The oncology patient: dental clearance before treatment prevents complications that cannot be addressed later

A patient about to begin cancer treatment has a window in which dental care is possible, and after which it becomes difficult or contraindicated.

Dental assessment before the start is therefore part of the preparation, and delay in requesting it is one of the commonest organisational problems.

The aim is to eliminate foci of infection and sources of trauma before the patient enters a phase of immunosuppression or reduced healing capacity.

A compromised tooth that becomes infected during neutropenia is an emergency in a patient who cannot be operated on, and the cost of that delay is high.

Mucositis is the commonest and most disabling complication. It affects a high proportion of patients on chemotherapy and almost all those irradiated in the head and neck region.

It compromises nutrition and in some cases leads to suspending or reducing the cancer treatment, which makes its prevention an objective beyond comfort.

Meticulous oral hygiene reduces the severity of mucositis, and the commonest error is suspending it precisely when the mouth hurts, entering a cycle that worsens everything.

Ultra-soft brushes are needed, alcohol-free mouthwashes so as not to increase burning, and suspension of removable dentures during acute phases.

Xerostomia after head and neck radiotherapy may be permanent, because damage to the salivary glands is dose-dependent and partly irreversible.

A very high caries risk follows, with rapid cervical and cuspal lesions to be prevented with high-concentration fluoride and close review.

Osteonecrosis of the jaw is the long-term risk after radiotherapy and in patients on antiresorptive drugs for bone metastases.

Extractions in an irradiated field or in a patient on these drugs must be considered with extreme caution and in agreement with the oncologist, which is why preventive clearance matters so much.

In summary: assessment precedes cancer therapy and must be requested in time, mucositis is prevented by maintaining hygiene rather than suspending it, post-radiation xerostomia requires lifelong high-concentration fluoride, and later extractions are agreed with the oncologist.