An assessment of the oral health status and dental treatment needs of oncology patients receiving bone modifying agents
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Date
2024
Authors
Byrne, Harriet
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Publisher
University College Cork
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Abstract
Aims
To assess the oral health status and dental care treatment needs of oncology patients receiving bone modifying agents (BMAs). Additionally, to explore barriers to dental care for this cohort of patients.
Materials and Methods
This was a mixed methods study conducted in 2 phases. In Phase 1, patients were recruited from the oncology clinics in the Cork University Hospital (CUH), South Infirmary Victoria University Hospital (SIVUH) and Mercy University Hospital (MUH). The oral health status and dental care needs were assessed using the Decayed, Missing and Filled teeth (DMFT) index, periodontal staging and grading classification (AAP) and their dental care requirements. Dental treatment was then completed to stabilise the oral health prior to commencing a BMA. Multivariate analysis was conducted to identify certain characteristics which may highlight added risk factors for dental disease and dental treatment needs. Phase 2 included focus group discussions with general dental practitioners alongside a focus group and qualitative interviews with patients to explore their opinions of the oncodental interface. Ethical approval was granted for a prospective, observational study by the Clinical Research Ethics Committee, University College Cork.
Results
In Phase 1, a total of 150 patients were assessed prior to a BMA. 70% (n=105) were female and 30% (n=45) were male, with a mean age of 61.5 years (SD 11.75 years). Breast cancer was the most common cancer amongst females (n=95) and prostate cancer amongst males (n=22). 94% (n=142) were planned for intravenous (IV) zoledronic acid and 6% (n=8) were planned for subcutaneous (SC) denosumab. 37 patients were current smokers (24.7%), and 23 patients were ex-smokers (15.3%). 65 patients (43.3%) did not have a general dental practitioner (GDP) at the time of presentation and 76 patients (50%) had a dental presenting complaint, where dental neglect (n=53, 35.3%) and functional issues (n=35, 23.3%) were the most common presenting complaints.
The mean DMFT was 17.68 (SD 7.85) and 145 (97%) had periodontal disease. 20% (n=30) wore a denture, 9% (n=3) did not adequately fit and 16% (n=5) had clinical evidence of substandard denture hygiene. 86 restorations were placed and 188 teeth were extracted over the course of treatments. 121 teeth (64.4%) were extracted due to periodontal disease and 67 (35.6%) teeth were extracted due to dental decay. 82 teeth (95%) were restored due to primary decay and 6 teeth (5%) were restored due to secondary decay. 8 patients (5%) required an intraoral biopsy and dysplasia was reported in 2 patients. 7 patients (5%) required a new denture and 147 patients (98%) achieved dental fitness prior to BMA treatment. Multivariate analysis revealed a significant result for a periodontal extraction and increasing age, which increased by 21.2% every 10 years (p=0.0239). Patients who did not have a GDP were twice as likely to require dental restorations (OR=2.122) and required 67.5% more restorations. Patients that attended on an irregular (every 2-4 years) were 2.5 times and rare (5 years or more) basis were 3.4 times as likely to require an extraction compared to frequent attenders (OR=2.5 and OR=3.407), respectively. A current smoker was 3.4 times as likely to require an extraction, particularly due to periodontal disease (p<0.001).
In Phase 2, 10 patients and 20 dentists were included in qualitative interviews. Data was collected until data saturation was achieved. Data were then transcribed and analysed using thematic analysis. Multiple themes emerged amongst dentists, including the difficulties of treatment planning for oncology patients planned for or receiving BMA, lack of guidance criteria to assist treatment planning, poor knowledge of medication-related osteonecrosis of the jaw (MRONJ) amongst general medical practitioners (GMPs), and management of these patients in the emergency setting. Patients expressed concerns about the additional burden of dental care, their lack of knowledge of MRONJ prior to their dental assessment, and the reassurance of a multidisciplinary co-ordinated dental service.
Conclusion
Our study highlights the vulnerability of this cohort of patients due to their dental care treatment needs. Dental disease is an integral factor for MRONJ, which must be addressed as a component of their overall oncology treatment plan.
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Keywords
Dental-oncology , Service , Bone modifying agents , Oral health , Dental treatment needs
Citation
Byrne, H. 2024. An assessment of the oral health status and dental treatment needs of oncology patients receiving bone modifying agents. DClinDent Thesis, University College Cork.