which can negatively affect the survival rates of patients with head and neck cancer (HNC). Beyond causing inflammation, these bacteria might also facilitate the advancement of HNC through various other mechanisms. For instance, Fusobacterium nucleatum, a well-known type of periodontopathogenic bacteria, has been demonstrated to enhance cell proliferation and boost cellular migration and invasion, thus potentially accelerating HNC progression.
Maintaining a Healthy Smile
Oral hygiene is essential for cancer patients as treatments can lead to oral complications. Proper dental care prevents infections and helps manage pain, ensuring patients can maintain nutrition and comfort during their treatment journey. Education on oral health empowers cancer patients to take control of their dental care. Providing resources and support fosters a sense of hope, assuring them that a healthy smile is achievable despite their challenges.
A Retrospective study: Assessment of Oral Health and care in Head and Neck oncology patients in KFSH&RC-Jeddah
Most previous studies in literature have described the oral manifestations of cancer in general, including the head and neck, or have described the oral complications of cancer therapy. However, few studies have reported the oral hygiene status of cancer patients or the self perception of oral health. “ No other studies were found in the Saudi Arabian literature that assessed baseline oral health indices and practices for head and neck oncology patients who will undergo cancer therapy. In addition, because of the significant prevalence of oral complications in patients with head and neck cancer and because many cancer treatments will result in unavoidable patients with oral conditions, oral care should be a priority for healthcare providers.” The primary objective of this study was to evaluate the oral hygiene indices, dental health, and oral health practices among patients with head and neck cancer at King Faisal Specialist Hospital and Research Center (KFSHRC) in Jeddah, as there is a notable lack of knowledge and research in this region of Saudi Arabia. This will later help establish a clear understanding of the necessary protocols and programs designed to support oral health for head and neck cancer patients before, during, and after their treatment journey. The focus will be on enhancing their quality of life by ensuring the maintenance of healthy teeth.
Material and Methods
117 dental charts and radiographs were reviewed, and data were extracted by three investigators trained by one supervising investigator before data extraction.
Dental hygiene visits were performed and information was extracted by only one individual, the dental hygienist, and reviewed again by the supervising investigator. In this chart review, data from the initial examination, radiographs, and dental hygiene visits were collected to measure the following dental indices:
* DMFT index & significant caries index (SiC)
* Calculus index (CI)
* Modified gingival index (MGI)
* Level of oral hygiene (OH) care
* Presence or absence of other systemic diseases
Conclusion
Within the limitations of the study, we can conclude the following for the study of head and neck cancer patients in KFSHRC-J:-The total DMFT score was 14.33.-The total SiC was 25.87.-DMFT scores in male and female patients were similar.-Cancer location and presence or absence of systemic diseases did not affect the DMFT score.-DMFT score and CI were not correlated, but there was a correlation between the DMFT score and MGI and oral hygiene index.
HOW DOES THIS IMPACT ORAL HEALTH EDUCATION?
the results of this study has motivated the following changes in the oral health education program we conducted in the hospital:
Additional emphasis of clearance referrals and oral hygiene care for patient undergoing major medical interventions.
This includes patient going for Oncology treatments, Major surgeries, Renal Haemodialysis.
Emphasizing the importance of oral hygiene care to patients, care-givers and hospital staff/Nurses
Part of the Oral hygiene education sessions were dedicated to the medical staff present in the visited area and they were encouraged to attend by. creating certificates of attendance and giving time for a hands on session on how the proper oral hygiene care is carried out.
Connecting the dots when it comes to oral health, and oral manifestation of systemic disease, in addition to shedding the light on the importance of managing oral side effects of medication.
This built a higher level of trust between dental clinic visitors and the dental professional in terms of having more confidence that early intervention even during medical treatment is a possibility. it has also added value to the common phrase “ An ounce of prevention is worth a pound of cure”.
Restructuring the HOPE project
The HOPE project: Hospital Oral health Patient Education was created in 2017 with the mission of Creating scheduled educational sessions, educational fun visits, and contribution to Awareness days in order to create a positive transformation in oral health care at King Faisal Specialist Hospital and Research center, and spreading awareness on the importance of oral Health and its strong connection to General Health.
Goals and objective of HOPE:
1- Expanding Role of Dental Professionals outside the Clinic, including dental interns
2- Early Detection of Oral Conditions that have an effect, directly or indirectly, on the patient’s well-being. (I.e. Poor brushing leading to severe periodontal disease)
3- Opportunity for patients and caregivers to take part in the treatment process and guiding them through the basic Oral Care methods to maintain good oral health which contributes to better general health
4- Clarifying the Link between General Health and Oral Health to Medical Staff (Nurses and attending Physicians), patients and their escorting family members
5- better communication between departments, physicians and nurses and the Dental clinic to improve the quality of patient care
Changes in approach after the 2021 Research was concluded:
Hospitalized Patient visits : customized to needs of patients before, During and after treatment
Awareness Day collaboration : Collaborating with medical specialists for best approach to patient care
Pediatric Fun & Education day : Customized for pediatric patients and caregivers in a more attractive
HOPE clinic : Increased focus on Oncology patients before, during & after treatment
International Outreach : Spreading awareness in the community and other Countries
By 2022, the HOPE project managed to accomplish several achievements in which I was luck to orchestrate alongside a dedicated team of:
* dental professional from the dental department of King Faisal specialist hospital and research center in Jeddah, Saudi Arabia
* Medical Nurses from different departments including: Oncology, Cardiology, Surgical recovery unit and Renal Haemodialysis Unit.
* Dental Interns from King Abdul Aziz University
and so far two groups of student volunteers at 57357 Children Cancer center in Cairo Egypt.
The HOPE project has accomplished multiple visits during the time I was an employee at KFSH and Research center and still carries on to to sustain the regular routine visits in hospital wards including Chemotherapy units for both adults and Pediatric patients, Post Cardiac surgery. inn patient rooms, Renal Haemodialysis units and Pediatric Inn-patient rooms.
As for me individually I have dedicated two visits so far, in 2022, then 2023 to the 57357 Children cancer Center in Cairo Egypt and look forward to continue this outreach.
References
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